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Introduction: Participation of women in medicine has increased markedly in recent decades, but gender disparities still exist, particularly in academic medicine. To provide insight into the gender gap, specifically in academic orthopaedic sports medicine, we investigated the relationship between gender and authorship in orthopaedic sports literature from 1972 to 2018. Methods: Information about every original article in four prominent orthopaedic sports medicine journals between 1972 and 2018 was extracted from PubMed. The proportions of female first, second, middle, and senior authors over time were determined. Gender influences on level of evidence, academic degrees, and academic productivity and longevity were also studied. Student t-test, multiple linear regression, chi-square test, Cochran-Armitage trend test, and Kaplan-Meier analysis were used to determine significance between groups. Results: In our sample, 16.6% of all authors were female. The proportion of female authors increased from 2.6% (1972 to 1979) to 14.7% (2010 to 2018). Female authors averaged fewer publications (1.9 versus 2.8 articles for male authors) and were more likely to be attributed middle authorship (45.9% versus 37.1%) than senior authorship (14.7% versus 22.1%, P < 0.001). Female authors were more likely to be full-time research staff, such as a PhD (18.2% versus 9.0%, P < 0.001), which correlated with a higher level of evidence (B = −0.162, P < 0.001). Gender differences in academic longevity decreased over decades (1972 to 1989, 1990 to 1999, 2000 to 2008), demonstrated by decreasing significance of Kaplan-Meier log-rank tests (<0.01, <0.01, 0.045). Conclusion: Female investigators in orthopaedic sports medicine are authoring publications at a growing rate, increasing almost sevenfold from 1972 to 2018. Although women published two-thirds the volume of male investigators overall, and were more likely to be full-time research staff, gender differences in academic productivity and longevity have decreased over time. Level of Evidence: Level III, Retrospective Cohort Design, Observational Study

Background: Although objective outcomes assessing knee function are essential measurements for return to sport, psychological factors have become increasingly recognized as equally important parameters for determining an athlete’s ability to return to sport after surgery. Purpose: To systematically review the literature to determine whether patients who returned to sport after anterior cruciate ligament (ACL) reconstruction had improved psychological scores (as measured with validated questionnaires) compared with patients who did not return to sport. Study Design: Systematic review and meta-analysis; Level of evidence, 3. Methods: A systematic review was performed using PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines and was preregistered on PROSPERO. Four databases were searched for level 1 to 3 studies that compared at least 1 psychological outcome measured by a validated questionnaire for patients who did and did not return to sport after primary ACL reconstruction. The following data were recorded: study and patient characteristics; psychological metrics (ACL–Return to Sport Injury [ACL-RSI] scale, Knee Self-Efficacy Scale [K-SES], and Tampa Scale of Kinesiophobia [TSK/TSK-11]); International Knee Documentation Committee (IKDC) score; and clinical metrics. Study methodological quality was analyzed using the methodological index for non-randomized studies (MINORS), and the mean difference (MD) and 95% CI were calculated for each psychological outcome score using the inverse variance method. Results: We included and analyzed 16 articles (3744 patients; 38.9% female; mean age range, 17-28.7 years; mean MINORS score, 19.9 ± 1.4). Overall, 61.8% of athletes returned to sport (66.8% of male patients; 55.4% of female patients). Patients who returned scored significantly higher on the ACL-RSI scale (MD, 20.8; 95% CI, 15.9 to 25.7; P < .001), significantly higher on the K-SES (MD, 1.3; 95% CI, 0.2 to 2.3; P = .036), and significantly lower on the TSK/TSK-11 (MD, 10.1%; 95% CI, −12.1% to −8.2%; P = .004). Those returning to sport did not exceed the minimal clinically important difference for IKDC score versus those not returning to sport. Conclusion: Patients who returned to sport after primary ACL reconstruction had significantly higher psychological readiness, higher self-efficacy, and lower kinesiophobia compared with those who did not return to sport, despite having clinically similar knee function scores. Evaluation of psychological readiness, in combination with other objective measurements, is a critical component of return-to-sport evaluation in athletes after primary ACL reconstruction. Registration: CRD42021284735 (PROSPERO).