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Nairn LN, Aziz A, Moayad L, Gyemi LA, Simunovic N, Madden K, Simunovic M, Ayeni OR. Sports Injuries in Female and Non-Binary Athletes: A Systematic Review. Curr Rev Musculoskelet Med 2025:10.1007/s12178-025-09974-7. [PMID: 40347308 DOI: 10.1007/s12178-025-09974-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/22/2025] [Indexed: 05/12/2025]
Abstract
PURPOSE OF REVIEW The main purpose of this review was to summarize the current evidence on treatment and outcomes of sports injuries requiring surgical intervention in female and non-binary athletes and identify key gaps in the related literature concerning sports injuries requiring surgical intervention to guide future research. RECENT FINDINGS Of the 59 included studies, all focused on biological sex or sex-based differences, while none of the studies discussed gender or the inclusion of non-binary and transgender individuals. Most of the studies (47/59, 80%) focused on ACL reconstruction (37%), hip arthroscopy (27%) or rotator cuff repair (15%). Important sex-based differences were seen with these injuries including differences in fears regarding recovery after ACL injury and pre- and post-operative pain scores following rotator cuff injury. Despite increasing recognition of the role of biologic sex in the treatment and outcomes of sports injuries, very little is known about the impact of gender in sports injuries. Previous sociological literature suggests that gender may play an important role in one's athletic experience, and thus their injury experience. With most of the included studies focused on only three injury types, the experiences of female and non-binary athletes with all other sports injuries are poorly characterized. The lack of gender-inclusive sports injuries research means that the complete experiences of female, non-binary and transgender athletes are not comprehensively captured in the current literature. Future research should aim to characterize the effect of gender on the treatment and outcomes on all sport-related injuries, with the goal of providing inclusive surgical care for all athletes.
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Affiliation(s)
- Leah N Nairn
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada
| | - Amar Aziz
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada
| | - Lana Moayad
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada
| | - Lauren A Gyemi
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada
| | - Nicole Simunovic
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada
| | - Kim Madden
- Department of Health Research Methods, Evidence & Impact, Department of Surgery, McMaster University, Hamilton, ON, Canada
| | - Marko Simunovic
- Division of General Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada
| | - Olufemi R Ayeni
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada.
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Heder Ternell K, Tosarelli F, Buckthorpe M, Samuelsson K, Hamrin Senorski E, Della Villa F. A Systematic Video Analysis of Anterior Cruciate Ligament Injuries in Professional Female Basketball Players. Am J Sports Med 2025; 53:1368-1380. [PMID: 40189839 PMCID: PMC12044211 DOI: 10.1177/03635465251330007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2024] [Accepted: 02/10/2025] [Indexed: 05/02/2025]
Abstract
BACKGROUND Anterior cruciate ligament (ACL) injuries are common in female basketball players, who have a 2 to 3 times higher risk for an ACL injury than their male counterparts. Improving our understanding of the situations and biomechanics that result in an ACL injury in basketball players may support the design of more effective programs to mitigate the injury risk. PURPOSE To describe the injury mechanisms, situational patterns, and biomechanics of ACL injuries during matches in professional female basketball players. STUDY DESIGN Case series; Level of evidence, 4. METHODS A total of 105 ACL injuries in professional female European basketball leagues from the 2018 to 2023 seasons were identified. There were 41 (39%) injury videos analyzed for injury mechanisms and situational patterns, while biomechanical analysis was possible in 33 cases. There were 3 independent reviewers who rated each video. Data according to player position, phase of the match, and location on the court were also evaluated (n = 41). Analysis regarding neurocognitive perturbation was assessed in 41 cases (100%). RESULTS Most injuries (n = 28 [68%]) occurred during offensive possession. Indirect contact injuries were more prevalent (n = 23 [56%]) than noncontact injuries (n = 18 [44%]). Overall, 3 main situational patterns constituted 95% of injuries: offensive cut (n = 20 [49%]), defensive cut (n = 12 [29%]), and landing from a jump (n = 7 [17%]). Injuries involving a knee-dominant pattern with valgus were identified in 64% of cases. Injuries were evenly distributed between the first (53%) and second (47%) halves of a game. Half (50%) occurred within the first 10 minutes of effective playing time, and the most frequent months of injury were October and November (44%; early season). Nearly half (46%) of the injuries occurred in small forwards, with 59% of injuries occurring in zone 5. Neurocognitive errors were seen in 56% of injuries, while 92% of defensive injuries showed signs of neurocognitive errors. CONCLUSION ACL injuries in professional female basketball players were caused by indirect contact or noncontact, involving offensive and defensive cuts as well as landing from a jump. Biomechanical analysis confirmed a multiplanar mechanism with a knee-dominant pattern and valgus. Most injuries occurred early in the season and within the first 20 effective minutes played (89%), making accumulated fatigue an unlikely risk factor for ACL injuries in basketball players.
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Affiliation(s)
- Kristian Heder Ternell
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Sahlgrenska Sports Medicine Center, Gothenburg, Sweden
| | - Filippo Tosarelli
- Education and Research Department, Isokinetic Medical Group, Bologna, Italy
| | - Matthew Buckthorpe
- Education and Research Department, Isokinetic Medical Group, Bologna, Italy
- Faculty of Sport, Technology and Health Sciences, St Mary’s University, Twickenham, London, UK
| | - Kristian Samuelsson
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Sahlgrenska Sports Medicine Center, Gothenburg, Sweden
- Department of Orthopaedics, Sahlgrenska University Hospital, Sahlgrenska Academy, University of Gothenburg, Mölndal, Sweden
| | - Eric Hamrin Senorski
- Sahlgrenska Sports Medicine Center, Gothenburg, Sweden
- Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Smith NP, Gallo RA. Return to play and athletic performance in division I female volleyball players following anterior cruciate ligament injury. PHYSICIAN SPORTSMED 2025; 53:12-17. [PMID: 38709544 DOI: 10.1080/00913847.2024.2351790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Accepted: 03/10/2024] [Indexed: 05/07/2024]
Abstract
OBJECTIVES The purpose of this study is to examine NCAA Division I volleyball players' return to play rates and performance statistics compared to pre-injury levels following ACL injury. METHODS Female volleyball players that sustained ACL injuries from 2008 to 2020 and competed in one of seven collegiate conferences (n = 99) were identified via an internet search algorithm. Players were categorized by position, academic year, and playing time pre- and post-injury. Post-injury performance statistics were gathered for a subset of outside hitters and middle blockers that played in ≥35 sets in a single season for up to 3 years following injury (mean 1.7 seasons). A control group (n = 512) was generated for demographic and statistical comparison. Mean pre-injury and post-injury statistics were compared for players that did not change positions and played ≥35 sets before and after injury. RESULTS Volleyball attackers were 54.7% of the control population but sustained 78.8% of identified injuries. Following ACL injury, 6.1% of players registered no in-game statistics, 16.2% played in <35 sets, 65.7% played in ≥35 sets, and 12.1% graduated. Mean performance statistics increased linearly the more years players were from ACL injury. CONCLUSIONS Female collegiate volleyball players return to play following ACL injury at high rates (93.1%) and maintain pre-injury performance levels. Volleyball attackers sustain ACL injuries more commonly than setters and libero/defensive specialists.
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Affiliation(s)
- Nathan P Smith
- Department of Orthopaedics and Rehabilitation, Penn State Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Robert A Gallo
- Department of Orthopaedics and Rehabilitation, Penn State Milton S. Hershey Medical Center, Hershey, PA, USA
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Dewig DR, Boltz AJ, Moffit RE, Rao N, Collins CL, Chandran A. Epidemiology of Anterior Cruciate Ligament Tears in National Collegiate Athletic Association Athletes: 2014/2015-2018/2019. Med Sci Sports Exerc 2024; 56:29-36. [PMID: 37616175 DOI: 10.1249/mss.0000000000003281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/26/2023]
Abstract
PURPOSE This study aimed to describe the epidemiology of ACL tears in NCAA men's and women's sports. METHODS Injury and exposure data collected within the NCAA Injury Surveillance Program from 2014/2015 to 2018/2019 were analyzed. ACL tear frequencies, injury rates (IR), and injury proportions were used to describe injury incidence by sport, event type, injury mechanism, and injury history. Injury rate ratios (IRR) were used to examine differential injury rates, and injury proportion ratios (IPR) were used to examine differential distributions. RESULTS A total of 729 ACL tears were reported from 8,474,401 recorded athlete exposures (AE) during the study period (IR = 0.86 per 10,000 AE), and the competition-related ACL tear rate was higher than the practice-related rate (IRR = 5.52, 95% confidence interval [CI] = 4.75-6.39). Among men's sports, the highest overall ACL tear rate was observed in men's football (IR = 1.44 per 10,000 AE), whereas among women's sports, the highest overall rate was observed in women's soccer (IR = 2.60 per 10,000 AE). Among sex-comparable sports, ACL tear rates were higher in women's basketball, softball, and soccer, as compared with their men's counterparts. ACL tears were more prevalently attributed to player contact mechanisms in men's sports than women's sports (IPR = 1.73, 95% CI = 1.37-2.19), but more prevalently attributed to noncontact mechanisms in women's sports than men's sports (IPR = 1.17, 95% CI = 1.01-1.35). CONCLUSIONS ACL tear risk in women's sports continues to warrant attention and prevention efforts. Given the differential rates by event type, future research efforts may also evaluate initiatives to reduce competition-related injury burden in NCAA sports.
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Affiliation(s)
- Derek R Dewig
- College of Education, Health and Human Performance, Fairmont State University, Fairmont WV
| | | | - Reagan E Moffit
- Datalys Center for Sports Injury Research and Prevention, Indianapolis, IN
| | - Neel Rao
- Datalys Center for Sports Injury Research and Prevention, Indianapolis, IN
| | - Christy L Collins
- Datalys Center for Sports Injury Research and Prevention, Indianapolis, IN
| | - Avinash Chandran
- Datalys Center for Sports Injury Research and Prevention, Indianapolis, IN
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Hong IS, Pierpoint LA, Hellwinkel JE, Berk AN, Salandra JM, Meade JD, Piasecki DP, Fleischli JE, Ahmad CS, Trofa DP, Saltzman BM. Clinical Outcomes After ACL Reconstruction in Soccer (Football, Futbol) Players: A Systematic Review and Meta-Analysis. Sports Health 2023; 15:788-804. [PMID: 36988238 PMCID: PMC10606974 DOI: 10.1177/19417381231160167] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/30/2023] Open
Abstract
CONTEXT The risk factors for anterior cruciate ligament (ACL) tear for athletes participating in pivoting sports includes young age and female sex. A previous meta-analysis has reported a reinjury rate of 15% after ACL reconstruction (ACLR) for athletes across all sports. To the best of the authors' knowledge, this is the first systematic review and meta-analysis of available literature reporting outcomes after ACLR in soccer players. OBJECTIVE To review and aggregate soccer-specific outcomes data after ACLR found in current literature to help guide a more tailored discussion regarding expectations and prognosis for soccer players seeking operative management of ACL injuries. DATA SOURCES A comprehensive search of publications was performed using PubMed, EMBASE, Cochrane Central Register of Controlled Trials, and SPORTDiscus databases. STUDY SELECTION Inclusion criteria consisted of original studies, level of evidence 1 to 4, studies reporting clinical and patient-reported outcomes (PROs) after primary ACLR in soccer players at all follow-up length. STUDY DESIGN The primary outcomes of interest were graft failure/reoperation rates, ACL injury in contralateral knee, return to soccer time, and PROs. LEVEL OF EVIDENCE Level 4. DATA EXTRACTION Search of literature yielded 32 studies for inclusion that involved 3112 soccer players after ACLR. RESULTS The overall graft failure/reoperation rate ranged between 3.0% and 24.8% (mean follow-up range, 2.3-10 years) and the combined ACL graft failure and contralateral ACL injury rate after initial ACLR was 1.0% to 16.7% (mean follow-up range, 3-10 years); a subgroup analysis for female and male players revealed a secondary ACL injury incidence rate of 27%, 95% CI (22%, 32%) and 10%, 95% CI (6%, 15%), respectively. Soccer players were able to return to play between 6.1 and 11.1 months and the majority of PROs showed favorable scores at medium-term follow-up. CONCLUSION Soccer players experience high ACL injury rates after primary ACLR and demonstrated similar reinjury rates as found in previous literature of athletes who participate in high-demand pivoting sports.
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Affiliation(s)
- Ian S. Hong
- OrthoCarolina Sports Medicine Center, Charlotte, North Carolina and Musculoskeletal Institute, Atrium Health, Charlotte, North Carolina
| | | | - Justin E. Hellwinkel
- Department of Orthopaedic Surgery, New York-Presbyterian/Columbia University Irving Medical Center, New York, New York
| | - Alexander N. Berk
- OrthoCarolina Sports Medicine Center, Charlotte, North Carolina and Musculoskeletal Institute, Atrium Health, Charlotte, North Carolina
| | - Jonathan M. Salandra
- Department of Orthopaedic Surgery, Jersey City Medical Center, RWJBarnabas Health, Jersey City, New Jersey
| | - Joshua D. Meade
- OrthoCarolina Sports Medicine Center, Charlotte, North Carolina, and Musculoskeletal Institute, Atrium Health, Charlotte, North Carolina
| | - Dana P. Piasecki
- OrthoCarolina Sports Medicine Center, Charlotte, North Carolina and Musculoskeletal Institute, Atrium Health, Charlotte, North Carolina
| | - James E. Fleischli
- OrthoCarolina Sports Medicine Center, Charlotte, North Carolina and Musculoskeletal Institute, Atrium Health, Charlotte, North Carolina
| | - Christopher S. Ahmad
- Department of Orthopaedic Surgery, New York-Presbyterian/Columbia University Irving Medical Center, New York, New York
| | - David P. Trofa
- Department of Orthopaedic Surgery, New York-Presbyterian/Columbia University Irving Medical Center, New York, New York
| | - Bryan M. Saltzman
- OrthoCarolina Sports Medicine Center, Charlotte, North Carolina and Musculoskeletal Institute, Atrium Health, Charlotte, North Carolina
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Schweizer N, Strutzenberger G, Franchi MV, Farshad M, Scherr J, Spörri J. Screening Tests for Assessing Athletes at Risk of ACL Injury or Reinjury-A Scoping Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:2864. [PMID: 35270563 PMCID: PMC8910677 DOI: 10.3390/ijerph19052864] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Revised: 02/25/2022] [Accepted: 02/26/2022] [Indexed: 12/23/2022]
Abstract
Various tests are available to assess athletes for factors associated with their susceptibility and risk of anterior cruciate ligament (ACL) injury or reinjury; however, it is unclear which tests are clinically meaningful and what should be considered when using them. Therefore, the aim of this scoping review was to screen and summarize testing and to derive evidence-based recommendations for clinicians, practitioners and future research. Five databases were searched to identify studies addressing musculoskeletal morphology or functional-performance-related screening tests with a clear conceptual link or an evidence-based relationship to ACL (re)injury. A quality rating was carried out using the National Institutes of Health (NIH) Study-Quality Assessment Tool. Six different categories of common screening tests were identified: balance and postural control, gait- and running-related tests, joint laxity, joint morphology and anthropometrics, jump tests and strength tests. Predicting future injury in a complex, dynamic system based on a single screening test is methodologically challenging, which is also reflected in the highly controversial findings in the literature regarding potential associations between specific screening tests and the occurrence of ACL injuries and reinjuries. Nonetheless, various screening tests can provide clinically relevant information on ACL-(re)injury-related factors and help to provide tailored preventive measures. A selection of corresponding evidence-based recommendations is derived and presented in this scoping review.
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Affiliation(s)
- Noah Schweizer
- Sports Medical Research Group, Department of Orthopaedics, Balgrist University Hospital, University of Zurich, 8008 Zurich, Switzerland; (N.S.); (G.S.); (J.S.)
- University Centre for Prevention and Sports Medicine, Department of Orthopaedics, Balgrist University Hospital, University of Zurich, 8008 Zurich, Switzerland
| | - Gerda Strutzenberger
- Sports Medical Research Group, Department of Orthopaedics, Balgrist University Hospital, University of Zurich, 8008 Zurich, Switzerland; (N.S.); (G.S.); (J.S.)
- Motion Analysis Zurich, Department of Orthopaedics, Balgrist University Hospital, Children’s Hospital, University of Zurich, 8008 Zurich, Switzerland
| | - Martino V. Franchi
- Department of Biomedical Sciences, Institute of Physiology, University of Padova, 35131 Padova, Italy;
| | - Mazda Farshad
- University Spine Centre, Department of Orthopaedics, Balgrist University Hospital, University of Zurich, 8008 Zurich, Switzerland;
| | - Johannes Scherr
- Sports Medical Research Group, Department of Orthopaedics, Balgrist University Hospital, University of Zurich, 8008 Zurich, Switzerland; (N.S.); (G.S.); (J.S.)
- University Centre for Prevention and Sports Medicine, Department of Orthopaedics, Balgrist University Hospital, University of Zurich, 8008 Zurich, Switzerland
- Motion Analysis Zurich, Department of Orthopaedics, Balgrist University Hospital, Children’s Hospital, University of Zurich, 8008 Zurich, Switzerland
| | - Jörg Spörri
- Sports Medical Research Group, Department of Orthopaedics, Balgrist University Hospital, University of Zurich, 8008 Zurich, Switzerland; (N.S.); (G.S.); (J.S.)
- University Centre for Prevention and Sports Medicine, Department of Orthopaedics, Balgrist University Hospital, University of Zurich, 8008 Zurich, Switzerland
- Motion Analysis Zurich, Department of Orthopaedics, Balgrist University Hospital, Children’s Hospital, University of Zurich, 8008 Zurich, Switzerland
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Collings TJ, Bourne MN, Barrett RS, du Moulin W, Hickey JT, Diamond LE. Risk Factors for Lower Limb Injury in Female Team Field and Court Sports: A Systematic Review, Meta-analysis, and Best Evidence Synthesis. Sports Med 2021; 51:759-776. [DOI: 10.1007/s40279-020-01410-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/05/2020] [Indexed: 02/01/2023]
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