Examining The Representation Of Female Subjects In Sports Medicine Research: Acl Reconstruction

PURPOSE: Anterior cruciate ligament (ACL) rupture is a common injury with female athletes at significantly greater risk than their male counterparts. Literature has shown this to be a product of intrinsic factors, such as anatomical and hormonal dimorphisms, including ACL cross-sectional area and menstrual cycle phase, and extrinsic factors, such as sports participation. ACL reconstruction is the gold standard treatment, particularly when considering optimal knee stability, return to sports, and high functional outcomes. Despite these benefits, female patients are less likely to undergo reconstructive surgery and experience worse outcomes when they do. Establishing evidence-based recommendations specific to female patients has been overlooked in sports medicine. We aimed to examine female representation in ACL reconstruction literature. METHODS: A PubMed search was performed to identify articles related to ACL reconstruction published in the last five years. Only peer-reviewed, full-text, randomized control trials that examined patients before, during, or after ACL reconstruction were included (n = 187). Significance was analyzed via unpaired t-test. RESULTS: Female representation was 6,689 of 17,031 subjects (39%), significantly lower than male (p = 0.0017), among all studies and 151 of 650 subjects (23%), significantly lower than male (p = 0.035), among studies examining competitive athletes (Figure 1). 18 studies were male only, whereas 3 studies were female only. Female representation did not increase with time. No study collected data related to menstrual status. CONCLUSIONS: Female subjects, especially those who are competitive athletes, are underrepresented in ACL reconstruction literature, despite increased risk of ACL rupture. Our findings indicate a need for increased representation of female athletes in sports medicine literature and for the acknowledgement of biological dimorphisms as they relate to ACL rupture and repair.