Let's talk about sex (and gender) after ACL injury: a systematic review and meta-analysis of self-reported activity and knee-related outcomes.

OBJECTIVE: Investigate sex/gender differences in self-reported activity and knee-related outcomes after anterior cruciate ligament (ACL) injury. DESIGN: Systematic review with meta-analysis. DATA SOURCES: Seven databases were searched in December 2021. ELIGIBILITY CRITERIA: Observational or interventional studies with self-reported activity (including return to sport) or knee-related outcomes after ACL injury. RESULTS: We included 242 studies (n=123 687, 43% females/women/girls, mean age 26 years at surgery). One hundred and six studies contributed to 1 of 35 meta-analyses (n=59 552). After ACL injury/reconstruction, very low-certainty evidence suggests females/women/girls had inferior self-reported activity (ie, return to sport, Tegner Activity Score, Marx Activity Scale) compared with males/men/boys on most (88%, 7/8) meta-analyses. Females/women/girls had 23%-25% reduced odds of returning to sport within 1-year post-ACL injury/reconstruction (12 studies, OR 0.76 95% CI 0.63 to 0.92), 1-5 years (45 studies, OR 0.75 95% CI 0.69 to 0.82) and 5-10 years (9 studies, OR 0.77 95% CI 0.57 to 1.04). Age-stratified analysis (<19 years) suggests female athletes/girls had 32% reduced odds of returning to sport compared with male athletes/boys (OR 0.68, 95% CI 0.41 to 1.13, I2 0.0%). Very low-certainty evidence suggests females/women/girls experienced inferior knee-related outcomes (eg, function, quality of life) on many (70%, 19/27) meta-analyses: standardised mean difference ranging from -0.02 (Knee injury and Osteoarthritis Outcome Score, KOOS-activities of daily living, 9 studies, 95% CI -0.05 to 0.02) to -0.31 (KOOS-sport and recreation, 7 studies, 95% CI -0.36 to -0.26). CONCLUSIONS: Very low-certainty evidence suggests inferior self-reported activity and knee-related outcomes for females/women/girls compared with males/men/boys after an ACL injury. Future studies should explore factors and design targeted interventions to improve outcomes for females/women/girls. PROSPERO REGISTRATION NUMBER: CRD42021205998.

Influência da preocupação com quedas na mobilidade e na força de reação do solo em idosas durante descida de escada / Influence of concern about falls in mobility and ground reaction forcein elderly women?s during stairs descent

Objetivos: Verificar a diferença entre idosas com e sem preocupação com quedas na mobilidade e na força vertical de reação do solo durantea descida de escada.Métodos: O estudo incluiu idosas atendidas pelo Centro de Reabilitação Física da Universidade Estadual do Oeste do Paraná com idadeentre 60 e 75 anos, sem doenças neurológicas e cardiovasculares que acarretassem risco pelas atividades do estudo. Foram excluídas tambémidosas com órteses para locomoção, doenças osteoarticulares ou cirurgias de membros inferiores e histórico de queda. As participantes foramdivididas em dois grupos, com e sem preocupação com quedas em atividades diárias, identificados pela Falls Efficacy Scale Internationaltraduzida para o português. Para avaliação da mobilidade, todas as voluntárias realizaram o teste Timed Up and Go. A força de reação dosolo foi avaliada em cinco descidas de escada para coleta dos dados cinéticos (primeiro pico da força vertical de reação do solo) através deuma plataforma de força alocada no quarto degrau de uma escada de sete degraus. Após ser confirmada a normalidade dos dados, o teste t deStudent para amostras independentes foi utilizado para comparação entre os grupos.Resultados: A amostra foi composta por dezessete idosas sem preocupação com quedas (idade de 66,57±4,1 anos) e dezesseis idosas compreocupação com quedas (idade de 66,67±5,8 anos). O grupo sem preocupação com quedas desempenhou o teste Timed Up and Go de formamais veloz (9,71±1,02 segundos) comparado ao grupo preocupação com quedas (11,5±1,04 segundos) (p=0,008). Não houve diferença entreos grupos para o primeiro pico da força de reação do solo vertical (p=0,66).Conclusões: Idosas com preocupação com queda apresentaram menor desempenho no teste funcional do que idosas com ausência dessapreocupação. Entretanto, não houve diferença entre os grupos quanto à variável cinética.

Aims: To investigate the difference between elderly women with and without concern about falls in mobility and vertical ground reactionforce during stair descent.Methods: The study included older women assisted in the Centre for Physical Rehabilitation of the Universidade Estadual do Oeste do Paraná,aged between 60 and 75 years, without neurological and cardiovascular disease involving risk by the activities of the study. Women withorthoses for locomotion, osteoarticular diseases or surgery of lower limbs, and previous fall history were also excluded. The participants weredivided into two groups, with and without concern about falls in daily activities, identified by the Falls Efficacy Scale International translatedinto Portuguese. To assess mobility, all subjects performed the Timed Up and Go Test. Ground reaction force was assessed by walking stepsdown five times to collect kinetic data (first peak of the vertical ground reaction force) through a force platform allocated in the fourth step ofa staircase of seven steps. After confirmed normality of data, Student t test for independent samples was used to compare the groups.Results: The sample was composed of seventeen elderly women with no concern about falling (aged 66.57±4.1 years) and sixteen elderlywomen with concerns about falling (aged 66.67±5.8 years). The group without concern with falls performed the Timed Up and Go Test faster(9.71±1,02 seconds) than the group with concern about falls (11.5±1,04 seconds) (p=0.008). There was no difference between groups on thefirst peak of vertical ground reaction force (p=0.66).Conclusions: Elderly women with concern about falls had lower performance in the functional test than elderly women with no such concern.However, there was no difference between the groups in terms of the kinetic variable.