Anterior cruciate ligament laxity related to the menstrual cycle: an updated systematic review of the literature (original) (raw)
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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 ...
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.
Examination of the failure properties of the anterior cruciate ligament during the estrous cycle
The Knee, 2005
The purpose of this study was to determine whether the mechanical properties of the rat anterior cruciate ligament (ACL) vary when tested in vitro at different stages of the estrous cycle. Sixty female rats were allocated to four groups according to their stage of the estrous cycle: diestrus (n = 16), proestrus (n = 17), estrus (n = 13) and metestrus (n = 14). Right hindlimbs were harvested for mechanical testing and left hindlimbs were harvested for immunohistochemical staining to confirm the presence of the estrogen receptor. Results from the first relaxation test showed a significant difference between the estrus and proestrus stage, which was not observed in a second subsequent relaxation test. Likewise, no significant differences were found when comparing failure load and stiffness between the different stages of the estrous cycle. These results suggest that normal physiological fluctuations in estrogen during the estrous cycle did not alter the failure properties of the rat ACL. D
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...
Relationship Between Anterior Knee Laxity and General Joint Laxity During the Menstrual Cycle
Orthopaedic Journal of Sports Medicine
Background: Anterior cruciate ligament (ACL) injury has been reported to have a higher incidence in women than in men. Purpose/Hypothesis: The purpose was to examine the relationship of anterior knee laxity (AKL), stiffness, and generalized joint laxity (GJL) with respect to the menstrual cycle. It was hypothesized that AKL and GJL would increase during the ovulation phase, when estrogen levels are high. Study Design: Descriptive laboratory study. Methods: A total of 15 female university students aged >20 years and with normal menstrual cycles were evaluated. AKL was measured as anterior tibial displacement of the femur after application of 44-, 89-, and 133-N loads to the tibia. Stiffness was calculated as Δ force/Δ displacement at loads between 44 and 89 N and between 89 and 133 N. The University of Tokyo joint laxity test was used for evaluation of GJL. The participants’ menstrual cycle was divided into the early follicular, late follicular, ovulation, and luteal phases using ...
2013
Introduction: Women run a 4-8-fold greater risk of anterior cruciate ligament (ACL) tear than men, and especially during the pre-ovulation stage of their cycle. The main study objective was to describe the distribution of ACL lesions according to menstrual cycle in a large population of female recreational skiers. Materials and methods: A prospective study was conducted during the 2010-11 ski season on women sustaining ACL tear during skiing. Patients filled out a questionnaire during consultation with the mountain physician, including date of last menstrual period (LMP) and contraceptive method. Fifty-seven of the 229 patients with diagnosed ACL tear were excluded from analysis, 41 being post-menopausal (mean age, 47 ± 9 years), and 16 having irregular cycles or LMP > 30 days. One hundred and seventy-two patients (mean age, 34 ± 8.7 years) were thus included. Results: Fifty-eight women (33.72%) were in follicular phase, 63 (36.63%) in ovulatory phase and 51 (29.65%) in luteal phase; difference with respect to the theoretic distribution regardless of menstrual phase was highly significant: 2 = 48.32; P = 0.00001. Fifty-three of the 172 women (30.8%) were taking oral contraceptives. ACL tear was 2.4-fold more frequent in pre-ovulatory than post-ovulatory phase, whether in women using oral or other contraceptives: 85/119 (71.4%) vs. 36/53 (67.9%); P = 0.64. Conclusion: ACL tear risk in skiing in women is not constant over the menstrual cycle, being 2.4-fold more frequent in pre-ovulatory (follicular and ovulatory) than post-ovulatory phase (luteal). Oral contraception seems not to exert any protective effect. Level of evidence: Level IV. Retrospective cohort study.
Anterior knee laxity in young women varies with their menstrual cycle
International Orthopaedics, 2002
We studied 16 women 21-23 years old with regular menstrual cycles (28±4 days) and no history of knee injury. From their basal body temperatures and the serum concentrations of estradiol and progesterone, the follicular, ovulatory, and luteal phases were delineated. Using a KT-2000 arthrometer, anterior displacement at 89 N and 134 N and anterior terminal stiffness (N/mm) at 134 N were measured two or three times every week over a 4-week period. Eight men 21-23 years old were also measured. In women the anterior displacement at 89 N varied between the follicular and the ovulatory phase and between the follicular and the luteal phase (P<0.05) and at 134 N between the follicular and the luteal phase (P<0.05). There were no statistical differences in the anterior displacement with time in men, nor in anterior terminal stiffness in either sex. We conclude that anterior cruciate ligament laxity in women might be dependent on the concentrations of hormones.