Danielsen Ann Caroline, Gompers Annika, Bekker Sheree, Richardson Sarah S
Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA.
Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, Georgia, USA
Br J Sports Med. 2025 Feb 3;59(3):177-184. doi: 10.1136/bjsports-2024-108812.
High rates of anterior cruciate ligament (ACL) injuries in girls' and women's sports have garnered significant attention from researchers, sport organisations and the media. Gender/sex disparities in ACL injury rates are often estimated using the construct of athlete-exposures (AEs), a widely used measure of exposure time in sports science and epidemiology that is defined as one athlete participating in one practice or competition. In this narrative review, we explain the limitations of AEs as a measure of exposure time and develop a series of conceptual critiques regarding the use of AEs for the purposes of comparing injury rates by gender/sex. We show that the differing training-to-match ratio and average team size between women and men-rooted in persistent gendered inequities in sports participation and professionalisation-may jeopardise the validity of using AEs for cross-gender comparisons and skew gender/sex disparities in ACL injury rates. To avoid bias, we invite researchers interested in gender/sex disparities in injury rates to collect finer-grained data including individual-level AEs disaggregated by training and competition, as well as to appropriately control for team size and training-to-match ratio at the data analysis stage. Any quantitative comparisons of injury rates should also thoroughly contextualise the limitations of AEs, including their inability to capture the potential qualitative differences between women's and men's training and sporting environments that may influence injury rates.
女孩和女性体育运动中前交叉韧带（ACL）损伤的高发生率引起了研究人员、体育组织和媒体的广泛关注。ACL损伤率的性别差异通常使用运动员暴露量（AEs）这一指标来估计，AEs是体育科学和流行病学中广泛使用的一种暴露时间衡量指标，定义为一名运动员参加一次训练或比赛。在这篇叙述性综述中，我们解释了AEs作为暴露时间衡量指标的局限性，并对使用AEs来比较性别损伤率的目的提出了一系列概念性批评。我们表明，男女之间不同的训练与比赛比例以及平均团队规模——根源在于体育参与和职业化中持续存在的性别不平等——可能会损害使用AEs进行跨性别比较的有效性，并扭曲ACL损伤率的性别差异。为避免偏差，我们邀请对损伤率性别差异感兴趣的研究人员收集更细化的数据，包括按训练和比赛分类的个体层面的AEs，以及在数据分析阶段适当控制团队规模和训练与比赛比例。损伤率的任何定量比较还应全面阐述AEs的局限性，包括其无法捕捉男女训练和体育环境之间可能影响损伤率的潜在质量差异。
