The influence of sex hormones on anterior cruciate ligament ruptures in males (original) (raw)
Related papers
The Menstrual Cycle, Sex Hormones, and Anterior Cruciate Ligament Injury
Journal of athletic training, 2002
OBJECTIVE: To determine if anterior cruciate ligament (ACL) injuries in female athletes occur randomly or correlate with a specific phase of the menstrual cycle. DESIGN AND SETTING: Female athletes who sustained ACL injuries reported the days of their menstrual cycles and provided saliva samples for sex-hormone determination. Salivary sex-hormone profiles were assessed to confirm the self-reported menstrual histories. SUBJECTS: A total of 38 female athletes (20 college, 15 high school, 1 middle school, 2 recreational) with recent ACL injuries participated in the study over a 3-year period. MEASUREMENTS: Athletes with recent ACL injuries completed a questionnaire defining the injury, the last menstrual cycle, prior knee injury, school, and type of birth control used (if any). Each subject provided a 30-cc saliva sample within 72 hours of injury. Saliva samples were placed into sealed containers and frozen at -20 degrees C. We obtained 13 additional control samples from uninjured fema...
BMJ Open Sport & Exercise Medicine, 2021
Exercising women report three to six times more ACL tears than men, which happen, in the majority of cases, with a non-contact mechanism. This sex disparity has, in part, been attributed to the differences in reproductive hormone profiles between men and women. Many studies have shown that anterior knee (AK) laxity and the rate of non-contact ACL injuries vary across the menstrual cycle, but these data are inconsistent. Similarly, several studies have investigated the potential protective effect of hormonal contraceptives on non-contact ACL injuries, but their conclusions are also variable. The purpose of this systematic review and meta-analysis is to, identify, evaluate and summarise the effects of endogenous and exogenous ovarian hormones on AK laxity (primary outcome) and the occurrence of non-contact ACL injuries (secondary outcome) in women. We will perform a systematic search for all observational studies conducted on this topic. Studies will be retrieved by searching electron...
Association of Menstrual-Cycle Hormone Changes with Anterior Cruciate Ligament Laxity Measurements
Journal of athletic training, 2003
OBJECTIVE: To determine whether anterior cruciate ligament (ACL) laxity (as evaluated with the KT-2000 and radiographic measures) is associated with concentrations of reproductive hormones during the menstrual cycle and whether the KT-2000 knee arthrometer is a valid measurement technique, compared with radiographic techniques. DESIGN AND SETTING: A within-subjects linear model was used. Venipuncture was conducted in an exercise science laboratory. The KT-2000 and radiographic measurements were performed in a hospital radiology laboratory. SUBJECTS: Twelve females presented with a dominant right leg free of injury. They were mild to moderately active and had a 12-month history of normal menstrual cycles (28-35 days). Subjects had not used hormonal therapy for the previous 3 months. MEASUREMENTS: Subjects were tested at the onset of menses, near ovulation, and on day 23 of the midluteal phase of the menstrual cycle. At each session, 14 mL of blood was obtained by venipuncture. Blood ...
Misplaced Focus: Assumptions About Sex Hormones and ACL Injury in Female Athletes
Over the past decade it has become apparent that women in sports are anywhere from 2 to 8 times more likely to suffer an anterior cruciate ligament (ACL) injury than their male counterparts in the same sports.i Researchers cite several factors that may be relevant in this disparity between injuries to men and injuries to women. The two major categories identified by biomechanics and sports medicine researchers are intrinsic factors, such as anatomical differences, and extrinsic factors, such as coaching, conditioning, and equipment. While both intrinsic and extrinsic factors may play a part in the increased rate of ACL injuries in women, the predominant focus of sports medicine and orthopedic research has been on the intrinsic factors. The list of intrinsic anatomical differences that have been blamed for ACL injuries in women include: lower extremity alignment (both hip-to-knee and hip-to-foot or Q-angle), notch size and shapeii, ACL strength, muscle strength, ligament laxity, range of motion in the knee, and hormonal influences. By far the most popular focus is on female hormones as the underlying cause of injury..iii In this article we take issue with the focus on female hormones as having a causal link in sports injuries. We argue that the focus on female hormones is misplaced, as extrinsic factors such as training and conditioning and socialization into sport sufficiently explain ACL injury rate differences between female athletes and their male counterparts.
Clinical Journal of Sport Medicine, 2000
To identify a significant change in the laxity of the anterior cruciate ligament (ACL) in the competitive adolescent female athlete throughout the different phases of the menstrual cycle. Design: Prospective, single-blinded 8-week study set during a winter sports season. Setting: Suburban Ohio Division I high school. Participants: 26 members of gymnastics, soccer, track, tennis, and basketball teams. All participants were screened for normal menstrual cycles (26-30 days, menses 4-7 days long). Main Outcome Measures: KT-1000 arthrometer was used to measure laxity by performing repeated measures throughout an 8-week period. Measurements were taken before the athletes' workouts. The athlete charted the menstrual periods on a monthly calendar. The measurements were then grouped into the three phases of the menstrual cycle (follicular, ovulatory, and luteal) and averaged. Results: Right knee laxity measured 4.98 mm follicular phase, 5.24 mm ovulatory, and 5.09 mm luteal. Left knee laxity measured 4.51 mm follicular, 4.43 mm ovulatory, and 4.62 mm luteal. There was no statistical difference among the three phases in the left (p ס 0.9) and right (p ס 0.7977). Additionally, left ACL laxity was significantly less in all three phases. We found no statistically significant variability in laxity among the five sports sampled (p > 0.63 to 0.10) and different ages (p ס 0.404) Conclusions: We found an insignificant change in ACL laxity from follicular to luteal phases of the menstrual cycle. This indicates that no single phase of the menstrual cycle clinically affects the ACL more than the next. Although the presence of sex hormones-particularly estrogen-may indeed predispose females to higher ACL injury rates, we did not find any evidence that hormonal level changes equate with significant ACL laxity changes. We conclude that the menstrual cycle does not significantly affect ACL laxity in the competitive adolescent female athlete.
British Journal of Sports Medicine, 2009
Purpose-It is unclear whether sex hormone profiles obtained in two consecutive months are consistent within women. Month-to-month consistency in daily, nadir, peak and mean hormone concentrations during the early follicular and luteal phases in recreationally active, young eumenorrheic women was prospectively examined. Methods-60 healthy, non-smoking women who reported normal and consistent menstrual cycles lasting 26-32 days for the past 6 months were followed prospectively to obtain serum samples for the first 6 days of menses and for 8 days after a positive ovulation test over two consecutive months. Month-to-month consistency of daily concentrations of oestradiol (pg/ml), progesterone (ng/ml), testosterone (ng/dl), sex hormone-binding globulin (nmol/l) and free androgen index were determined using linear mixed models. Month-to-month consistency in nadir, peak and mean concentrations were then assessed using intraclass correlation coefficients and SEM to more precisely examine intraindividual consistency. Results-Linear mixed models revealed stable hormone concentrations across cycles and cycles by day. Reliability estimates for nadir, peak, mean menses and mean postovulatory concentrations range from 0.56 to 0.86 for oestradiol, 0.44 to 0.91 for progesterone, 0.60 to 0.86 for testosterone, 0.88 to 0.97 for sex hormone-binding globulin and 0.78 to 0.91 for free androgen index. Conclusions-Hormone profiles were reproducible over two consecutive months. To reduce month-to-month intraindividual variations and improve measurement consistency, it is recommended that multiple samples be taken over consecutive days as opposed to a single sample. Article: Variations in sex hormone concentrations in young, physically active women may be associated with the risk of non-contact anterior cruciate ligament (ACL) injury. Studies report a greater number of injuries than expected during the perimenstrual 1-3 and periovulatory 4 5 days, whereas others generally identified the follicular phase as being the phase of higher risk. 6 7 These studies collected a single sample (blood or urine) shortly after the injury (range 2 h 7 to 72 h 2), making it difficult to identify the specific time in a particular phase when injury occurred (ie, whether hormone levels were rising, falling or near their peak). Other work suggests a time delay
2014
ABSTRACT Introduction Ligament reconstruction of the anterior cruciate ligament (ACL) is one of the most frequent arthroscopic procedures. According to the Technical Agency for Information on Hospitalizations (ATIH) 41,122 ligament reconstructions were performed in France in 2012. Treatment of the injury is costly and not always successful at returning patients to their preinjury activity level. Identification of all factors associated with increased risk of ACL injury during sport is important to provide an appropriate level of counseling and programs for prevention. These factors have been categorized as intrinsic (inherent to the individual athlete) or extrinsic (external to the athlete). Risk of ACL injury in female athletes depending on sports Female athletes have been identified at increased risk of injuring their ACL during certain sports, with reported injury rates that are 3.6 times greater for basketball and 5.1 times greater for handball when compared with male athletes who participate in these sports at similar levels of play. Extrinsic risk factors Several extrinsic factors seem increase the risk of ACL injury in both female and male athletes with a slightly increased risk in female: competition, wet and rainy weather, the type and number of cleats, the design of the shoe, the type of grass, artificial grass or floor surface and previous ACL reconstruction. Intrinsic risk factors Several anatomic risk factors have been identified, mainly an increased anterior-posterior knee laxity, a smaller intercondylar notch width with a shorter ACL, and a greater condyle offset ratio. Neuromuscular and biomechanical risk factors are also involved as increased dynamic valgus and muscle and proprioceptive deficit of the non-dominant leg in female. The hormonal theory is based on several reports of elevated ACL tear rates in pre- as compared to postovulatory phase. Other risk factors were evocated: a familial predisposition to noncontact ACL tears, genetic factors and a higher body mass index. Multivariate risk factor analysis Given the multiplicity of risk factors it seems important to develop multivariable models but very few studies have followed this approach. Conclusion Several intrinsic factors may explain the sex-ration in ACL tear but intrinsic and extrinsic risk factors act in combination to increase the risk of ACL injury. The identification of these factors has led to the development of appropriate prevention programs with good but still insufficient results. Optimizing prevention requires the organization of large cohort studies for each sport, involving all participants. A generalization of multivariate statistical analyzes would take into account the possible interactions and to quantify the risk for each factor. Comprehensive prevention programs specific to each sport, incorporating all the factors, could then be developed.
Knee ligament mechanical properties are not influenced by estrogen or its receptors
AJP: Endocrinology and Metabolism, 2006
Women are at greater risk of tearing their knee anterior cruciate ligament (ACL) than men participating in similar athletic activities. There is currently no conclusive explanation for this disparity; however, as ACL injuries in women have been linked with estrogen fluctuations during the menstrual cycle, one hypothesis is that estrogen has a direct detrimental effect on knee ligament mechanical properties. This study investigated the influence of estrogen and its receptors (ER␣ and ER) on knee ligament mechanical properties. This was achieved by testing the viscoelastic and tensile mechanical properties of knee medial collateral ligaments (MCL) and ACLs from: 1) male Sprague-Dawley rats treated with either estrogen (17␣-ethynylestradiol; 0.03 mg/kg) or an ER␣-specific agonist (propyl pyrazole triol; 2 mg/kg), and 2) female mice with a null mutation of the gene encoding for ER. Estrogen treatment had no significant effects on the viscoelastic or tensile mechanical properties of the rat MCL or ACL. Similarly, pharmacological stimulation of ER␣ using a selective agonist in rats and genetic modulation of ER by null mutation of its gene in mice did not influence MCL or ACL properties. These data indicate that estrogen does not have a major direct effect on ligament mechanical properties. Energies for the prevention of the disproportionately high rate of knee ligament injuries in women may be better spent focusing on more established and modifiable risk factors, such as abnormalities in neuromuscular control about the knee.