{
  "abstract": "Objective Examine potentially modifiable risk factors (MRFs) for female/woman/girl athletes’ lower-extremity injuries.Design Systematic review with meta- or semiquantitative analyses and Grading of Recommendations, Assessment, Development and Evaluation.Data sources MEDLINE, CINAHL, APA PsycINFO, Cochrane Systematic Review Database, CENTRAL, SPORTDiscus, EMBASE, ERIC searched 30 October or 23 November 2023.Eligibility Primary data studies with comparison group(s) assessing the association of MRFs for sport-related lower-extremity injury(s) with ≥1 female/woman/girl per study group.Results Across 195 studies (n=115; 58.9% female/woman/girl-specific estimates) including 1 525 662 participants (2.4% females/women/girls), eight injury outcomes were assessed (n=75 general lower-extremity, n=3 groin, n=6 hip, n=17 thigh, n=88 knee, n=17 lower-leg, n=27 ankle, n=9 foot). Sixty-six MRF categories were identified. Substantial heterogeneity in MRFs and injury outcomes exists, with high risk of bias present in 37.4% of studies. Considering female/woman/girl specific estimates, we performed meta-analyses for 10 MRFs (body mass, x (BMI), weekly training distance, muscle strength, artificial turf, off-season plyometric training, readiness to return-to-sport, single-leg hop asymmetry, vertical drop jump peak knee flexion angle and ground reaction force) and semiquantitative analyses for 26 MRFs for a variety of injuries. Meta-analyses suggest no association between any lower-extremity strength outcome (g=0.01, 95% CI −0.11 to 0.14; I 2=37.3%; very low certainty evidence) or artificial turf (Incidence Rate Ratio=0.97, 95% CI 0.88 to 1.07; I2=2.4%; low certainty evidence) and various lower-extremity injuries. Higher body mass (g=0.19, 95% CI 0.00 to 0.38; I2=71.7%) and/or BMI (g=0.22, 95% CI 0.09 to 0.36; I2=37.0%) are associated with several lower-extremity injuries (very low certainty evidence).Conclusion This review synthesises a large body of exploratory research, exposes important knowledge gaps and provides a foundation for understanding MRFs for female/woman/girl athlete lower-extremity injuries.PROSPERO registration number PROSPERO CRD42024486715.",
  "authors": [
    {
      "affiliations": [
        "Department of Physical Therapy, Faculty of Medicine, The University of British Columbia, Vancouver, British Columbia, Canada",
        "Arthritis Research Canada, Vancouver, British Columbia, Canada"
      ],
      "name": "Jackie L Whittaker"
    },
    {
      "affiliations": [
        "Elon University, Elon, North Carolina, USA"
      ],
      "name": "Anu M Räisänen"
    },
    {
      "affiliations": [
        "UNC-Chapel Hill, Chapel Hill, North Carolina, USA"
      ],
      "name": "Chelsea Martin"
    },
    {
      "affiliations": [
        "Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada"
      ],
      "name": "Jean-Michel Galarneau"
    },
    {
      "affiliations": [
        "Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada"
      ],
      "name": "Maitland Martin"
    },
    {
      "affiliations": [
        "Informatics, Decision-Enhancement, and Analytic Sciences Center of Innovation, George E Wahlen Department of Veterans Affairs Medical Center, Salt Lake City, Utah, USA",
        "Division of Epidemiology, The University of Utah School of Medicine, Salt Lake City, Utah, USA"
      ],
      "name": "Justin M Losciale"
    },
    {
      "affiliations": [
        "Department of Orthopaedic Surgery, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA",
        "Centre for Sport, Exercise and Osteoarthritis Research Versus Arthritis, University of Oxford, Oxford, UK"
      ],
      "name": "Garrett S Bullock"
    },
    {
      "affiliations": [
        "La Trobe Sport and Exercise Medicine Research Center, La Trobe University, Melbourne, Victoria, Australia",
        "Australian IOC Research Centre, La Trobe University, Melbourne, Victoria, Australia"
      ],
      "name": "Marc-Olivier Dubé"
    },
    {
      "affiliations": [
        "Research, Schulthess Clinic Human Performance Lab, Zürich, Switzerland",
        "Leukerbad, VS, Switzerland"
      ],
      "name": "Mario Bizzini"
    },
    {
      "affiliations": [
        "School of Allied Health Sciences and Menzies Health Institute Queensland, Griffith University - Gold Coast Campus, Gold Coast, Queensland, Australia",
        "La Trobe University College of Science Health and Engineering, Bundoora"
      ],
      "name": "Matthew N Bourne"
    },
    {
      "affiliations": [
        "Department of Medical Education, Aspetar Qatar Orthopaedic and Sports Medicine Hospital, Doha, Qatar",
        "Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK"
      ],
      "name": "H Paul Dijkstra"
    },
    {
      "affiliations": [
        "La Trobe Sport and Exercise Medicine Research Center, La Trobe University, Melbourne, Victoria, Australia"
      ],
      "name": "Michael Girdwood"
    },
    {
      "affiliations": [
        "Libraries and Cultural Resources, University of Calgary, Calgary, Alberta, Canada"
      ],
      "name": "K Alix Hayden"
    },
    {
      "affiliations": [
        "Health, Medicine and Caring Sciences, Linköping University, Linkoping, Sweden"
      ],
      "name": "Martin Hägglund"
    },
    {
      "affiliations": [
        "Discipline of Physiotherapy, School of Allied Health, Australian Catholic University Faculty of Health Sciences, North Sydney, New South Wales, Australia"
      ],
      "name": "Shreya McLeod"
    },
    {
      "affiliations": [
        "NtombiSport, Cape Town, South Africa"
      ],
      "name": "Nonhlanhla Sharon Mkumbuzi"
    },
    {
      "affiliations": [
        "La Trobe Sport and Exercise Medicine Research Center, La Trobe University, Melbourne, Victoria, Australia",
        "Australian IOC Research Centre, La Trobe University, Melbourne, Victoria, Australia"
      ],
      "name": "Andrea Britt Mosler"
    },
    {
      "affiliations": [
        "School of Medical and Health Sciences, Edith Cowan University, Joondalup, Western Australia, Australia"
      ],
      "name": "Myles Calder Murphy"
    },
    {
      "affiliations": [
        "Sports Medicine, Norwegian School of Sports Sciences, Oslo, Norway"
      ],
      "name": "Grethe Myklebust"
    },
    {
      "affiliations": [
        "Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark"
      ],
      "name": "Merete Møller"
    },
    {
      "affiliations": [
        "Physical Therapy, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil"
      ],
      "name": "Juliana Melo Ocarino"
    },
    {
      "affiliations": [
        "Translational Injury Prevention Lab, Physical Therapy and Athletic Training, Saint Louis University, Saint Louis, Missouri, USA"
      ],
      "name": "Oluwatoyosi B A Owoeye"
    },
    {
      "affiliations": [
        "Edinburgh Sports Medicine Research Network, Institute for Sport, PE and Health Sciences, University of Edinburgh, Edinburgh, UK",
        "UK Collaborating Centre on Injury and Illness Prevention in Sport, University of Edinburgh, UK"
      ],
      "name": "Debbie Palmer"
    },
    {
      "affiliations": [
        "Integrative Neuromuscular Sport Performance Laboratory, University of Calgary, Calgary, Alberta, Canada",
        "Tampere Research Center of Sports Medicine, Ukk Instituutti, Tampere, Finland"
      ],
      "name": "Kati Pasanen"
    },
    {
      "affiliations": [
        "La Trobe Sport and Exercise Medicine Research Center, La Trobe University, Melbourne, Victoria, Australia"
      ],
      "name": "Ebonie Kendra Rio"
    },
    {
      "affiliations": [
        "Sports Orthopaedic Research Center–Copenhagen (SORC-C), Arthroscopic Center, Department of Orthopedic Surgery, Copenhagen University Hospital, Amager-Hvidovre, Hvidovre Hospital, Hvidovre, Denmark"
      ],
      "name": "Kristian Thorborg"
    },
    {
      "affiliations": [
        "General Practice, Erasmus Medical Center, Rotterdam, The Netherlands"
      ],
      "name": "Marienke van Middelkoop"
    },
    {
      "affiliations": [
        "Department of Public and Occupational Health, EMGO, Amsterdam UMC Locatie VUmc, Amsterdam, The Netherlands"
      ],
      "name": "Evert Verhagen"
    },
    {
      "affiliations": [
        "Department of Physical Therapy, Indiana University Indianapolis, Indianapolis, Indiana, USA"
      ],
      "name": "Stuart J Warden"
    },
    {
      "affiliations": [
        "Centre of Medical and Exercise Physiology, School of Medicine, University of Wollongong, Wollongong, New South Wales, Australia"
      ],
      "name": "Matthew Whalan"
    },
    {
      "affiliations": [
        "La Trobe Sport and Exercise Medicine Research Center, La Trobe University, Melbourne, Victoria, Australia"
      ],
      "name": "Kay M Crossley"
    },
    {
      "affiliations": [
        "Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada"
      ],
      "name": "Carolyn A Emery"
    }
  ],
  "title": "Modifiable risk factors for lower-extremity injury: a systematic review and meta-analysis for the Female, woman and/or girl Athlete Injury pRevention (FAIR) consensus",
  "uid": "9f2c9e41-8d54-5f0f-9188-b2b887524198"
}