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Anterior cruciate ligament injury: Towards a gendered environmental approach

Parsons, Joanne L.; Coen, Stephanie E.; Bekker, Sheree

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Joanne L. Parsons

Sheree Bekker


Background: The anterior cruciate ligament (ACL) injury rate for girls/women has not changed in over 20 years, and they remain 3-6 times more likely to experience injury compared with boys/men. To date, ACL injury prevention and management has been approached from a sex-based biological point of view which has furthered our understanding of injury risk factors, mechanisms, and prevention and rehabilitation programmes. However, the traditional sex-based approach does not take into account the growing recognition of how sex and gender (a social construct) are 'entangled' and influence each other. Objective: This paper discusses the curious absence of gender as an influencer in the dialogue surrounding ACL injuries. We propose adding gender as a pervasive developmental environment as a new theoretical overlay to an established injury model to illustrate how gender can operate as an extrinsic determinant from the presport, training and competition environments through to ACL injury and the treatment environment. Approach: We draw on social epidemiological theories of the embodiment of gender and health to provide plausible examples of how gender may influence ACL injury, and demonstrate the opportunity for new, interdisciplinary research in the field. Conclusion: Over 20 years of research has failed to decrease the ACL injury rate disparity between girls/women and boys/men. Embedding gender in the study of ACL injury will heighten awareness of possible influences outside the traditional biological elements, challenge us to think about the inextricable 'entanglement' of sex and gender, and inform more effective approaches to ACL injury prevention and treatment.


Parsons, J. L., Coen, S. E., & Bekker, S. (2021). Anterior cruciate ligament injury: Towards a gendered environmental approach. British Journal of Sports Medicine,

Journal Article Type Review
Acceptance Date Feb 22, 2021
Online Publication Date Mar 10, 2021
Publication Date Mar 10, 2021
Deposit Date Mar 29, 2021
Publicly Available Date Apr 13, 2021
Journal British Journal of Sports Medicine
Print ISSN 0306-3674
Electronic ISSN 1473-0480
Publisher BMJ Publishing Group
Peer Reviewed Peer Reviewed
Keywords Physical Therapy, Sports Therapy and Rehabilitation; Orthopedics and Sports Medicine; General Medicine
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