Background: Sports participation and the risk of developing osteoarthritis (OA) has been a concern for decades. However, little research efforts have been dedicated to clarify this issue for female sports participation, even though females are considered at greater risk of developing OA than males. In contrast, several reviews have established an association between sports participation and OA for males. Objective: The main aim of the systematic review was to assess the association between OA and participation in popular sports for females. Secondarily, to assess the impact of sex on the risk of de-veloping OA from sports. Method: The systematic review was conducted using the PRISMA guidelines. Two major databases (PubMed and Embase) were searched systematically, and Google Scholar was free-text searched as a supplementary database. Study quality was assessed using both the Scottish Intercollegiate Guide-lines Network (SIGN) and the National Institutes of Health (NIH) quality assessment tools. Results: The search provided 578 articles after duplicates were discarded. A total of nine eligible studies were included for analysis in the present systematic review. The included studies covered ballet, running, tennis, Olympic sports, volleyball, and cross-country skiing. Seven of the studies in-cluded data from both females and males. The most common anatomical joint assessed were knee and hip. Seven of the included articles assessed female elite sports participation and two articles ex-amined used females participating in non-elite sports. Conclusion: Female participating in sports at elite level was both associated with a higher risk of OA development and the need for surgical treatment of OA. Female sports participation at non-elite level was associated with higher risk of OA development, but did not materialize to an increased risk for surgical treatment. Few studies compared females and males, and these studies suggested that sex did not affect the risk of developing OA from participating in sports. Nevertheless, to isolate the pre-cise effect of sports participation for the development of OA remains difficult as injuries are common among athletes and are independently associated with an increased risk of OA.