OBJECTIVE: To determine the incidence and severity of hamstring injuries (HSIs) in female athletes who play field sports. DESIGN: Systematic review with meta-analysis of prospective epidemiology studies. LITERATURE SEARCH: We searched the PubMed, EMBASE, OVID Medline, and SPORTDiscus databases from inception to June 30, 2021. STUDY SELECTION CRITERIA: We included prospective epidemiology studies quantifying HSI in female field sport athletes. We excluded retrospective studies, intervention studies and studies that included male athletes only. DATA SYNTHESIS: Risk-of-bias assessments were conducted using a tool for assessing risk of bias in prospective epidemiology studies. The certainty of evidence was assessed using Grading of Recommendations, Assessment, Development and Evaluations (GRADE). Data were pooled to report overall injury risk per 1000 exposure hours using a random-effects meta-analysis. RESULTS: We included 12 studies for quantitative synthesis. There were injury data available from 1070 female athletes with a mean age of 22.7 years. The predominant sport was soccer (50%). The risk of bias was low across the studies. Overall, there was moderate certainty evidence that injury incidence was 0.6 injuries per 1000 exposure hours (95% CI 0.4-0.8). Due to a lack of reporting, we could not estimate the severity of HSIs. CONCLUSION: There was moderate certainty evidence that the incidence of hamstring injuries was 0.6 injuries per 1000 exposure hours in female field sport athletes. Appropriate reporting from those working with female athletes is essential to support understanding and better implement effective injury prevention strategies for female athletes.
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