Journal of Pediatric Orthopaedics - 2026-08-10 - Journal Article
Examining Sex-Based Inequities in Pediatric Sports Medicine Research: A Systematic Review.
Sonnier JH, Patel NM, Watson SL, Gippo I, Lew L, Durudogan EH, Miller A, Paek S, Wolf SF
Topics
Key Takeaway
Across 409 pediatric sports medicine studies, female athletes comprised only 36% of participants on average, with single-sport studies enrolling only-female cohorts at half the rate of only-male cohorts (15.4% vs. 48.7%).
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Summary
This PRISMA-compliant systematic review examined sex-based inclusion across 409 original research articles published 2020–2024 in 12 top sports medicine journals to quantify male-female representation in pediatric athlete research. Females represented a median of 39% and mean of 36% of enrolled participants; single-sport studies enrolled only-female cohorts at 15.4% versus only-male at 48.7% (P<0.001). Linear regression demonstrated female underrepresentation was concentrated in higher-evidence study designs examining injury, reinjury, return to play, and patient-reported outcomes, with no disparity in mental health research.
Key Limitation
The review excluded orthopaedic-specific journals, meaning the findings may not accurately reflect sex-based inclusion patterns in the literature most directly informing pediatric orthopaedic surgical decision-making.
Original Abstract
BACKGROUND
Inequalities in the inclusion of male and female athletes have been documented in the sports medicine literature. However, the extent to which this phenomenon exists in studies of pediatric athletes remains poorly defined. The purpose of this study is to characterize the inclusion of male versus female athletes in pediatric sports medicine.
METHODS
All articles published from 2020 to 2024 in 12 top interdisciplinary sports medicine journals were manually reviewed, and results were reported following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) protocols. Inclusion criteria were: (1) full-text original research study, (2) isolated athletes, and (3) isolated a pediatric patient population. Exclusion criteria were: (1) editorial or review article, (2) case report with only one subject, and (3) cadaveric study. Data were collected to characterize study design, inclusion, and outcomes of interest. Statistical analysis was performed using the asymptotic χ2 (Pearson) test as the default. To examine absolute inequality in the inclusion of male and female athletes, mean differences (MDs) were calculated from linear regression models for continuous outcomes.
RESULTS
Across 409 included studies, 30% enrolled only male athletes, 10% enrolled only female athletes, and 60% included both male and female athletes. The median inclusion was 61% male and 39% female (mean 64% and 36%, respectively). Among 234 studies that focused on a single sport, 48.7% included only males, 15.4% included only females, and 35.9% included both males and females (P<0.001). Using MDs from linear regression, female athletes were shown to be underrepresented in study designs representing a higher level of evidence that analyzed variables such as patient-reported outcomes, injury, reinjury, or return to play. No difference in inclusion was seen in studies of mental health outcomes.
CONCLUSION
Females are underrepresented in studies of youth athletes, particularly in single-sport studies and study designs with a higher level of evidence.
CLINICAL RELEVANCE
Given that there are known differences in sex-related outcomes, future research should prioritize equity in the inclusion of male and female athletes.
LEVELS OF EVIDENCE
Level IV-systematic review.