New findings, published in respected and influential British Journal of Sports Medicine, challenge the common claim that women are more likely than men to suffer ACL injuries.
The ACL (anterior cruciate ligament) is one of the four main ligaments in the knee that connects the thin bone to the shin bone and prevents it from sliding out of place.
ACL injuries such as tears and sprains can commonly occur in soccer, basketball and other sports which involve constant direction change. It has been reported that injury rates are higher for women than men.
The latest study argues that current methods used to measure ACL injury rates fails to consider the gendered inequalities women face in sports, leading to biased results.
The team at GenderSci Lab, who led the study, say these inequalities may have artificially inflated women’s ACL injury rates over the years.
To measure ACL injury rates, researchers typically divide the number of injuries by the ‘athlete exposures’ or how much time athletes spend training and competing.
However, this study argues that these methods fail to recognise the inequalities women in sport face such as fewer training opportunities, smaller team sizes and limited access to resources.
“This research exposes the biases deeply embedded in how we measure injury risks and highlights how the current framing of ACL injuries could discourage women from participating in sports, prompting decisions driven by fear rather than accurate risk assessments,” says Dr Sheree Bekker, founder of the Feminist Sport Lab and author of the study.
“Addressing these biases is a critical step toward fostering safer, more equitable sporting environments for everyone.”
Sports injuries
A fan holds up a banner wishing Sam Kerr to get well soon following her ACL injury during the Women’s FA Cup match between Chelsea and West Ham United on January 14, 2024 in England. (Photo by Visionhaus/Getty Images)
One bias the team outlined was that women’s teams frequently have less access to training opportunities.
This means women typically spend proportionally more time playing competitive sports in comparison to training, leading differing training-to-match ratios between women and men’s teams.
Statistically, ACL injuries are more likely to be acquired during a match than at training, meaning a failure to distinguish between training and match time can inflate injury rates for women.
“Gender assumptions can influence scientific knowledge in many different ways,” says Professor Sarah Richardson from Harvard University who also worked on the study.
“When gendered assumptions are built into scientific measures, sex difference findings may not be accurate.”
Another bias was that many women’s teams have a smaller number of athletes in comparison to men. This is often the result of systemic underfunding of women’s sport, pay gaps and cultural attitudes that can create barriers for women to access sport.
Given that the exposure risk for ACL injuries is calculated by multiplying team size, consistently smaller women’s teams can distort the data when comparing injury rates among men and women.
Smaller teams also mean less turnover between players during a game, meaning some women may spend more time on the ground due to fewer substitutes.
“We hope that this research will contribute to capturing patterns of ACL injury among women and men more accurately,” says author of the study Ann Danielsen from Harvard T. H. Chan School of Public Health.
“Athletes deserve solid statistics to understand the extent and drivers of disparities in ACL injury,” says Annika Gompers from the Rollins School of Public Health at Emory University.
“Our work highlights that current research fails to account for biases in the data produced by gendered factors, which skews comparisons of injury rates between women and men. We call for more rigorous epidemiologic measurement of gender disparities going forward.”
ACL injuries and hormones
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