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Cited by 300Knee injuries and reconstruction techniquesSex and Gender in HealthcareSports, Gender, and Society

Anterior cruciate ligament injury: towards a gendered environmental approach

Open access
Parsons, Joanne L, Coen, Stephanie E, Bekker, Sheree·2021·British Journal of Sports Medicine
DOI 10.1136/bjsports-2020-103173
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Abstract

BACKGROUND: The anterior cruciate ligament (ACL) injury rate for girls/women has not changed in over 20 years, and they remain 3-6 times more likely to experience injury compared with boys/men. To date, ACL injury prevention and management has been approached from a sex-based biological point of view which has furthered our understanding of injury risk factors, mechanisms, and prevention and rehabilitation programmes. However, the traditional sex-based approach does not take into account the growing recognition of how sex and gender (a social construct) are 'entangled' and influence each other. OBJECTIVE: This paper discusses the curious absence of gender as an influencer in the dialogue surrounding ACL injuries. We propose adding gender as a pervasive developmental environment as a new theoretical overlay to an established injury model to illustrate how gender can operate as an extrinsic determinant from the presport, training and competition environments through to ACL injury and the treatment environment. APPROACH: We draw on social epidemiological theories of the embodiment of gender and health to provide plausible examples of how gender may influence ACL injury, and demonstrate the opportunity for new, interdisciplinary research in the field. CONCLUSION: Over 20 years of research has failed to decrease the ACL injury rate disparity between girls/women and boys/men. Embedding gender in the study of ACL injury will heighten awareness of possible influences outside the traditional biological elements, challenge us to think about the inextricable 'entanglement' of sex and gender, and inform more effective approaches to ACL injury prevention and treatment.

Integrity signals

Registry

Crossref · 10.1136/bjsports-2020-103173

Cites

110 of 110 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

22 of 74 cited sources checked · 11 supported · 0 flagged · accuracy not yet measured

  • Premisecitation

    ACL injury prevention and management has been approached from a sex-based biological point of view.

    “To date, ACL injury prevention and management has been approached from a sex-based biological point of view which has furthered our understanding of injury risk factors, mechanisms, and prevention and rehabilitation programmes.”
    • Also stated in: § INTRODUCTION · plain
      “investigation into the injury rate disparity between women and men has focused heavily on 'sex'-based biological traits such as anatomy, physiology and hormones, 3”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites [3] Shultz, 2019, Anterior cruciate ligament research retreat VIII summary statement: an update on injury risk identification and prevention across the anterior cruciate ligament injury continuum, March 14–16, 2019, Greensboro, NC, J Athl Train source

      The Biological Factors and Primary Prevention passages (pages not provided) discuss hormonal risk factors, sex differences, and prevention-program findings in female athletes. But Primary Risk Assessment describes ACL injury risk as multifactorial, and the paper does not characterize prevention and management overall as having been approached from a sex-based biological point of view. (LLM, conf=0.82)

      Experimental — accuracy not yet measured
  • Interpretationcitation

    Many assumptions behind perceived sex differences in training are based on a belief that they are biological and unchangeable, when in fact they are heavily shaped by modifiable gendered factors.

    “However, many of the assumptions behind these perceived differences are based on a belief that they are biological and unchangeable, when in fact they are heavily shaped by modifiable gendered factors.17”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites [17] Fox, 2020, Anterior cruciate ligament injuries in Australian football: should women and girls be playing? You’re asking the wrong question, BMJ Open Sport Exerc Med source
  • Interpretationcitation

    These gendered training dynamics may be a significant contributor to the ACL injury rate disparity between women and men, given lower resistance training participation among girls/women and the importance of that activity for effective ACL injury prevention.

    “These gendered training dynamics may be a significant contributor to the ACL injury rate disparity between women and men, given the well-documented lower resistance training participation rates among girls and women compared with boys and men, 40 41 and the importance of that activity for effective ACL injury prevention programmes.38”
    Quote in the paperSubstantial claim2 of 3 sources checked
    • cites [40] Bennie, 2019, The epidemiology of aerobic physical activity and muscle-strengthening activity guideline adherence among 383,928 U.S. adults, Int J Behav Nutr Phys Act source

      Split into 2 atoms — 0 confirmed, 2 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.

      Experimental — accuracy not yet measured
    • cites [41] Caspersen, 2000, Changes in physical activity patterns in the United States, by sex and cross-sectional age, Med Sci Sports Exerc source
    • cites [38] source
    • The authors state this as an assumption: Both biological and social factors are at play in ACL injury.
  • Premisecitation

    No strong evidence exists that the biomechanics at the moment of ACL injury is different between sexes.

    “but no strong evidence exists that the biomechanics at the moment of ACL injury is different between sexes.34 35”
    Quote in the paperSubstantial claim1 of 2 sources checked
    • cites [34] Gamada, 2014, The mechanism of non-contact anterior cruciate ligament injury in female athletes: is the injury mechanism different between the genders?, Int J Phys Med Rehabil source
    • cites [35] Owusu-Akyaw, 2018, Determination of the position of the knee at the time of an anterior cruciate ligament rupture for male versus female patients by an analysis of bone bruises, Am J Sports Med source

      The Discussion reports no statistically significant sex differences in four predicted knee-position measures at non-contact ACL injury. But the finding is limited to participants with bone bruises on both medial and lateral surfaces of the femur and tibia; it does not establish that no strong evidence of any biomechanical difference exists more generally. The Introduction also notes video evidence supporting a role for valgus collapse, particularly in females. (LLM, conf=0.84)

      Experimental — accuracy not yet measured
  • Interpretationreasoning

    It is sexism, not simply sex, that plays a role in ACL injury outcomes.

    “In the same way that these contemporary understandings have shown that it is racism, not race that influences health and injury outcomes, 94 95 we argue here that it is sexism (positioned as a”
    Quote in the paperSubstantial claim1 of 3 sources checked
    • cites [94] source
    • cites [95] Krieger, 2020, Measures of racism, sexism, heterosexism, and gender binarism for health equity research: from structural injustice to embodied harm—An ecosocial analysis, Annu Rev Public Health source
    • cites [96] Manne K . Down girl: the logic of misogyny. Oxford University Press, 2017. source
  • May combine two claims. 18
  • Classified as probably not a substantial claim. 16

  • May combine two claims.

    Premisecitation

    ACL injury results in only 65% of individuals returning to their preinjury level of sport, with men 1.7 times more likely than women to do so.

    “ACL injury results in only 65% of individuals returning to their preinjury level of sport, with men 1.7 times more likely than women to do so.4”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites [4] source

      The Participation section reports that 65% returned to their preinjury level of sport, but this rate is for people following ACL reconstruction surgery, not ACL injury generally. The Person-related factors and Gender differences sections report an odds ratio of 1.4 for men versus women returning to their preinjury level; 1.7 applies to returning to competitive sport instead. (LLM, conf=0.92)

      Experimental — accuracy not yet measured

  • May combine two claims.

    Premisecitation

    Experiencing an ACL injury at a young age is associated with a higher likelihood of developing early-onset osteoarthritis and requiring total joint arthroplasty.

    “experiencing an ACL injury at a young age is associated with a higher likelihood of developing early-onset osteoarthritis, and requiring a total joint arthroplasty.10”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [10] Suter, 2017, Projecting lifetime risk of symptomatic knee osteoarthritis and total knee replacement in individuals sustaining a complete anterior cruciate ligament tear in early adulthood, Arthritis Care Res source

  • May combine two claims.

    Premisecitation

    ACL injuries are not limited to high level athletes; the largest difference in incidence rates between women and men was seen in recreational athletes.

    “However, ACL injuries are not limited to high level athletes; in one study, the largest difference in incidence rates between women and men was seen in recreational athletes.9”
    Quote in the paperSubstantial claim1 of 1 sources checked

  • Classified as probably not a substantial claim.

    Premisecitation

    In the wider gender and health literature, there is increasing recognition that sex and gender are entangled-the biological and social influence each other in ways that are not always empirically discernible but are theoretically plausible.

    “In the wider gender and health literature, there is increasing recognition that sex and gender are 'entangled'that is, the biological and the social influence each other in ways that are not always empirically discernible but are theoretically plausible.47”
    Quote in the paperSubstantial claim1 of 1 sources checked

  • May combine two claims.

    Premisecitation

    Reducing women's injury risk to biological causes fundamentally misrepresents the root cause of ACL injury, which is likely strongly influenced by gendered environmental disparities including access to and experiences with sport and training.

    “Fox et al put forward a compelling case that reducing women's injury risk to biological causes (eg, hormones, anatomy, physiology) fundamentally misrepresents the root cause of ACL injury, 17”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites [17] Fox, 2020, Anterior cruciate ligament injuries in Australian football: should women and girls be playing? You’re asking the wrong question, BMJ Open Sport Exerc Med source

      Split into 2 atoms — 0 confirmed, 2 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.

      Experimental — accuracy not yet measured

  • May combine two claims.

    Premisecitation

    Girls and women participate in resistance training at a much lower rate than boys and men, and this gap is associated with strong gendered expectations of how a woman's body is supposed to look and the gender typing of weightlifting as masculine.

    “However, girls and women participate in resistance training at a much lower rate than boys and men, 40 41 and this gap is associated with strong gendered expectations of how a woman's body is 'supposed' to look and the gender typing of weightlifting as masculine.23 42-45”
    Quote in the paperSubstantial claim1 of 3 sources checked
    • cites [40] Bennie, 2019, The epidemiology of aerobic physical activity and muscle-strengthening activity guideline adherence among 383,928 U.S. adults, Int J Behav Nutr Phys Act source

      Split into 2 atoms — 0 confirmed, 1 partially supported, 0 disputed, 0 misattributed, 1 unverifiable. Expand the claim to see per-atom verdicts.

      Experimental — accuracy not yet measured
    • cites [41] Caspersen, 2000, Changes in physical activity patterns in the United States, by sex and cross-sectional age, Med Sci Sports Exerc source
    • cites 23 42-45

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • Probably not a substantial claim: may not pass S4 (based).

    Findingnone given

    Gendered factors present in the presport, training, competition and rehabilitation environments have not been explicitly included in anterior cruciate ligament injury models to date.

    “Gendered factors present in the presport, training, competition and rehabilitation environments have not been explicitly included in anterior cruciate ligament injury models to date.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    The ACL injury rate for girls/women has not changed in over 20 years, and girls/women remain 3-6 times more likely to experience ACL injury compared with boys/men.

    “The anterior cruciate ligament (ACL) injury rate for girls/women has not changed in over 20 years, and they remain 3-6 times more likely to experience injury compared with boys/men.”
    • Also stated in: § INTRODUCTION · plain
      “The fact that girls and women were experiencing these life-altering injuries at 3-6 times the rate of boys and men 1 2”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites 1 2

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

    • cites [7] source

  • Probably not a substantial claim: may not pass S4 (based).

    Premisenone given

    The traditional sex-based approach does not take into account the growing recognition of how sex and gender are entangled and influence each other.

    “However, the traditional sex-based approach does not take into account the growing recognition of how sex and gender (a social construct) are 'entangled' and influence each other.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    In collegiate athletes, ACL injury incidence has increased, with women experiencing higher rates than men in the same sports.

    “In collegiate athletes, injury incidence has actually increased, with women experiencing higher rates than men in the same sports.8”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [8] Agel, 2016, Collegiate ACL injury rates across 15 sports: National Collegiate Athletic Association injury surveillance system data update (2004-2005 through 2012-2013), Clin J Sport Med source

  • May combine two claims.

    Premisecitation

    Annual ACL injury rates in the general population have remained unchanged in girls and women, while they have decreased among boys and men.

    “Annual ACL injury rates in the general population have remained unchanged in girls and women, while they have decreased among boys and men, 7”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [7] source

  • May combine two claims.

    Premisecitation

    Implicit gendered experiences and expectations are pervasive, extend to schools, and result in environmentally induced physical abilities and a motor control gender gap.

    “These types of implicit experiences and expectations are pervasive, extend to other environments such as schools, and result in 'environmentally induced' physical abilities 65 and a motor control gender gap.66”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [65] source
    • cites [66] Barnett, 2010, Gender differences in motor skill proficiency from childhood to adolescence: a longitudinal study, Res Q Exerc Sport

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • May combine two claims.

    Interpretationcitation

    Bone, joint and muscle loading that may appear to manifest sex differences could also be a result of gendered processes, and gender is an extrinsic factor created by society.

    “however, bone, joint and muscle loading that may appear to manifest sex differences could also be a result of gendered processes, 58 and gender is an extrinsic factor created by society.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [58] source

  • May combine two claims.

    Premisecitation

    During the teenage years, boys experience a muscular strength and motor performance growth spurt, while girls plateau.

    “During the teenage years, boys experience a muscular strength and motor performance growth spurt, while girls plateau.27 28”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [27] Beunen, 1988, Growth and physical performance relative to the timing of the adolescent spurt, Exerc Sport Sci Rev source
    • cites [28] Hewett, 2004, Decrease in neuromuscular control about the knee with maturation in female athletes, J Bone Joint Surg Am source

  • Probably not a substantial claim: may not pass S4 (based).

    Premisenone given

    It is common practice in sport medicine literature related to ACL injury to use the terms sex and gender interchangeably, without consideration or explanation as to how research participants were delineated and why this was appropriate.

    “First, it is important to acknowledge that it is common practice in sport medicine literature related to ACL injury to use the terms sex and gender (similarly: female and women) interchangeably, without consideration or explanation as to how research participants were delineated and why this was appropriate in the given context.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    The weight room environment is a highly gendered space where many women feel uncomfortable, and women materially shrink their consumption of time, space and equipment in response.

    “The weight room environment itself is a highly gendered space where many women feel uncomfortable, 23-26 42-45 and even materially shrink their consumption of time, space and equipment in response.23”
    Quote in the paperSubstantial claim0 of 8 sources checked
    • cites [23] Coen, 2018, “It’s gym, like g-y-m not J-i-m”: Exploring the role of place in the gendering of physical activity, Soc Sci Med source
    • cites [24] Coen SE , Davidson J , Rosenberg MW . Where is the space for continuum?’ Gyms and the visceral "stickiness" of binary gender. Qual Res Sport Exerc Health 2020:1–17. source
    • cites [25] Coen, 2020, Towards a critical geography of physical activity: emotions and the gendered boundary-making of an everyday exercise environment, Trans Inst Br Geogr source
    • cites [26] Parsons JL , Ripat J . Understanding the experiences of girls using a high school weight room. PHE Journal 2020;86.

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

    • cites [42] Dworkin, 2001, “Holding Back”: negotiating a glass ceiling on women’s muscular strength, Sociol Perspect source
    • cites [43] source
    • cites [44] Dworkin SL . A woman’s place is in the… cardiovascular room?? Gender relations, the body, and the gym. Athletic intruders: Ethnographic research on women, culture, and exercise 2003:131–58.

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

    • cites [45] source

  • Probably not a substantial claim: may not pass S4 (based). May combine two claims.

    Interpretationreasoning

    It is likely that training is already different for girls/women and boys/men, but in a way that disadvantages girls/women.

    “It is likely that training is already different, but in a way that disadvantages girls/women.”
    Quote in the paperNot a substantial claim
    • The authors state this as an assumption: Both biological and social factors are at play in ACL injury.

  • Classified as probably not a substantial claim.

    Premisereasoning

    The role of gender, a social construct present from the moment we are born, is conspicuously missing from the ACL injury discussion.

    “The role of gender, a social construct which is present from the moment we are born, is conspicuously missing from the ACL injury discussion.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    Mothers underestimated the crawling abilities of their daughters, but overestimated the abilities of their sons.

    “a study which found that mothers underestimated the crawling abilities of their daughters, but overestimated the abilities of their sons.64”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [64] source

  • Probably not a substantial claim: may not pass S4 (based).

    Premisenone given

    No literature exists regarding how ACL injury prevention programmes, or resistance training in general, are communicated or presented to girls/women and boys/men.

    “As far as we are aware, no literature exists regarding how ACL injury prevention programmes, or resistance training in general, are communicated or presented to girls/women and boys/men.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    Contact injury rates are higher in boys and men, while non-contact mechanisms are more frequently reported in girls and women.

    “Contact injury rates are higher in boys and men, while non-contact mechanisms are more frequently reported in girls and women, 8 perhaps partly reflecting participation in different types of sports.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [8] Agel, 2016, Collegiate ACL injury rates across 15 sports: National Collegiate Athletic Association injury surveillance system data update (2004-2005 through 2012-2013), Clin J Sport Med source

  • Probably not a substantial claim: may not pass S2 (checkable).

    Interpretationreasoning

    The addition of gender as an environmental factor in the ACL injury model moves toward a more dynamic consideration of sex/gender in ACL injury research.

    “The addition of gender as an environmental factor in the ACL injury model (figure 1) moves us toward a more dynamic consideration of sex/ gender in ACL injury research.”
    Quote in the paperNot a substantial claim
    • The authors state this as an assumption: Both biological and social factors are at play in ACL injury.

  • Probably not a substantial claim: may not pass S2 (checkable), S4 (based).

    Interpretationnone given

    Effects observed at the individual level can be understood as outcomes of ways that the social and material contexts of sport condition sporting bodies.

    “Effects observed at the individual level can be understood as outcomes of ways that the social and material contexts of sport condition sporting bodies.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S2 (checkable).

    Premisecitation

    Understanding and acting on upstream social and contextual factors is vital in improving individual and population health.

    “Through Marmot's work on the Social Determinants of Health, 93 we now know that understanding and acting on upstream social and contextual factors is vital in improving individual and population health.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [93] Marmot M , Wilkinson R . Social determinants of health. Oxford University Press, 2005. source

  • Classified as probably not a substantial claim.

    Premisecitation

    Prevention efforts are most effective when broader society and cultural norms are targeted, rather than placing the burden on individual people to change their behaviour.

    “Work in public health tells us that prevention efforts are most effective when broader society and cultural norms are targeted, rather than placing the burden on individual people to change their behaviour.99 100”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [99] Lund, 2004, Accident prevention. Presentation of a model placing emphasis on human, structural and cultural factors, Saf Sci source
    • cites [100] source

  • May combine two claims.

    Interpretationreasoning

    Sex/gender are entangled to produce diverse sport experiences for women and men, which must factor into ACL injury risk.

    “These are clear examples of how sex/gender are 'entangled' to produce diverse sport experiences for women and men, which we argue must factor into ACL injury risk.”
    Quote in the paperNot a substantial claim
    • The authors state this as an assumption: Both biological and social factors are at play in ACL injury.

  • Probably not a substantial claim: may not pass S2 (checkable). May combine two claims.

    Interpretationreasoning

    Until the approach to studying ACL injury includes consideration of gendered factors, we will continue to have an incomplete picture of ACL injury and the disadvantages to girls and women will endure.

    “Until the approach to studying ACL injury transforms and includes consideration of gendered factors, we will continue to have an incomplete picture of ACL injury and the disadvantages to girls and women will endure.”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: Over 20 years of research has failed to decrease the ACL injury rate in girls and women.

  • Probably not a substantial claim: may not pass S2 (checkable), S4 (based).

    Interpretationnone given

    Moving beyond a biological starting point to incorporate both biology and society as possible influences on ACL injury risk can lead to new advances in the field.

    “Moving beyond a biological starting point to incorporate both biology and society as possible influences on ACL injury risk can lead to new advances in the field.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    Risk-taking behaviour and winning are traditionally viewed as masculine traits and are highly valued in sport environments, but can lead to injury.

    “Risk-taking behaviour and winning are traditionally viewed as masculine traits and are highly valued in sport environments, but can lead to injury.83”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [83] Kroshus, 2017, Concussion reporting, sex, and conformity to traditional gender norms in young adults, J Adolesc source

  • Probably not a substantial claim: may not pass S4 (based).

    Interpretationnone given

    Comparing postsurgical outcomes between men and women assumes that their preinjury status, rehabilitation and subsequent training environments are equivalent.

    “Comparing postsurgical outcomes between men and women again assumes that their preinjury status, rehabilitation and subsequent training environments are equivalent.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S2 (checkable), S4 (based).

    Interpretationnone given

    Gender, as an extrinsic social construct, likely influences many of the risk factors previously considered intrinsic to the athlete.

    “Gender, as an extrinsic social construct, likely influences many of the risk factors previously considered intrinsic to the athlete.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S4 (based).

    Interpretationnone given

    The faster return to sport by boys and men after ACL injury could also relate to the types of training environments that women and men experience and have access to during rehabilitation.

    “But it could also relate to the types of training environments that women and men experience and have access to during rehabilitation.”
    Quote in the paperNot a substantial claim
32 of 32

  • The authors state this as an assumption.

    Both biological and social factors are at play in ACL injury.

    “Our proposal disrupts the primacy of sex-based explanations of ACL injury and instead suggests that we start from a point of assuming that both biological and social factors are at play.”

  • The paper relies on this without support.

    Over 20 years of research has failed to decrease the ACL injury rate in girls and women.

    “Over 20 years of research has failed to decrease the ACL injury rate in girls and women; it is time to take a different approach.”

  • The paper relies on this without support.

    The ACL injury rate disparity between girls/women and boys/men has not changed in over 20 years.

    “The anterior cruciate ligament injury rate disparity between girls/women and boys/men has not changed in over 20 years.”

  • The paper relies on this without support.

    The approach to addressing the injury rate disparity and establishing effective prevention and treatment programmes is multifactorial and complex.

    “The approach to addressing the injury rate disparity and establishing effective prevention and treatment programmes is multifactorial and complex.”
4 of 4

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

Each contradiction between two passages listed here was confirmed by an independent check.

  • Unchanged disparity conflicts with the reported rate trends

    Minor

    The paper says the injury-rate disparity has not changed, but also says rates for girls and women stayed constant while rates for boys and men fell. Those trends would widen the disparity in the general population, whether measured as a difference or a ratio.

1 of 1

Cites

Flagged first, then by citations

Research works printed but not linked: 1

  1. Parsons JL , Ripat J . Understanding the experiences of girls using a high school weight room. PHE Journal 2020;86.

Cited by

Sorted by citations

Related

Authors
Parsons, J. L., Coen, S. E., & Bekker, S.
Affiliations
  • University of Manitoba (CA)
  • University of Nottingham (GB)
  • University of Bath (GB)
Corresponding author
Parsons, Joanne L
ORCID
Venue
British Journal of Sports Medicine
Publisher
BMJ
Published
2021-03-10
Volume
55
Issue
17
Pages
984-990
ISSN
  • 0306-3674 (ISSN-L)
  • 1473-0480
DOI
10.1136/bjsports-2020-103173
OpenAlex
W3135883013
Semantic Scholar
8cc077bcb8d31dbfe66986328bbae2d54ed633a4
Cited by
300
References
108
Citations by year
2026: 53 · 2025: 76 · 2024: 89 · 2023: 45 · 2022: 27 · 2021: 10
FWCI
10.36
Type
journal article
Language
en
Open access
Locations
  • British Journal of Sports Medicine (publishedVersion)
  • PubMed (publishedVersion)
  • Repository@Nottingham (University of Nottingham) (acceptedVersion, other-oa)
  • Repository@Nottingham (University of Nottingham) (submittedVersion, cc-by-nc)
Topics
  • Health Sciences › Medicine › Surgery › Knee injuries and reconstruction techniques
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Sex and Gender in Healthcare
  • Social Sciences › Gender Studies › Sports, Gender, and Society
Keywords
anterior cruciate ligament injury, gender, sex differences, gender construction, embodiment, injury prevention, injury risk factors, women in sport, social epidemiology, ACL rehabilitation
MeSH terms
Anterior Cruciate Ligament Injuries, Female, Humans, Male, Risk Factors, Sex Factors, Anterior Cruciate Ligament

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Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

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