Category
Textual or Investigative
Description
Context: Female athletes are at an elevated risk for ACL injuries due to fluctuating hormones throughout the menstrual cycle, along with anatomical and neuromuscular factor such as an increased Q angle, intercondylar notch size, joint laxity, muscular size, and landing mechanics. Hormonal contraceptives are widely used in female athletes not only for contraception but also to regulate menstrual cycle and menstrual related symptoms by stabilizing hormonal fluctuation. Fluctuations in menstrual hormones have also been shown to influence knee laxity, which is considered one of the strongest risk factors for ACL injury. This leads to the clinical question, “Do hormonal contraceptives methods have an effect on ACL incidence rate in female athletes when compared with non-users?” Thus, the purpose of this study is to review the current best available published literature to examine the impact of hormonal contraceptive methods on ACL injury incidence rates.
Methods: Literature was searched in the PubMed database using strategies that focused on “ACL tears”, “female athletes”, and “hormonal contraceptives.” Hormonal contraceptives include patches, oral contraceptives, IUDs, and copper arm implants. The initial search revealed 62 articles, which were then narrowed down to four articles based on publication within the past 10 years, relevance of the title and abstract, and the retrospective study design. The CASP checklists were used to assess the validity and reliability of the articles.
Results: Across the three selected studies, there was an 18-63% decrease in ACL incidence rate among female athletes using hormonal contraceptives compared with non-users. According to the Strength of Recommendation Taxonomy guidelines, the level of evidence is classified as Grade B.
Conclusions: While the exact mechanism remains unclear, female athletes using hormonal contraceptives have been reported to demonstrate lower ACL injury rates. One potential explanation is the stabilization of hormonal fluctuations, including relaxin, progesterone, and estrogen. This hormonal regulation may reduce fluctuations in knee laxity across the menstrual cycle, which could contribute to a decreased incidence of ACL injury. It is recommended that further research be conducted regarding the use of contraceptives as a preventative for ACL injuries, how different type of contraceptives affect ACL injury incidence.
The Effect of Hormonal Contraceptives on ACL Tear Incidence: A Critically Appraised Topic
Textual or Investigative
Context: Female athletes are at an elevated risk for ACL injuries due to fluctuating hormones throughout the menstrual cycle, along with anatomical and neuromuscular factor such as an increased Q angle, intercondylar notch size, joint laxity, muscular size, and landing mechanics. Hormonal contraceptives are widely used in female athletes not only for contraception but also to regulate menstrual cycle and menstrual related symptoms by stabilizing hormonal fluctuation. Fluctuations in menstrual hormones have also been shown to influence knee laxity, which is considered one of the strongest risk factors for ACL injury. This leads to the clinical question, “Do hormonal contraceptives methods have an effect on ACL incidence rate in female athletes when compared with non-users?” Thus, the purpose of this study is to review the current best available published literature to examine the impact of hormonal contraceptive methods on ACL injury incidence rates.
Methods: Literature was searched in the PubMed database using strategies that focused on “ACL tears”, “female athletes”, and “hormonal contraceptives.” Hormonal contraceptives include patches, oral contraceptives, IUDs, and copper arm implants. The initial search revealed 62 articles, which were then narrowed down to four articles based on publication within the past 10 years, relevance of the title and abstract, and the retrospective study design. The CASP checklists were used to assess the validity and reliability of the articles.
Results: Across the three selected studies, there was an 18-63% decrease in ACL incidence rate among female athletes using hormonal contraceptives compared with non-users. According to the Strength of Recommendation Taxonomy guidelines, the level of evidence is classified as Grade B.
Conclusions: While the exact mechanism remains unclear, female athletes using hormonal contraceptives have been reported to demonstrate lower ACL injury rates. One potential explanation is the stabilization of hormonal fluctuations, including relaxin, progesterone, and estrogen. This hormonal regulation may reduce fluctuations in knee laxity across the menstrual cycle, which could contribute to a decreased incidence of ACL injury. It is recommended that further research be conducted regarding the use of contraceptives as a preventative for ACL injuries, how different type of contraceptives affect ACL injury incidence.
