Association Between the Menstrual Cycle and Anterior Cruciate Ligament Injuries in Female Athletes

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.

[1]  John Kleinig,et al.  Out of Joint , 2008, Medical world.

[2]  G. Finerman,et al.  Estrogen Affects the Cellular Metabolism of the Anterior Cruciate Ligament , 1997, The American journal of sports medicine.

[3]  J. Bjordal,et al.  Epidemiology of Anterior Cruciate Ligament Injuries in Soccer , 1997, The American journal of sports medicine.

[4]  F R Noyes,et al.  Plyometric Training in Female Athletes , 1996, The American journal of sports medicine.

[5]  J. Bateman,et al.  The effect of relaxin on collagen metabolism in the nonpregnant rat pubic symphysis: the influence of estrogen and progesterone in regulating relaxin activity. , 1996, Endocrinology.

[6]  J. Loudon,et al.  The relationship between static posture and ACL injury in female athletes. , 1996, The Journal of orthopaedic and sports physical therapy.

[7]  L. Huston,et al.  Neuromuscular Performance Characteristics in Elite Female Athletes , 1996, The American journal of sports medicine.

[8]  Rong-Sen Yang,et al.  Primary immunolocalization of estrogen and progesterone target cells in the human anterior cruciate ligament , 1996, Journal of orthopaedic research : official publication of the Orthopaedic Research Society.

[9]  X. Zhu,et al.  Perimenstrual symptoms among Chinese women in an urban area of China. , 1996, Health care for women international.

[10]  E. Arendt,et al.  Knee Injury Patterns Among Men and Women in Collegiate Basketball and Soccer , 1995, The American journal of sports medicine.

[11]  S. H. Cheah,et al.  The effects of oestradiol and relaxin on extensibility and collagen organisation of the pregnant rat cervix. , 1995, Journal of Endocrinology.

[12]  M. Hutchinson,et al.  Knee Injuries in Female Athletes , 1995, Sports medicine.

[13]  L. Engebretsen,et al.  Intercondylar notch width and the risk for anterior cruciate ligament rupture. A case-control study in 46 female handball players. , 1994, Acta orthopaedica Scandinavica.

[14]  F. Noyes,et al.  Incidence of Injury in Indoor Soccer , 1994, The American journal of sports medicine.

[15]  C. Lebrun The effect of the phase of the menstrual cycle and the birth control pill on athletic performance. , 1994, Clinics in sports medicine.

[16]  R. LaPrade,et al.  Femoral Intercondylar Notch Stenosis and Correlation to Anterior Cruciate Ligament Injuries , 1994, The American journal of sports medicine.

[17]  C. Schwabe,et al.  Human relaxins: chemistry and biology. , 1994, Endocrine reviews.

[18]  V. Krogh,et al.  Perimenstrual symptom prevalence rates: an Italian-American comparison. , 1993, American journal of epidemiology.

[19]  S. Lightman,et al.  Relationship between ovarian steroids, gonadotrophins and relaxin during the menstrual cycle. , 1993, Acta endocrinologica.

[20]  I. Schiff,et al.  Modern Management of Premenstrual Syndrome , 1993 .

[21]  A Ferretti,et al.  Knee ligament injuries in volleyball players , 1992, The American journal of sports medicine.

[22]  K. Jamieson,et al.  Variations in performance in simple muscle tests at different phases of the menstrual cycle. , 1991, The Journal of sports medicine and physical fitness.

[23]  M. Hammar,et al.  Sports Injuries and Oral Contraceptive Use , 1991, Sports medicine.

[24]  C. Johansson,et al.  Soccer injuries among elite female players , 1991, The American journal of sports medicine.

[25]  R. Moffatt,et al.  The menstrual cycle: does it affect athletic performance? , 1991 .

[26]  A. Rossignol,et al.  Prevalence and severity of the premenstrual syndrome. Effects of foods and beverages that are sweet or high in sugar content. , 1991, The Journal of reproductive medicine.

[27]  L. Espey,et al.  Characteristics and control of the normal menstrual cycle. , 1990, Obstetrics and gynecology clinics of North America.

[28]  M. Ireland,et al.  491 EPIDEMIOLOGY AND COMPARISON OF KNEE INJURIES IN ELITE MALE AND FEMALE UNITED STATES BASKETBALL ATHLETES , 1990 .

[29]  B. Nicklas,et al.  The Menstrual Cycle and Exercise: Performance, Muscle Glycogen, and Substrate Responses , 1989, International journal of sports medicine.

[30]  M. Hammar,et al.  Women's soccer injuries in relation to the menstrual cycle and oral contraceptive use. , 1989, Medicine and science in sports and exercise.

[31]  J. Evans,et al.  Bilaterality in anterior cruciate ligament injuries , 1988, The American journal of sports medicine.

[32]  R. Steiner,et al.  The Corpus Luteum: Determinants of Progesterone Secretion in the Normal Menstrual Cycle , 1988, Obstetrics and gynecology.

[33]  Susan R. Johnson,et al.  Epidemiology of premenstrual symptoms in a nonclinical sample. I. Prevalence, natural history and help-seeking behavior. , 1988, The Journal of reproductive medicine.

[34]  S. Pullon,et al.  The prevalence of premenstrual symptoms in Wellington women. , 1987, The New Zealand medical journal.

[35]  S. Bull,et al.  Detecting changes in functional ability in women with premenstrual syndrome. , 1987, American journal of obstetrics and gynecology.

[36]  A. Maclennan,et al.  SERUM RELAXIN IN PREGNANCY , 1986, The Lancet.

[37]  A. Maclennan,et al.  SERUM RELAXIN AND PELVIC PAIN OF PREGNANCY , 1986, The Lancet.

[38]  J. Whiteside,et al.  Women athletes with menstrual irregularity have increased musculoskeletal injuries. , 1986, Medicine and science in sports and exercise.

[39]  R. Moos,et al.  Perimenstrual symptoms: prevalence and risk factors. , 1986, Psychosomatic medicine.

[40]  J. Taunton,et al.  A Survey of Injuries to the Anterior Cruciate Ligament of the Knee in Female Basketball Players , 1985, International journal of sports medicine.

[41]  Zhang Qb,et al.  Menstrual patterns in Chinese women. , 1984, Chinese medical journal.

[42]  N. Woods,et al.  Prevalene of perimenstrual symptoms. , 1982, American journal of public health.

[43]  J A Zelisko,et al.  A comparison of men's and women's professional basketball injuries , 1982, The American journal of sports medicine.

[44]  R. Dyer,et al.  The effect of 17 beta-estradiol on collagen and noncollagenous protein synthesis in the uterus and some periodontal tissues. , 1980, Endocrinology.

[45]  Patricia A Whiteside Men's and Women's Injuries in Comparable Sports. , 1980, The Physician and sportsmedicine.

[46]  G. M. Fischer,et al.  Effect of sex hormones on blood pressure and vascular connective tissue in castrated and noncastrated male rats. , 1977, The American journal of physiology.

[47]  R. F. Vollman The menstrual cycle. , 1977, Major problems in obstetrics and gynecology.

[48]  T. Yamamuro,et al.  Experimental studies on connective tissue of the capsular ligament. Influences of aging and sex hormones. , 1976, Acta orthopaedica Scandinavica.

[49]  J. Woessner,et al.  Effect of progesterone on collagen breakdown and tissue collagenolytic activity in the involuting rat uterus. , 1975, The Journal of endocrinology.

[50]  J. Owen Physiology of the menstrual cycle. , 1975, The American journal of clinical nutrition.

[51]  O. Vellar,et al.  Dysmenorrhea in Industrial Workers , 1975, Acta obstetricia et gynecologica Scandinavica.

[52]  G. M. Fischer Comparison of collagen dynamics in different tissues under the influence of estradiol. , 1973, Endocrinology.

[53]  B. Procopé,et al.  Premenstrual syndrome and physical exercise. , 1972, Acta obstetricia et gynecologica Scandinavica.

[54]  C. Tipton,et al.  Ligamentous strength measurements in pre-pubescent and pubescent rats. , 1970, Growth.

[55]  R. Moos,et al.  The Development of a Menstrual Distress Questionnaire , 1968, Psychosomatic medicine.

[56]  S. Nagai Regulation of relaxin secretion. , 1966, The Tohoku journal of experimental medicine.

[57]  V. Pennington Meprobamate (miltown) in premenstrual tension. , 1957, Journal of the American Medical Association.

[58]  J. Ferguson,et al.  Premenstrual Tension: Two surveys of its prevalence and a description of the syndrome , 1957, Obstetrics and gynecology.

[59]  Ferguson Jh,et al.  Premenstrual tension; two surveys of its prevalance and a description of the syndrome. , 1957 .

[60]  Epub Gratuit,et al.  THE MENSTRUAL CYCLE , 1933 .

[61]  B. V. VON Schoultz,et al.  Serum levels of relaxin during the menstrual cycle and oral contraceptive use. , 1995, Gynecologic and obstetric investigation.

[62]  K. Barnhart,et al.  A clinician's guide to the premenstrual syndrome. , 1995, The Medical clinics of North America.

[63]  T. Bäckström,et al.  Endocrinological aspects of the premenstrual syndrome. , 1986, Progress in clinical and biological research.

[64]  J. Shikata,et al.  Experimental studies of the elastic fiber of the capsular ligament: influence of ageing and sex hormones on the hip joint capsule of rats. , 1979, Connective tissue research.

[65]  J. L. Webb,et al.  Gynecological survey of American female athletes competing at the Montreal Olympic Games. , 1979, The Journal of sports medicine and physical fitness.

[66]  M. Cormack,et al.  Variations in menstrual cycle symptom reporting. , 1976, Journal of psychosomatic research.

[67]  Janice M. Stocker Motor performance and state anxiety at selected stages of the menstrual cycle , 1973 .