Differences in Injury Profiles Between Female and Male Athletes Across the Participant Classification Framework: A Systematic Review and Meta-Analysis.

Anterior cruciate ligament injury is well known to differ by sex in sport, but whether this pattern extends to other injury types across different levels of sport participation has been less clear. This systematic review and meta-analysis pooled 180 cohort and epidemiology studies spanning recreational to elite athletes to compare injury profiles between female and male athletes in sex-comparable sports. The review found female athletes had greater risk of knee, foot/ankle, bone stress, and concussion injuries, while male athletes had greater risk of hip/groin and hamstring injuries and acute fractures, the latter especially during competition. These sex-specific patterns are interesting because they suggest injury prevention strategies may need to differ by sex and injury type rather than assuming a single approach fits all athletes.

The main limitation is that most included studies were rated only moderate quality, which tempers confidence in how precise these risk estimates are across the full range of sports and participation levels studied.

If you play sport, you may have heard that women are more likely to tear their ACL, a key knee ligament. This review looked at whether sex differences in injury show up for other injury types too, using evidence from 180 studies covering athletes from recreational to elite levels. The researchers found that female athletes had a higher risk of knee injuries, foot and ankle injuries, bone stress injuries (like stress fractures), and concussion compared to male athletes playing the same sports.

Male athletes, on the other hand, had a higher risk of hip and groin injuries, hamstring injuries, and bone fractures, especially during competition rather than practice. These patterns don't tell us why these differences happen, only that they were observed across many studies. It's also worth knowing that most of the underlying studies were only rated as moderate quality, so the exact size of these risk differences should be interpreted with some caution.

This is a summary of research, not medical advice. Talk to your own healthcare provider about anything affecting your care.

This review addresses whether sex is a meaningful factor in injury risk beyond the well-established ACL story, a question relevant to how physiotherapists think about screening and prevention across male and female athletes. Pooling 180 studies across six participant tiers (from tier-1 elite to tier-5 recreational), the authors found moderate evidence that female athletes carried greater risk of knee injury, foot/ankle injury, bone stress injury, and concussion, while male athletes showed greater risk of hip/groin and hamstring injuries, and were 1.8 to 2.8 times more likely to sustain acute fractures, with the highest fracture risk occurring in competition rather than training. For clinical reasoning, this informs that injury prevention and even return-to-sport considerations, particularly for concussion, may warrant sex-specific thinking rather than a uniform protocol, though the review itself does not test any intervention and cannot establish that modifying programmes by sex reduces injury rates.

The hamstring and hip/groin findings were more pronounced in dynamic sports, a subgroup detail that should be read as less certain than the overall pooled result. The main limitation for applying these findings is that 174 of 180 studies were rated only moderate quality on the Downs and Black checklist, and heterogeneity across sport types, tiers, and injury definitions was not resolved, so the precision of individual risk ratios should be interpreted cautiously.