Changing Hormone Levels during the Menstrual Cycle Affect Knee Laxity and Stiffness in Healthy Female Subjects

Park, Sang-Kyoon; Stefanyshyn, Darren J.; Loitz-Ramage, B.; Hart, David A.; Ronsky, Janet L.

doi:10.1177/0363546508326713

Cited by 96 publications

(85 citation statements)

References 79 publications

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“…Findings of studies on the effects of the menstrual cycle on knee joint laxity are summarized in Figure 1. Five of the eleven studies observed significant associations between the menstrual cycle and anterior knee laxity and all five reported that laxity increased during the ovulatory or luteal phases of the cycle [75][76][77][78][79][80]. Furthermore, a meta-analysis of nine studies found that anterior knee laxity was greater in the ovulatory phase than in the luteal phase and was lowest in the follicular phase [81].…”

Section: Hormonal Cycle and Ligamentous Laxitymentioning

confidence: 99%

The Mechanism of Non-contact Anterior Cruciate Ligament Injury in Female Athletes: Is the Injury Mechanism Different between the Genders?

Gamada¹,

Kubota²

2014

Int J Phys Med Rehabil

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ACL injury is one of the most frequent and costly injuries in sports, and is a major risk factor for early knee osteoarthritis. Although female gender is a major risk factor for ACL injury, differences in the injury mechanism between males and females have not yet been determined. The goal of this review was to determine whether there is any evidence of gender differences in the mechanisms of ACL injury. MRI studies demonstrated that the location of bone bruises after ACL injury was similar between genders and that males demonstrated more extensive damage in the joint, suggesting the involvement of higher energy but not a difference in injury mechanism. Video analyses of the process of ACL injury has shown common body positions at the time of injury, but failed to reveal differences in the joint motions between genders. Therefore, the mechanism of ACL injury is likely to be similar across genders.

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Section: Hormonal Cycle and Ligamentous Laxitymentioning

confidence: 99%

The Mechanism of Non-contact Anterior Cruciate Ligament Injury in Female Athletes: Is the Injury Mechanism Different between the Genders?

Gamada¹,

Kubota²

2014

Int J Phys Med Rehabil

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“…Joint stiffness is defined as the rate of change of load with deformation. 28 In previous studies, 13,25,34 a linear first-order approximation has been used to determine the slope of the load-elongation curve. With the LigMaster arthrometer, the encoders record forcedisplacement (load-deformation) data that the software subsequently processes to produce second-order plots of applied force against induced strain, rather than stress against strain.…”

Section: Sex Differences and Joint Laxitymentioning

confidence: 99%

“…Theories have been generated and extensive research has been conducted to explain the two-to eightfold increase in ACL injuries in female athletes over male athletes. [1][2][3][4] Although a single cause has not been identified, risk factors have been generalized into 4 categories 5 : environmental (external factors such as surface and footwear), 5 anatomic and postural, [1][2][3][4] hormonal, [6][7][8][9][10][11][12][13] and biomechanical [14][15][16] (such as kinematics 16,17 and neuromuscular factors 15,18,19 ). The injury rate to the collateral ligaments of the knee is also greater in females than males but not to the same extent as for ACL injury.…”

mentioning

confidence: 99%

Medial Tibiofemoral-Joint Stiffness in Males and Females Across the Lifespan

Aronson¹,

Rijke²,

Hertel³

et al. 2014

Journal of Athletic Training

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Context: Analyzing ligament stiffness between males and females at 3 maturational stages across the lifespan may provide insight into whether changes in ligament behavior with aging may contribute to joint laxity.Objective: To compare the stiffness of the medial structures of the tibiofemoral joint and the medial collateral ligament to determine if there are differences at 3 distinct ages and between the sexes.Design: Cross-sectional study. Setting: Laboratory. Patients or Other Participants: A total of 108 healthy and physically active volunteers with no previous knee surgery, no acute knee injury, and no use of exogenous hormones in the past 6 months participated. They were divided into 6 groups based on sex and age (8-10, 18-40, 50-75 years).Main Outcome Measure(s): Ligament stiffness of the tibiofemoral joint was measured with an arthrometer in 08 and 208 of tibiofemoral-joint flexion. The slope values of the forcestrain line that represents stiffness of the medial tibiofemoral joint at 08 and the medial collateral ligament at 208 of flexion were obtained.Results: When height and mass were controlled, we found a main effect (P , .001) for age group: the 8-to 10-year olds were less stiff than both the 18-to 40-and the 50-to 75-year-old groups. No effects of sex or tibiofemoral-joint position on stiffness measures were noted when height and mass were included as covariates.Conclusions: Prepubescent medial tibiofemoral-joint stiffness was less than postpubescent knee stiffness. Medial tibiofemoral-joint stiffness was related to height and mass after puberty in men and women.Key Words: medial collateral ligament, arthrometry, hormones, sex differences Key PointsMedial tibiofemoral-joint stiffness was less in prepubescents than in postpubescents. After puberty, medial tibiofemoral-joint stiffness was influenced by height and mass in both men and women.

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“…5,11,[21][22][23][24][25] Numerous authors have concluded that anterior laxity differs between sexes, with males having less laxity than females. [25][26][27][28][29][30][31] Again, this area is not without controversy, as several authors have concluded that anterior knee laxity does not change across the menstrual cycle.…”

mentioning

confidence: 99%

“…41 One limitation of these studies is that some women may be more responsive to hormonal fluctuations than others (ie, responders versus nonresponders). 5,11 We theorize that females with histories of ACL injury may be responsive to hormonal fluctuations, and this increased sensitivity may have a greater effect on tissue and ultimately landing mechanics. Additionally, up to 25% of individuals who sustain primary ACL ruptures will have second ACL injuries, with many second injuries occurring in the contralateral limb.…”

mentioning

confidence: 99%

Jump-Landing Biomechanics and Knee-Laxity Change Across the Menstrual Cycle in Women With Anterior Cruciate Ligament Reconstruction

Bell

Blackburn

Hackney

et al. 2014

Journal of Athletic Training

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Context: Of the individuals able to return to sport participation after an anterior cruciate ligament(ACL) injury, up to 25% will experience a second ACL injury. This population may be more sensitive to hormonal fluctuations, which may explain this high rate of second injury. Objective: To examine changes in 3-dimensional hip and knee kinematics and kinetics during a jump landing and to examine knee laxity across the menstrual cycle in women with histories of unilateral noncontact ACL injury. Design Controlled laboratory study. Setting: Laboratory. Patients or Other Participants: A total of 20 women (age = 19.6 ± 1.3 years, height = 168.6 ± 5.3 cm, mass = 66.2 ± 9.1 kg) with unilateral, noncontact ACL injuries. Intervention(s) Participants completed a jump-landing task and knee-laxity assessment 3 to 5 days after the onset of menses and within 3 days of a positive ovulation test. Main Outcome Measure(s): Kinematics in the uninjured limb at initial contact with the ground during a jump landing, peak kinematics and kinetics during the loading phase of landing, anterior knee laxity via the KT-1000, peak vertical ground reaction force, and blood hormone concentrations (estradiol-β-17, progesterone, free testosterone). Results: At ovulation, estradiol-β-17 (t = −2.9, P = .009), progesterone (t = −3.4, P = .003), and anterior knee laxity (t = −2.3, P = .03) increased, and participants presented with greater knee-valgus moment (Z = −2.6, P = .01) and femoral internal rotation (t = −2.1, P = .047). However, during the menses test session, participants landed harder (greater peak vertical ground reaction force; t = 2.2, P = .04), with the tibia internally rotated at initial contact (t = 2.8, P = .01) and greater hip internal-rotation moment (Z = −2.4, P = .02). No other changes were observed across the menstrual cycle. Conclusions Knee and hip mechanics in both phases of the menstrual cycle represented a greater potential risk of ACL loading. Observed changes in landing mechanics may explain why the risk of second ACL injury is elevated in this population.

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Changing Hormone Levels during the Menstrual Cycle Affect Knee Laxity and Stiffness in Healthy Female Subjects

Abstract: Female hormone levels are related to increased knee joint laxity and decreased stiffness at ovulation. To understand subject variations in knee joint laxity during the menstrual cycle in female athletes, further investigation is warranted.

Cited by 96 publications

References 79 publications

The Mechanism of Non-contact Anterior Cruciate Ligament Injury in Female Athletes: Is the Injury Mechanism Different between the Genders?

The Mechanism of Non-contact Anterior Cruciate Ligament Injury in Female Athletes: Is the Injury Mechanism Different between the Genders?

Medial Tibiofemoral-Joint Stiffness in Males and Females Across the Lifespan

Jump-Landing Biomechanics and Knee-Laxity Change Across the Menstrual Cycle in Women With Anterior Cruciate Ligament Reconstruction

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