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Braman M, Root C, Harmon I, Long R, Vopat L, Vopat B, Herda A. Auditing the Representation of Female Athletes in Sports Medicine Research: Achilles Repair. FOOT & ANKLE ORTHOPAEDICS 2024; 9:24730114241255360. [PMID: 38827564 PMCID: PMC11143824 DOI: 10.1177/24730114241255360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2024] Open
Abstract
Background Establishing evidence-based recommendations specific to female athletes has been overlooked in sports medicine. Achilles tendon rupture is one of the most common musculoskeletal injuries, occurring in 15 to 55 per 100 000 people annually. Differences in injury rates could be due to hormonal effects, as estrogen receptors have been identified in tendons along with decreased tendon strain based on oral contraceptive use. The primary purpose of this study was to audit the representation of female athletes in the literature regarding Achilles repair. Methods An electronic search was performed using PubMed to identify articles related to Achilles repair using the protocol by Smith et al. Studies were assessed by population, size, athletic caliber, study impact, research theme, and menstrual status. Results Female representation across all studies was 1783 of 10 673 subjects (16.7%). Composition of included studies was predominantly mixed-sex cohorts with 131 of 169 (77.5%) included studies. Within mixed-sex cohort studies, the total representation of female athletes was 1654 of 8792 participants (18.9%). Thirty-two studies were male only, constituting 1540 participants, whereas 3 studies were female only composed of 86 athletes. Importantly, the disparity between male and female representation worsened as the athletic caliber of the study population increased, with 5.0% female representation in studies with professional athletes. No study collected data related to menstrual status and its potential relationship to Achilles rupture or postoperative outcomes. Conclusion Mixed-sex cohort studies underrepresented female athletes, and male-only cohort studies were more common than female-only studies. These findings indicate a need for increased representation of female athletes as well as acknowledgment of menstrual status in research related to Achilles repair. Future studies should focus on representation of female athletes and data collection related to sex-specific hormones, hormonal contraceptive use, and menstrual status to improve treatment of Achilles tendon ruptures for female athletes. Level of Evidence Level IV, case series.
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Affiliation(s)
- Michael Braman
- The University of Kansas School of Medicine, Kansas City, KS, USA
| | - Cooper Root
- The University of Kansas School of Medicine, Kansas City, KS, USA
| | - Ian Harmon
- Department of Orthopedic Surgery and Sports Medicine, University of Kansas Health System, Kansas City, KS, USA
| | - Rachel Long
- Department of Orthopedic Surgery and Sports Medicine, University of Kansas Health System, Kansas City, KS, USA
| | - Lisa Vopat
- Department of Orthopedic Surgery and Sports Medicine, University of Kansas Health System, Kansas City, KS, USA
| | - Bryan Vopat
- Department of Orthopedic Surgery and Sports Medicine, University of Kansas Health System, Kansas City, KS, USA
| | - Ashley Herda
- Department of Health, Sport & Exercise Science, School of Education and Human Sciences, University of Kansas, Overland Park, KS, USA
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Martínez-Fortuny N, Alonso-Calvete A, Da Cuña-Carrera I, Abalo-Núñez R. Menstrual Cycle and Sport Injuries: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:3264. [PMID: 36833966 PMCID: PMC9958828 DOI: 10.3390/ijerph20043264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 02/09/2023] [Accepted: 02/10/2023] [Indexed: 06/18/2023]
Abstract
The presence of female athletes has only increased in recent years, as has the incidence of injuries in female sports activities. These injuries are conditioned by multiple factors, including hormonal agents. It is estimated that the menstrual cycle may be related to the predisposition to suffer an injury. However, a causal relationship has not yet been established. The aim of this study was to analyse the relationship between the menstrual cycle and injuries in female sports practice. A systematic search of the scientific literature available in PubMed, Medline, Scopus, Web of Science, and Sport Discus was carried out in January 2022. With 138 articles, only eight studies were found that met the selection criteria for this study. Peak estradiol is associated with increased laxity, strength, and poor use of neuromuscular control. Thus, the ovulatory phase is associated with an increased risk of injury. In conclusion, it seems that hormonal fluctuations throughout the menstrual cycle alter values such as laxity, strength, body temperature, and neuromuscular control, among others. This fact causes women to constantly adapt to hormonal variations, which exposes them to a higher risk of injury.
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Affiliation(s)
| | - Alejandra Alonso-Calvete
- Facultade de Fisioterapia, Universidade de Vigo, 36005 Pontevedra, Spain
- REMOSS Research Group, Universidade de Vigo, 36005 Pontevedra, Spain
| | - Iria Da Cuña-Carrera
- Facultade de Fisioterapia, Universidade de Vigo, 36005 Pontevedra, Spain
- Fisioterapia Clínica (FS1) Research Group, Instituto de Investigación Sanitaria Galicia Sur (IIS Galicia Sur), SERGAS-UVIGO, 36005 Pontevedra, Spain
| | - Rocío Abalo-Núñez
- Facultade de Fisioterapia, Universidade de Vigo, 36005 Pontevedra, Spain
- Fisioterapia Clínica (FS1) Research Group, Instituto de Investigación Sanitaria Galicia Sur (IIS Galicia Sur), SERGAS-UVIGO, 36005 Pontevedra, Spain
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Shultz SJ, Cruz MR, Casey E, Dompier TP, Ford KR, Pietrosimone B, Schmitz RJ, Taylor JB. Sex-Specific Changes in Physical Risk Factors for Anterior Cruciate Ligament Injury by Chronological Age and Stages of Growth and Maturation From 8 to 18 Years of Age. J Athl Train 2022; 57:830-876. [PMID: 36638346 PMCID: PMC9842121 DOI: 10.4085/1062-6050-0038.22] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
OBJECTIVE To critically assess the literature focused on sex-specific trajectories in physical characteristics associated with anterior cruciate ligament (ACL) injury risk by age and maturational stage. DATA SOURCES PubMed, CINAHL, Scopus, and SPORTDiscus databases were searched through December 2021. STUDY SELECTION Longitudinal and cross-sectional studies of healthy 8- to 18-year-olds, stratified by sex and age or maturation on ≥1 measure of body composition, lower extremity strength, ACL size, joint laxity, knee-joint geometry, lower extremity alignment, balance, or lower extremity biomechanics were included. DATA EXTRACTION Extracted data included study design, participant characteristics, maturational metrics, and outcome measures. We used random-effects meta-analyses to examine sex differences in trajectory over time. For each variable, standardized differences in means between sexes were calculated. DATA SYNTHESIS The search yielded 216 primary and 22 secondary articles. Less fat-free mass, leg strength, and power and greater general joint laxity were evident in girls by 8 to 10 years of age and Tanner stage I. Sex differences in body composition, strength, power, general joint laxity, and balance were more evident by 11 to 13 years of age and when transitioning from the prepubertal to pubertal stages. Sex differences in ACL size (smaller in girls), anterior knee laxity and tibiofemoral angle (greater in girls), and higher-risk biomechanics (in girls) were observed at later ages and when transitioning from the pubertal to postpubertal stages. Inconsistent study designs and data reporting limited the number of included studies. CONCLUSIONS Critical gaps remain in our knowledge and highlight the need to improve our understanding of the relative timing and tempo of ACL risk factor development.
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Affiliation(s)
- Sandra J. Shultz
- Department of Kinesiology, University of North Carolina, Greensboro
| | | | | | | | | | - Brian Pietrosimone
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill
| | - Randy J. Schmitz
- Department of Kinesiology, University of North Carolina, Greensboro
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Lucien JN, Ortega MT, Calvert ME, Smith C, White X, Rogers H, Mosley B, Agrawal R, Drude A, McGee C, George M, Brown A, Downey K, Wild C, Njunge A, Kuzmiak CM, Zava D, Zava T, Pollard J, Francis J, Beery BL, Harlin M, Gonzalez GR, Shaw ND. The Launch of A Girl's First Period Study: Demystifying Reproductive Hormone Profiles in Adolescent Girls. J Pediatr Adolesc Gynecol 2022; 35:420-425. [PMID: 35031446 PMCID: PMC9271526 DOI: 10.1016/j.jpag.2021.12.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 12/17/2021] [Accepted: 12/31/2021] [Indexed: 01/01/2023]
Abstract
Limited data exist on the reproductive hormone dynamics that govern the transition from menarche to the establishment of the mature ovulatory cycles of a fertile young woman. It is also unclear how environmental and lifestyle factors could modulate this transition in contemporary girls. Here, we introduce A Girl's First Period Study, an ambitious longitudinal study aimed at charting the early post-menarchal course of a cohort of healthy girls in the Triangle region of North Carolina.
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Affiliation(s)
- Janet N Lucien
- Clinical Research Branch, National Institute of Environmental Health Sciences, National Institutes of Health, Research Triangle Park, North Carolina; Division of Pediatric Endocrinology, University of North Carolina School of Medicine, Chapel Hill, North Carolina.
| | - Madison T Ortega
- Clinical Research Branch, National Institute of Environmental Health Sciences, National Institutes of Health, Research Triangle Park, North Carolina
| | - Madison E Calvert
- Clinical Research Branch, National Institute of Environmental Health Sciences, National Institutes of Health, Research Triangle Park, North Carolina
| | - Cynthia Smith
- Clinical Research Branch, National Institute of Environmental Health Sciences, National Institutes of Health, Research Triangle Park, North Carolina
| | - Xiomara White
- Clinical Research Branch, National Institute of Environmental Health Sciences, National Institutes of Health, Research Triangle Park, North Carolina
| | - Heidi Rogers
- Clinical Research Branch, National Institute of Environmental Health Sciences, National Institutes of Health, Research Triangle Park, North Carolina
| | - Brittany Mosley
- Clinical Research Branch, National Institute of Environmental Health Sciences, National Institutes of Health, Research Triangle Park, North Carolina
| | - Ruhani Agrawal
- Clinical Research Branch, National Institute of Environmental Health Sciences, National Institutes of Health, Research Triangle Park, North Carolina
| | - Anna Drude
- Clinical Research Branch, National Institute of Environmental Health Sciences, National Institutes of Health, Research Triangle Park, North Carolina
| | - Christopher McGee
- Clinical Research Branch, National Institute of Environmental Health Sciences, National Institutes of Health, Research Triangle Park, North Carolina
| | - Margaret George
- Clinical Research Branch, National Institute of Environmental Health Sciences, National Institutes of Health, Research Triangle Park, North Carolina
| | - Audrey Brown
- Clinical Research Branch, National Institute of Environmental Health Sciences, National Institutes of Health, Research Triangle Park, North Carolina
| | - Kimberly Downey
- Clinical Research Branch, National Institute of Environmental Health Sciences, National Institutes of Health, Research Triangle Park, North Carolina
| | - Catherine Wild
- Clinical Research Branch, National Institute of Environmental Health Sciences, National Institutes of Health, Research Triangle Park, North Carolina
| | - Alexander Njunge
- Clinical Research Branch, National Institute of Environmental Health Sciences, National Institutes of Health, Research Triangle Park, North Carolina
| | - Cherie M Kuzmiak
- Department of Radiology, University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | | | | | - Jenny Pollard
- Clinical Research Branch, National Institute of Environmental Health Sciences, National Institutes of Health, Research Triangle Park, North Carolina
| | - Julie Francis
- Clinical Research Branch, National Institute of Environmental Health Sciences, National Institutes of Health, Research Triangle Park, North Carolina
| | - Breana L Beery
- Clinical Research Branch, National Institute of Environmental Health Sciences, National Institutes of Health, Research Triangle Park, North Carolina
| | - Margaret Harlin
- Clinical Research Branch, National Institute of Environmental Health Sciences, National Institutes of Health, Research Triangle Park, North Carolina
| | - Gladys Ruby Gonzalez
- Clinical Research Branch, National Institute of Environmental Health Sciences, National Institutes of Health, Research Triangle Park, North Carolina
| | - Natalie D Shaw
- Clinical Research Branch, National Institute of Environmental Health Sciences, National Institutes of Health, Research Triangle Park, North Carolina.
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