An athlete’s sex matters in sports-related injuries and treatment outcomes

ROSEMONT, Ill. (July 24, 2018)—The U.S. Centers for Disease Control (CDC) estimates an annual average occurrence of 8.6 million sports- and recreation-related injury episodes. Understanding how to avoid these injuries and how best to treat them is critical for optimizing safer sports participation. A new review article published in the July issue of the Journal of the American Academy of Orthopaedic Surgeons (JAAOS) examines the role that sex plays in common sports-related injuries (SRIs) and a patient’s treatment outcome.
 
Study authors looked at five common sports-related injuries: stress fracture; anterior cruciate ligament (ACL) tear; shoulder instability; concussion; and femoroacetabular impingement, a condition in which extra bone grows along one or both bones that form the hip joint.
 
“Males and females have different risk factors for experiencing SRIs,” said lead study author and orthopaedic surgeon Cordelia Carter, MD. “Anatomic and physiologic characteristics such as skeletal structure, muscle mass, ligament laxity, and hormone levels differ between the sexes and may contribute to disparate injury risk. The best ways to avoid or treat a sports-related injury in a male may be different for a female. Understanding the sex-based differences can help orthopaedic surgeons be better equipped to care for patients with these injuries and improve their treatment outcomes.”
According to one study referenced in the review article that looked at SRIs in Canadian children and adolescents, males are more frequently injured during sports participation than females. Males also comprised 71 percent of SRIs in 11 of the 13 sports investigated.  

Another study of children aged 5 to 17 years in the United States described the type and the frequency of SRIs to be a function of sex and highlighted the following findings:

 

• Females are more likely than males to sustain overuse injuries such as anterior knee pain, while males are at an increased risk of sustaining acute traumatic injuries such as fractures.
   
• While some risk factors are a part of one’s nature, others can be modified.  For example, females demonstrate patterns of landing after a jump that are different from male landing patterns and are associated with ACL tears.
   
• For both sexes, training programs can be used to teach at-risk athletes to modify landing patterns to help prevent ACL injury.

Other reviewed literature highlighted in the article reported that females have a higher incidence of concussion, most commonly in sports such as soccer, basketball, volleyball, and lacrosse.  Some studies have linked this to females having more slender necks and smaller heads compared with those of males, which can render females more vulnerable to concussion when head trauma is sustained.  Others have suggested this higher rate can be linked to females’ being more likely to communicate symptoms after an injury than males, which could lead to higher reported rates and severity of such injuries as concussions.

The review article authors also noted that while the relative risk of getting an ACL tear is higher in females by a rate of two to one, the number of injuries is higher in males due to greater exposure to high-risk activities.

Study authors concluded that there is a continued need for focused efforts at studying the role of sex in SRIs.

“We are still learning about how sex plays a role in an athlete’s experience of sports injury,” explained
Dr. Carter. “This paper paves the way for future researchers to begin to investigate how we can improve medical care for all athletes by recognizing that male and female athletes with the same injury may have better outcomes if their treatments are not the same but rather are sex-specific.”
 
The full study is available at: http://bit.ly/2mq18yI
For more information on overuse injuries and sports specialization, please visit OrthoInfo.org/onesportinjury.
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Disclosures
Dr. Carter or an immediate family member serves as a board member, owner, officer, or committee member of the American Academy of Orthopaedic Surgeons and the Pediatric Orthopaedic Society of North America. Dr. Ireland or an immediate family member serves as a board member, owner, officer, or committee member of the American Academy of Orthopaedic Surgeons, American College of Sports
Medicine, American Orthopaedic Society for Sports Medicine, and the Ruth Jackson Orthopaedic Society. Dr. Johnson or an immediate family member serves as a paid consultant to or is an employee of the Orthopaedic Devices Panel and the US Food & Drug Administration; has stock or stock options held in Pfizer; has received research or institutional support from Bergstrom Pharmaceuticals and Flexion
Therapeutics; and serves as a board member, owner, officer, or committee member of the American Academy of Orthopaedic Surgeons, American College of Sports Medicine, and the Society of Military Orthopaedic Surgeons. Dr. Levine or an immediate family member serves as an unpaid consultant to Zimmer and serves as a board member, owner, officer, or committee member of the American Orthopaedic Association. Dr. Bedi or an immediate family member serves as a paid consultant to or is an employee of Arthrex and serves as a board member, owner, officer, or committee member of the American Orthopaedic Society for Sports Medicine. Dr. Matzkin or an immediate family
member has received research or institutional support from Zimmer. Neither Dr. Martin nor any immediate family member has received anything of value from or has stock or stock options held in a commercial company or institution related directly or indirectly to the subject of this article.

J Am Acad Orthop Surg 2018;0:1-8 DOI: 10.5435/JAAOS-D-16-00607