O3271: Who is Represented in Pediatric Anterior Cruciate Ligament Injury Incidence Research? A Systematic Review

Background: The incidence of pediatric anterior cruciate ligament (ACL) injuries has risen substantially. Given the known disparities in access to sports participation and medical care, understanding associations between demographic characteristics and ACL injury could have implications on public health, resource allocation, and implementation of injury prevention programs. The purpose of this study was to determine the demographic, socioeconomic, and methodologic composition of studies on pediatric ACL injury incidence.

Methods: PubMed, Embase, and MEDLINE were queried for studies reporting the incidence of ACL injuries per Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Included studies were published between 2000-2024 and reported discrete data for patients < 19 years old. Case reports, review articles, and those from outside of the United States were excluded. Data was abstracted on the demographic and socioeconomic characteristics of participants as well as study location, athletic setting, and data collection methods. Descriptive statistics were calculated.

Results: A total of 21 studies with 14,685,917 participants were included. Since only one reported race and ethnicity, these characteristics were unknown for 14,684,425 participants in 20 studies (99%). Insurance type was not reported in 18/21 studies. The other three studies (1,688,625 patients) only included privately insured patients. Among the 20/21 studies that reported sex, 65% of participants were male and 35% female. Of the 15/21 studies that reported study environment, 27% were suburban, 7% urban, and 67% mixed location. All studies reported athletic setting and data collection method. Regarding sport setting, 63% were in school, 11% club, 16% mixed, and 10% other. A majority of the studies (57%) utilized an athletic trainer for data collection. No studies collected additional socioeconomic indicators.

Conclusion: The racial, ethnic, and socioeconomic composition of participants in pediatric ACL injury incidence research is almost completely unknown. Female athletes represent a minority of participants in these studies. A significant proportion of the data was collected by athletic trainers, who are less likely to be available in under-resourced areas. Rural athletes are not represented. Future research should include more detailed demographic information and strive for inclusivity in order to optimize accuracy and generalizability.