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

Arianna L Gianakos; Patrick Szukics; Nicole George; Sherif Elkattawy; Dawn M LaPorte; Mary K Mulcahey

doi:10.1016/j.asmr.2020.02.002

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

Arthrosc Sports Med Rehabil. 2020 Apr 28;2(3):e207-e212. doi: 10.1016/j.asmr.2020.02.002. eCollection 2020 Jun.

Authors

Arianna L Gianakos¹, Patrick Szukics², Nicole George³, Sherif Elkattawy¹, Dawn M LaPorte⁴, Mary K Mulcahey⁵

Affiliations

¹ Department of Orthopaedic Surgery, Robert Wood Johnson Barnabas Health-Jersey City Medical Center, Jersey City, New Jersey, U.S.A.
² Department of Orthopaedic Surgery, Rowan School of Osteopathic Medicine, Stratford, New Jersey, U.S.A.
³ Department of Orthopaedic Surgery, Aultman Hospital, Canton, Ohio, U.S.A.
⁴ Department of Orthopaedic Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, U.S.A.
⁵ Department of Orthopaedic Surgery, Tulane University School of Medicine, New Orleans, Louisiana, U.S.A.

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 case-control 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 = .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.