Gendered sport environments and their theoretical contributions to women’s ACL injury risk: a scoping review

Objective

To summarize the current literature that describes the gendered environments of women’s sports which are higher risk for ACL injury, and determine whether the existing literature relates gendered aspects of the sport environment to injury.

Design

Scoping review.

Data sources

Electronic search of Medline, Embase, CINAHL, SPORTDiscus, SCOPUS, and Women’s Studies International databases from inception to March 2024.

Eligibility criteria

Studies were included if at least 50% of the study participants were adult women participating in organized sports with higher risk for ACL injury.

Results

Of the initially identified 17,148 studies, 854 underwent full text review, and 73 were included in this scoping review. In 19 studies, reference to injury was restricted to one or two direct quotes from an athlete and the other 54 studies had no mention of injury. We identified three repeating patterns describing the gendered sport environments that women athletes encounter. Fifty-five studies described embedded stereotypes that devalue women and women’s sport. Forty-five studies described ways the sport environment reproduces restrictive gender norms for women. Forty-six studies reported that gendered inequities including gendered wage inequality and provision of subpar training facilities were structurally embedded in women’s sport environments.

Conclusion

Existing literature describes a range of gendered inequities that exist for women in their sport environments; however, there has been no concerted effort to date to link those gendered environmental factors to ACL injury. Such research is needed if we are serious about eliminating the ACL injury rate disparity between women and men.

What is already known

• Historically, gendered disparities in anterior cruciate ligament injury risk have focused on biological explanations

• Societal gendered norms and expectations of women can greatly affect their experiences and opportunities in sport environments

What are the new findings

• Existing literature describes a range of gendered inequities that exist for women in their sport environments

• Only a small percentage (∼25%) of studies describing the gendered aspects of women’s sport environments mention any relation to injury

• There has been no concerted effort to link gendered aspects of sport environments to women’s injury risk and experiences