Changes in sex distribution in Achilles tendon rupture literature over 74 years: A systematic review

PURPOSE: Evaluate changes in sex distribution within the Achilles tendon rupture (ATR) literature over time. METHODS: Four databases were searched (PubMed, Cochrane Central Register of Controlled Trials, SPORTDiscus and Web of Science). To be included, studies had to evaluate primary and complete ATR and report the years in which participants were enrolled, or injury occurred. A weighted linear regression evaluated the relationship between the article midpoint year (of participant enrolment) and the percentage of females across articles. The average sex distribution across studies (spanning 74 years) was 81 ± 12% male and 19 ± 12% female. The lowest percentage of females was 7% in 1990, and the highest percentage of females was 39% in 2015. Finally, 10.7% (57/532) of articles reported sex disaggregated data for both demographics and variable(s) of interest. CONCLUSIONS: The sex distribution in the ATR literature demonstrates a gradual rise in the percentage of females over time, but males continue to make up a majority of this population. The paucity of sex-disaggregated data or analyses limited the evaluation of trends among females specifically and limits insight into sex-specific patterns. LEVEL OF EVIDENCE: Level III, systematic review (includes studies from I to III).