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Let’s talk about sex (and gender) after ACL injury: a systematic review and meta-analysis of self-reported activity and knee-related outcomes

2023; BMJ; Volume: 57; Issue: 10 Linguagem: Inglês

10.1136/bjsports-2022-106099

1473-0480

A. Bruder, Adam G. Culvenor, Matthew King, M. Haberfield, Eliza A Roughead, John Mastwyk, Joanne L. Kemp, Marcella Ferraz Pazzinatto, T. West, Sally L. Coburn, S. Cowan, Allison M. Ezzat, Laura To, Karina Chilman, J. Couch, Jackie L. Whittaker, Kay M. Crossley,

Cardiovascular Effects of Exercise

Objective Investigate sex/gender differences in self-reported activity and knee-related outcomes after anterior cruciate ligament (ACL) injury. Design Systematic review with meta-analysis. Data sources Seven databases were searched in December 2021. Eligibility criteria Observational or interventional studies with self-reported activity (including return to sport) or knee-related outcomes after ACL injury. Results We included 242 studies (n=123 687, 43% females/women/girls, mean age 26 years at surgery). One hundred and six studies contributed to 1 of 35 meta-analyses (n=59 552). After ACL injury/reconstruction, very low-certainty evidence suggests females/women/girls had inferior self-reported activity (ie, return to sport, Tegner Activity Score, Marx Activity Scale) compared with males/men/boys on most (88%, 7/8) meta-analyses. Females/women/girls had 23%–25% reduced odds of returning to sport within 1-year post-ACL injury/reconstruction (12 studies, OR 0.76 95% CI 0.63 to 0.92), 1–5 years (45 studies, OR 0.75 95% CI 0.69 to 0.82) and 5–10 years (9 studies, OR 0.77 95% CI 0.57 to 1.04). Age-stratified analysis (<19 years) suggests female athletes/girls had 32% reduced odds of returning to sport compared with male athletes/boys (OR 0.68, 95% CI 0.41 to 1.13, I 2 0.0%). Very low-certainty evidence suggests females/women/girls experienced inferior knee-related outcomes (eg, function, quality of life) on many (70%, 19/27) meta-analyses: standardised mean difference ranging from −0.02 (Knee injury and Osteoarthritis Outcome Score, KOOS-activities of daily living, 9 studies, 95% CI −0.05 to 0.02) to −0.31 (KOOS-sport and recreation, 7 studies, 95% CI −0.36 to –0.26). Conclusions Very low-certainty evidence suggests inferior self-reported activity and knee-related outcomes for females/women/girls compared with males/men/boys after an ACL injury. Future studies should explore factors and design targeted interventions to improve outcomes for females/women/girls. PROSPERO registration number CRD42021205998.