The Effect of the Menstrual Cycle on Anterior Cruciate Ligament Injuries
Abstract & Commentary
Synopsis: ACL tears correlated most closely with the ovulatory phase of the menstrual cycle.
Source: Wojtys EM, et al. Am J Sports Med. 2002;30(2):182-188.
Anterior cruciate ligament (ACL) injury rates are reported to be higher in women than in men in similar sports. The purpose of this study was to investigate the association between the distribution of ACL tears and the phase of the menstrual cycle. Sixty-nine female athletes (average age, 28 years) who sustained an acute ACL injury and were evaluated within 24 hours of the injury were included in the study. Questionnaires regarding injury mechanism, previous injury, use of oral contraceptives, and details of the menstrual cycle were completed. Sex hormones were analyzed by urine analysis. A significantly greater number of ACL injuries occurred during the ovulatory phase of the menstrual cycle when a surge of estrogen occurs. This difference was diminished for those athletes taking oral contraceptives.
Comment by James R. Slauterbeck, MD
ACL injuries are occurring in female athletes at alarming rates. Both intrinsic and extrinsic differences in and between genders may account for this disparity. Neuromuscular differences between genders can be improved with strength training programs, but the effect of the menstrual cycle or sex hormones are still unclear.
This study, as well as the study presented at the National Athletic Training Association in 2001,1 both identified times during the menstrual cycle where athletes were at risk for injury. These studies, with a mixture of skiing, running, and cutting athletes, identified a time at risk for ACL injury during ovulation. The study presented at the NATA in 2001 included mostly college and high school athletes involved in running and cutting sports. The most common time of injury, however, was around menses. Although the conclusions of both studies identify different times during the menstrual cycle when ACL injury occurs, both support that ACL injury in females are not occurring in a random manner. The differences between the studies may be secondary to patient populations or mechanisms of injury.
Further studies identifying neuromuscular and hormonal risk factors for female athletes need more emphasis. Neuromuscular strength training programs should be encouraged for our young athletes to decrease ACL injury and will hopefully help prevent injury at ovulation, menses, or anytime during the menstrual cycle.
Dr. Slauterbeck, Associate Professor, Department of Orthopedic Surgery, Texas Tech University Health Sciences Center, San Antonio, is Associate Editor of Sports Medicine Reports.
Reference
1. Slauterbeck J, et al. Journal of Athletic Training. 2001;36(suppl):2.
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