Limitations of athlete-exposures as a construct for comparisons of injury rates by gender/sex: a narrative review

Review written by Dr Christina Le info

Key Points

  1. Athlete Exposures (AEs) are a limited measure of injury risk because they often do not distinguish between lower-risk training sessions and higher-risk match play.
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BACKGROUND & OBJECTIVE

ACL injuries in women’s sports have dominated media headlines with superstars like Alexia Putellas (soccer, Barcelona/Spain), Sam Kerr (soccer, Chelsea/Australia), and JuJu Watkins (college basketball, University of Southern California) sustaining this burdensome injury in recent years. The evidence tells us that the ACL injury incidence rate for women (1.88 injuries per 10,000 athlete-exposures (AEs)) is over two times higher than the rate for men (0.87 injuries per 10,000 AEs) (1).

With greater attention on women’s sports, some researchers have called for a closer examination of the role that gender biases and gendered environments play on injury risk (2). This extends to understanding how injury burden is measured in the first place. Subsequently, this narrative review explores the potential pitfalls of using AEs when comparing injury incidence between females and males.

The evidence tells us that the ACL injury incidence rate for women is over two times higher than the rate for men.
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Clinician’s should record training and match time separately considering injury risk is higher during match play compared to training.

TERMINOLOGY

First, a quick reminder that ‘sex’ refers to an individual's biological characteristics (e.g. anatomy, hormones, physiology) whereas ‘gender’ refers to an individual’s socially constructed identity (e.g. behaviors, expressions, roles). Historically, these constructs have been (incorrectly) used interchangeably in sports medicine

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