Sex-Specific Analysis at Two Time Points in Three High-Impact Orthopaedic Sports Medicine Journals

Abstract

Purpose: To determine how well the orthopaedic sports medicine literature reported sex-specific analysis (SSA) in 2011 and 2016. Methods: The 3 highest-impact orthopaedic sports medicine subspecialty journals (American Journal of Sports Medicine; Arthroscopy; and Knee Surgery, Sports Traumatology, Arthroscopy) were selected for review. Two independent investigators reviewed all journal issues published during 2 different calendar years (2011 and 2016). All randomized controlled, prospective and retrospective group, and caseecontrol studies were included. Studies were stratified into those that involved SSA, where sex was a variable in a multifactorial statistical model, and those that only reported sex as a demographic characteristic or used sex-matched groups without further analysis. Results: A total of 960 studies evaluating 3,400,569 patients met criteria and were included in this review. Although 44.4% of the overall study population was female, only 293 (30.5%) studies included patient sex as variable in a multifactorial statistical model. The proportion of studies that performed SSA did not differ between 2011 (29.6%) and 2016 (31.1%; P ¼ .607), although publications from American Journal of Sports Medicine were likely to report SSA (P < .05). Of the 293 studies that reported SSA, 91 (31%) demonstrated a significant difference in outcomes. The most commonly reported differences were in outcomes following anterior cruciate ligament, medial patellofemoral ligament, and posterior cruciate ligament reconstruction; autograft preparation; postoperative use of opiates following arthroscopy; and recovery after sports-related concussions. Conclusions: Although most sports medicine studies include approximately 50% female and 50% male patients, statistical analysis differentiating the 2 subsets is not routinely performed. Only 30.5% of all studies performed SSA, 31% of which reported a statistically significant difference in the data when comparing outcomes between male and female patients with the same treatment modalities. Clinical Relevance: The current study demonstrates that the orthopaedic sports medicine subspecialty literature is lacking in reporting SSA, and that there has been minimal improvement over a 5-year time period. In addition, this study highlights the high percentage of significant findings within the studies that performed SSA and underscores the differences in sex-specific injury patterns and treatment outcomes.

Current Concept Review: Inclusion and Analysis of Diverse Study Populations in Orthopaedic Research

“…24 Despite the push for improving the inclusion of females as research subjects, only a fraction of orthopaedic studies—roughly one-third—have done sex-specific analysis. 23,25,26 The lack of sex-specific reporting is of particular concern because when data are analyzed as a function of the patient's sex, a notable difference in outcomes is detected as often as 39% of the time. 26…”

“…23,25,26 The lack of sex-specific reporting is of particular concern because when data are analyzed as a function of the patient's sex, a notable difference in outcomes is detected as often as 39% of the time. 26…”

Sex-Specific Analysis Is Lacking in Abstracts Presented at Arthroscopy Association of North America and American Orthopaedic Society for Sports Medicine Annual Meetings From 2016 to 2019

“…Similarly, a study by Gianakos et al. 8 found that 30.5% of studies in 3 high-impact orthopaedic sports medicine subspecialty journals included SSA. Furthermore, another study by Gianakos et al.…”

“…Additionally, Hettrich et al 6 found that there was an increase in SSA reporting in high-impact orthopaedic journals from 2000 to 2010, but overall, fewer than one-third of studies included SSA. Similarly, a study by Gianakos et al 8 found that 30.5% of studies in 3 high-impact orthopaedic sports medicine subspecialty journals included SSA. Furthermore, another study by Gianakos et al 9 evaluated all articles published in 6 leading orthopaedic journals in 2016.…”

Editorial Commentary: Moving on from studying only the ACL: The importance of sex differences in other orthopaedic injuries

“…There is still a relative disparity of knowledge about women's sports injuries. [13][14] In their article "Sex Differences in Posterior Cruciate Ligament Injuries," Drs. Oganesyan, Anderson, Simeone, Chang and Tanaka continue that pursuit of narrowing the information gap by evaluating patterns of injury in the posterior cruciate ligament (PCL) injuries on MRI.…”