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Document Title: Wojtys-AJSM-Sep98
Article Title: Association between the menstrual cycle and anterior cruciate ligament injuries in female athletes
Authors: Edward M Wojtys, Laura J Huston, Thomas N Lindenfeld, Timothy E Hewett, Mary Lou V H Greenfield.
Publication: American Journal of Sports Medicine, Baltimore, Maryland
Date: Sep/Oct 1998.
Volume 26, Number 5, pages 614-619
Keywords: Knee, ACL, menstrual cycle, female athlete
(Figures included. Reference-denoting numbers appear in the same font and point size as the document text. Follow-up correspondence, in the form of letters to the editor, have been appended.)
Wojtys et al. studied the connections between the female menstrual cycle and ACL-injury occurrence. They found a significant statistical association between the menstrual-cycle stage and the likelihood for ACL injury. They observed more ACL injuries during the ovulation phase, and fewer ACL injuries during the follicular phase. The authors note that further study is needed before unassailable conclusions can be drawn with regards to whether or not the connective-tissue-weakening estrogen spikes (which occur during ovulation) are the definitive, principal, directly causative factor in the high female ACL-injury incidence. (So far, the only sure-fire way for a female athlete to reduce her knee-injury risk is to diligently pursue exercises geared towards strengthening hamstring musculature, increasing knee-flexion angle during landing of jumps, and improving overall proprioception, balance, and co-ordination.)
ABSTRACT
Anterior cruciate ligament injury rates are four to eight times higher in women than in men. Because of estrogen's direct effect on collagen metabolism and behavior and because neuromuscular performance varies during the menstrual cycle, it is logical to question the menstrual cycle's effect on knee injury rates. Of 40 consecutive female athletes with acute anterior cruciate ligament injuries (less than 3 months), 28 (average age, 23 +/- 11 years) met the study criteria of regular menstrual periods and noncontact injury. Details concerning mechanism of injury, menstrual cycle, contraceptive use, and previous injury history were collected. A chi-square test was used to compute observed and expected frequencies of anterior cruciate ligament injury based on three different phases of the menstrual cycle: follicular (days 1 to 9), ovulatory (days 10 to 14), and luteal (day 15 to end of cycle). A significant statistical association was found between the stage of the menstrual cycle and the likelihood for an anterior cruciate ligament injury (P = 0.03). In particular, there were more injuries than expected in the ovulatory phase of the cycle. In contrast, significantly fewer injuries occurred in the follicular phase. These hormones may be a factor in the knee ligament injury dilemma in women.
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