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Anterior cruciate ligament injury: towards a gendered environmental approach
  1. Joanne L Parsons1,
  2. Stephanie E Coen2,
  3. Sheree Bekker3
  1. 1College of Rehabilitation Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
  2. 2School of Geography, University of Nottingham, Nottingham, Nottinghamshire, UK
  3. 3Department for Health, University of Bath, Bath, UK
  1. Correspondence to Dr Joanne L Parsons, College of Rehabilitation Sciences, University of Manitoba, Winnipeg, Manitoba, Canada; joanne.parsons{at}


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.

  • ACL
  • injury prevention
  • gender

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  • Twitter @J_ParsonsUofM, @steph_coen, @shereebekker

  • Contributors JLP conceptualised the initial idea for the paper and outlined the current state of the ACL injury literature. SEC placed the new approach within existing theories of the embodiment of gender and health. JLP and SEC jointly developed the gendered environmental approach to ACL injury. SB contributed an intersectional lens, and an overall critical review of the paper. All authors approved the final version of the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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