High rates of anterior cruciate ligament (ACL) injuries in girls’ and women’s sports have garnered significant attention from researchers, sport organisations and the media. Gender/sex disparities in ACL injury rates are often estimated using the construct of athlete-exposures (AEs), a widely used measure of exposure time in sports science and epidemiology that is defined as one athlete participating in one practice or competition. In this narrative review, we explain the limitations of AEs as a measure of exposure time and develop a series of conceptual critiques regarding the use of AEs for the purposes of comparing injury rates by gender/sex. We show that the differing training-to-match ratio and average team size between women and men—rooted in persistent gendered inequities in sports participation and professionalisation—may jeopardise the validity of using AEs for cross-gender comparisons and skew gender/sex disparities in ACL injury rates. To avoid bias, we invite researchers interested in gender/sex disparities in injury rates to collect finer-grained data including individual-level AEs disaggregated by training and competition, as well as to appropriately control for team size and training-to-match ratio at the data analysis stage. Any quantitative comparisons of injury rates should also thoroughly contextualise the limitations of AEs, including their inability to capture the potential qualitative differences between women’s and men’s training and sporting environments that may influence injury rates.

中文翻译：

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运动员暴露作为按性别/性别比较受伤率的结构的局限性：叙述性回顾


女子运动中前交叉韧带 （ACL） 损伤的高发生率引起了研究人员、体育组织和媒体的极大关注。ACL 损伤率的性别/性别差异通常使用运动员暴露 （AE） 的结构来估计，AE 是运动科学和流行病学中广泛使用的暴露时间衡量标准，定义为一名运动员参加一项练习或比赛。在这篇叙述性综述中，我们解释了 AE 作为暴露时间量度的局限性，并就使用 AE 来比较性别/性别的伤害率提出了一系列概念性批评。我们表明，女性和男性之间不同的训练匹配率和平均团队规模——植根于体育参与和职业化方面持续的性别不平等——可能会危及使用 AE 进行跨性别比较的有效性，并扭曲 ACL 损伤率的性别/性别差异。为避免偏倚，我们邀请对受伤率的性别/性别差异感兴趣的研究人员收集更细粒度的数据，包括按训练和比赛分类的个体水平 AE，并在数据分析阶段适当控制团队规模和训练与匹配比率。任何受伤率的定量比较也应彻底说明 AE 的局限性，包括它们无法捕捉可能影响受伤率的女性和男性训练和运动环境之间的潜在定性差异。