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

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.