Document Title: Wojtys-AJSM-Mar02
Article Title: The effect of the menstrual cycle on anterior cruciate ligament injuries in women as determined by hormone levels
Authors: Edward M Wojtys, Laura J Huston, Melbourne D Boynton, Kurt P Spindler, Thomas N Lindenfeld.
Publication: American Journal of Sports Medicine, Baltimore, Maryland
Date: Mar/Apr 2002.
Volume 30, Number 2, pages 182-189
Keywords: Knee, ACL, female athlete, menstrual cycle

(Figures included. Reference-denoting numbers appear in the same point size as the document text.)

This absolutely superb article provides penetrating insight into the effect of the female menstrual cycle on ACL-injury proclivity. (Estrogen is known to decrease connective-tissue strength, and it has other impacts on musculoskeletal components as well. This hormone is at very high levels during ovulation.) The authors note, however, that more research remains to be done. More hormones are involved than merely estrogen. And, the central nervous system is also involved (given that it controls musculature; this, in turn, also affects injury propensity). The reasons behind female athletes being 2-8 times as likely as their male counterparts to incur ACL injuries are clearly extremely complex. Although the authors of this study conclude that taking contraceptives seems to decrease the likelihood of female ACL injuries (yet they note that a larger group [in particular of the contraceptive users] would be needed in order to ensure statistical validity), it should also be kept in mind that pursuing a dedicated female-athlete knee-injury-prevention training program (which would include ballistic jump training, hamstring strengthening, and various proprioceptive exercises) is well worthwhile. Such training has been very well-proven to reduce the female athlete's predilection towards knee-ligament injuries. (In other words, the value of contraceptive-pill-popping is unproven, while injury-prevention training programs are a safe bet.)

ABSTRACT

Anterior cruciate ligament injury rates are reported to be two to eight times higher in women than in men within the same sport. Because the menstrual cycle with its monthly hormonal fluctuations is one of the most basic differences between men and women, we investigated the association between the distribution of confirmed anterior cruciate ligament tears and menstrual cycle phase. Sixty-nine female athletes who sustained an acute anterior cruciate ligament injury were studied within 24 hours of injury at four centers. The mechanism of injury, menstrual cycle details, use of oral contraceptives, and history of previous injury were recorded. Urine samples were collected to validate menstrual cycle phase by measurement of estrogen, progesterone, and luteinizing hormone metabolites and creatinine levels at the time of the anterior cruciate ligament tear. Results from the hormone assays indicate that the women had a significantly greater than expected percentage of anterior cruciate ligament injuries during midcycle (ovulatory phase) and a less than expected percentage of those injuries during the luteal phase of the menstrual cycle. Oral contraceptive use diminished the significant association between anterior cruciate ligament tear distribution and the ovulatory phase.

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