Passive anterior tibial translation in women with and without joint hypermobility: an exploratory study

Stettler, M.; Luder, Gere; Schmid, Stefan; Mebes, Christine Mueller; Stutz, U.; Ziswiler, Hans-Rudolf; Radlinger, Lorenz

doi:10.1111/1756-185x.12917

Cited by 11 publications

(8 citation statements)

References 22 publications

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“…In recent years, generalized joint laxity (GJL) also has been shown to be a risk factor for ACL injury. 13,21,28 Stettler et al 27 reported higher values for AKL in individuals with higher GJL scores compared with those with normal mobility. In addition, GJL scores are higher in women than in men 10 ; this difference between men and women has been attributed to differences in sex hormone levels.…”

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confidence: 99%

Relationship Between Anterior Knee Laxity and General Joint Laxity During the Menstrual Cycle

Maruyama

Yamazaki

Sato

et al. 2021

Orthopaedic Journal of Sports Medicine

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Background: Anterior cruciate ligament (ACL) injury has been reported to have a higher incidence in women than in men. Purpose/Hypothesis: The purpose was to examine the relationship of anterior knee laxity (AKL), stiffness, and generalized joint laxity (GJL) with respect to the menstrual cycle. It was hypothesized that AKL and GJL would increase during the ovulation phase, when estrogen levels are high. Study Design: Descriptive laboratory study. Methods: A total of 15 female university students aged >20 years and with normal menstrual cycles were evaluated. AKL was measured as anterior tibial displacement of the femur after application of 44-, 89-, and 133-N loads to the tibia. Stiffness was calculated as Δ force/Δ displacement at loads between 44 and 89 N and between 89 and 133 N. The University of Tokyo joint laxity test was used for evaluation of GJL. The participants’ menstrual cycle was divided into the early follicular, late follicular, ovulation, and luteal phases using the basal body temperature method and an ovulation kit; AKL and GJL were measured once during each phase. Participants were also stratified according to the presence or absence of genu recurvatum (GR). Results: There was no significant difference in AKL, stiffness, or GJL among the menstrual phases. In the GR group, AKL values at 89 N and 133 N were significantly higher in the ovulation phase than in the early follicular phase ( P = .025 and P =.018, respectively); there were no significant differences in AKL among the phases in the non-GR group. In addition, the GR group in the ovulation phase had significantly higher AKL values at 44 N, 89 N, and 133 N compared with the non-GR group ( P = .013, P = .005, and P = .010, respectively). There were no significant differences in GJL among the phases in the GR or non-GR groups. Conclusion: Women with GR may have increased AKL in the ovulation phase when compared with the early follicular phase, which may be a risk factor for ACL injury. Clinical Relevance: The results of this study suggest that the ovulation phase may be related to the greater incidence of ACL injuries in women.

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mentioning

confidence: 99%

Relationship Between Anterior Knee Laxity and General Joint Laxity During the Menstrual Cycle

Maruyama

Yamazaki

Sato

et al. 2021

Orthopaedic Journal of Sports Medicine

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“…Regarding the relationship between the menstrual cycle and tissue structure of the ACL, it has been reported that estrogen receptors are present in the human ACL [5], and in vivo studies have reported that AKL increases during ovulation [8] and luteal phases [9]. Higher values for AKL in individuals with higher GJL scores compared to those with normal mobility have also been reported [16]. Previous studies have investigated the correlation between female hormones and plantar fascia elasticity, and reported that plantar fascia elasticity increases during ovulation, synchronous with high estrogen levels [10].…”

Section: Discussionmentioning

confidence: 98%

“…In recent years, generalized joint laxity (GJL) has also been shown to be a risk factor for ACL injury [15]. Stettler et al [16] reported higher values for AKL in individuals with higher GJL scores compared to those with normal mobility. In addition, GJL scores are higher in women than in men [17]; this difference between men and women has been attributed to differences in sex hormone levels.…”

Section: Introductionmentioning

confidence: 99%

Change in Ankle Joint Laxity and General Joint Laxity During the Menstrual Cycle

Yamasaki¹,

Maruyama²,

Sato³

et al. 2020

Preprint

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Background: The purpose of the present study was to examine the relationship between ankle joint laxity and general joint laxity (GJL) in relation to the menstrual cycle, which was divided into four phases based on basal body temperature and ovulation, assessed using an ovulation kit. Methods: Subjects were 14 female college students aged >20 years and with normal menstrual cycles. Anterior drawer stress to a magnitude of 120 N was applied for all subjects. Anterior talofibular ligament (ATFL) length was measured as the linear distance (mm) between its points of attachment on the lateral malleolus and talus. Data on ATFL length from each subject were used to calculate each subject’s normalized length change with anterior drawer stress (AD%). The University of Tokyo method was used for evaluation of GJL. AD% and GJL were measured once in each menstrual phase. Results: There was no statistically significant difference between AD% in each phase. GJL score was significantly higher in the ovulation and luteal phases compared with the early follicular phase. AD% and GJL showed a positive correlation with each other in the ovulation phase.Conclusions: Although it is unclear whether estrogen receptors are present in the ATFL, the present study suggests that women with high GJL scores might be more sensitive to the effects of estrogen, resulting in ATFL length change in the ovulation phase.

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“…All investigators who completed the measurements were blinded to group allocation. The main results of the project were published elsewhere [19,[24][25][26]. The study was approved by Canton Bern's Ethics Committee (#229/2008) and all participants gave written informed consent.…”

Section: Methodsmentioning

confidence: 99%

Symptoms in Daily Life and Activity Level of Women with and without Hypermobility

Christine¹,

Luder

Schmid³

et al. 2018

Rheumatology

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Objective: Generalized Joint Hypermobility (GJH) is defined as a condition in which several joints move beyond their normal limits. It seems to be associated with musculoskeletal disorders, pain, reduced activity level in sports and reduced strength. The aim of the current study was to record specific problems and disorders of hypermobile women and to build subgroups based on these results. As a second objective, the study aimed to identify differences in activity level between these subgroups.Methods: A total of 195 women were included in this exploratory study: 67 normomobile (NM) and 128 hypermobile. Of these, 56 were classified as hypermobile with symptoms and 47 as hypermobile without symptoms. Symptoms were first recorded with the Canadian Occupational Performance Measure (COPM) and then monthly over a period of 6 months with a face validated questionnaire including general impairment, localization, type, intensity and frequency of problems. Activity level was determined by the International Physical Activity Questionnaire.Results: On the COPM there was no significant difference between patients in the NM and HM groups. The face validated questionnaire identified the most important problem to be pain in different localizations after remaining in one position for too long. The highest activity level was found in the HM group (p=0.021). Conclusion:Hypermobile women are active for longer during the day than women with normal mobility, but the type and degree of activity needs further evaluation. More detailed recording of symptoms in women with GJH is required to identify the discrete differences between the groups. To build subgroups in GJH the procedure of screening has to be more comprehensive. Widespread pain and level of activity are aspects that have to be included in the holistic approach to the management of patients with GJH.

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Passive anterior tibial translation in women with and without joint hypermobility: an exploratory study

Abstract: HM women showed significantly higher TT distances, which were even more accentuated in those having symptoms. The findings point toward less passive stability of the knee joint and thus maybe a need of higher muscle activation in order to stabilize the joint.

Cited by 11 publications

References 22 publications

Relationship Between Anterior Knee Laxity and General Joint Laxity During the Menstrual Cycle

Relationship Between Anterior Knee Laxity and General Joint Laxity During the Menstrual Cycle

Change in Ankle Joint Laxity and General Joint Laxity During the Menstrual Cycle

Symptoms in Daily Life and Activity Level of Women with and without Hypermobility

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