Sex differences in injury rates in team-sport athletes: A systematic review and meta-regression analysis.
Level 1 - systematic review of randomized trials
Systematic review and meta-analysis of prospective cohort/surveillance studies
PubMed 34052518 · doi:10.1016/j.jshs.2021.04.003
What was done
Researchers systematically reviewed and meta-analyzed prospective injury surveillance studies comparing high-level female and male athletes (age ≥16 years) across six team sports: basketball, field hockey, football (soccer), handball, rugby (union and sevens), and volleyball. Two independent reviewers assessed study quality and extracted data for overall, match, training, and severe (>28 days' time loss) injuries, as well as specific anatomical locations and injury types. Incidence rate ratios (IRRs) comparing females to males were pooled in meta-analyses, and meta-regression was conducted when at least 10 studies were available.
What was found
Across 20 included studies (9 football, 3 rugby, 3 handball, 1 basketball, 1 field hockey, 2 volleyball, and 1 combined basketball/field hockey): - Overall injury incidence was lower in female athletes compared to male athletes (pooled IRR = 0.86, 95% CI: 0.76 to 0.98). - Injury rates were higher in males for upper extremity, hip/groin, thigh, and foot injuries. - Female players had a significantly higher rate of anterior cruciate ligament (ACL) injuries than male players (pooled IRR = 2.15, 95% CI: 1.27 to 3.62). - No statistically significant sex differences were found for match injuries, training injuries, severe injuries, concussions, or ankle sprains.
Why it matters
This meta-analysis demonstrates that while male team-sport athletes sustain higher overall injury rates, female athletes experience more than twice the risk of ACL injuries, highlighting the need for sex-specific injury prevention programs.
Limits
Evidence is heavily dominated by football (9 of 20 studies), with other sports represented by very few studies. Findings apply only to high-level athletes aged 16 and older, limiting generalizability to recreational or younger athletes. Total participant numbers, exposure hours, and heterogeneity values are not reported in the abstract.
Cited by
- supports Women are more susceptible to ACL injuries than men.