The influence of sex hormones on anterior cruciate ligament ruptures in males

Stijak, Lazar; Kadija, Marko; Djulejić, Vuk; Aksić, Milan; Petronijević, Nataša; Aleksić, Dubravka; Radonjić, Vidosava; Bumbaširević, Marko; Filipović, Branislav

doi:10.1007/s00167-014-3247-3

Cited by 9 publications

(9 citation statements)

References 30 publications

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“…In four studies, males were analysed separately. In three of these studies, significant associations were found between ACL injury and GJH; all the studies were controlled for the age of the participants 4 32 37. In the fourth study assessing males specifically, by Scerpella et al , two methods of evaluating GJH were used; one showed a significant association, while the other did not (details of the methods available in online supplementary table 2).…”

Section: Resultsmentioning

confidence: 99%

Generalised joint hypermobility increases ACL injury risk and is associated with inferior outcome after ACL reconstruction: a systematic review

Sundemo

Senorski

Karlsson

et al. 2019

BMJ Open Sport Exerc Med

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ObjectivesTo investigate the association between generalised joint hypermobility (GJH) and ACL injury risk. Secondary aims involved evaluating associations between GJH and postoperative outcome (including graft-failure risk, knee laxity and patient-reported outcome). Furthermore, we aimed to compare the performance of different grafts in patients with GJH.MethodsDatabases MEDLINE/PubMed, EMBASE and the Cochrane Library were searched, including 2760 studies. Two reviewers independently screened studies for eligibility. A modified version of the MINORS score was applied for quality appraisal. Studies assessing GJH while reporting the risk of ACL injury and/or postoperative outcome were included.ResultsTwenty studies were included, using several different methods to determine GJH. There was consistent evidence showing that GJH is a risk factor for unilateral ACL injury in males, while in females, the results were conflicting. There was limited evidence associating GJH with increased knee laxity 5 years postoperatively. There was consistent evidence of inferior postoperative patient-reported outcome in patients with GJH. Moreover, there was limited yet consistent evidence indicating that patellar-tendon autografts are superior to hamstring-tendon autografts in patients with GJH in terms of knee laxity and patient-reported outcome. There was insufficient evidence to draw conclusions regarding the outcomes of bilateral ACL injury and graft failure.ConclusionsIn men, GJH was associated with an increased risk of unilateral ACL injury. Moreover, GJH was associated with greater postoperative knee laxity and inferior patient-reported outcome. Based on the available evidence, a patellar-tendon autograft appears to be superior to a hamstring-tendon autograft in patients with GJH. However, the included studies were heterogeneous and there is a need for consensus in the assessment of GJH within sports medicine.

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Section: Resultsmentioning

confidence: 99%

Generalised joint hypermobility increases ACL injury risk and is associated with inferior outcome after ACL reconstruction: a systematic review

Sundemo

Senorski

Karlsson

et al. 2019

BMJ Open Sport Exerc Med

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“…However, it should be noted that small calcified depots have been described upon IA injections of patients with corticosteroids (Boulman, Slobodin, Rozenbaum, & Rosner, 2005;Harigane et al, 2011), possibly similar to the dystrophic calcifications found in the current study. In addition, corticosteroids can increase the elasticity of the ligament, thereby increasing knee joint laxity and the susceptibility for ligament ruptures (Khowailed, Petrofsky, Lohman, Daher, & Mohamed, 2015;Stijak et al, 2015), so even short-term IA exposure is not entirely without risks.…”

Section: Discussionmentioning

confidence: 99%

Local controlled release of corticosteroids extends surgically induced joint instability by inhibiting tissue healing

Rudnik-Jansen

Tellegen

Pouran

et al. 2019

British J Pharmacology

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Background and PurposeCorticosteroids are intra‐articularly injected to relieve pain in joints with osteoarthritis (OA) or acute tissue damage such as ligament or tendon tears, despite its unverified contraindication in unstable joints. Biomaterial‐based sustained delivery may prolong reduction of inflammatory pain, while avoiding harmful peak drug concentrations.Experimental ApproachThe applicability of prolonged corticosteroid exposure was examined in a rat model of anterior cruciate ligament and medial meniscus transection (ACLT + pMMx) with ensuing degenerative changes.Key ResultsIntra‐articular injection of a bolus of the corticosteroid triamcinolone acetonide (TAA) resulted in enhanced joint instability in 50% of the joints, but neither instability‐induced OA cartilage degeneration, synovitis, nor the OA‐related bone phenotype was affected. However, biomaterial microsphere‐based extended TAA release enhanced instability in 94% of the animals and induced dystrophic calcification and exacerbation of cartilage degeneration. In healthy joints, injection with TAA releasing microspheres had no effect at all. In vitro, TAA inhibited cell migration out of joint tissue explants, suggesting inhibited tissue healing in vivo as mechanisms for enhanced instability and subsequent cartilage degeneration.Conclusions and ImplicationsWe conclude that short‐term TAA exposure has minor effects on surgically induced unstable joints, but its extended presence is detrimental by extending instability and associated joint degeneration through compromised healing. This supports a contraindication of prolonged corticosteroid exposure in tissue damage‐associated joint instability, but not of brief exposure.

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“…Generalized joint hypermobility (GJH) has been associated with an increased risk of anterior cruciate ligament (ACL) injury [ 12 , 22 , 23 , 26 ]. Postoperative clinical outcomes in patients with an ACL injury with hypermobility have also been assessed [ 23 ].…”

Section: Introductionmentioning

confidence: 99%

Generalized joint hypermobility does not influence 1-year patient satisfaction or functional outcome after ACL reconstruction

Sundemo

Jacobsson

Karlsson

et al. 2022

Knee Surg Sports Traumatol Arthrosc

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Purpose The purpose of this study was to evaluate whether generalized joint hypermobility (GJH) influences postoperative results, including return to sport, patientreported outcomes, functional performance (hop tests), muscular strength, and the occurrence of ACL re-injury, in patients 1 year after anterior cruciate ligament (ACL) reconstruction. Methods Data was extracted from a regional rehabilitation-specific registry containing information on patients with ACL injury. Patients between the ages of 16–50 years previously undergoing ACL reconstruction with available 1 year follow-up data were eligible for inclusion. Generalized joint hypermobility was assessed using the Beighton score (BS). Patients were examined one year postoperatively in terms of return to sport, patient-reported outcome, hop tests, muscular strength and the occurrence of reinjury. For purpose of analysis, patients were allocated into two groups, depending on the existence of GJH. The KOOS subscale of sports and recreation was considered the primary outcome. Analyses were performed both dichotomously and by using adjusted logistic regression, to consider potential confounders. Results A total of 356 patients (41% males) were included, of which 76 (24% male) were categorized as having GJH. Patients with GJH had an inferior limb symmetry index preoperatively in terms of knee extension (mean 81.6 [SD 16.4] vs. 91.4 [SD 15.9], p = 0.02) and flexion strength (mean 91.9 vs. 99.1, p = 0.047) compared to patients without GJH. There was no difference between the groups in terms of the primary outcome, nor in any of the other postoperative outcomes. Nine patients (11.8%) in the group with GJH suffered ACL re-injury, compared with 13 patients (4.6%) in the control group (n.s.). Conclusion One year after ACL reconstruction the existence of GJH did not affect postoperative patient satisfaction, strength or functional outcome. No conclusive statements can be made regarding the influence of GJH on the risk of ACL re-injury in this particular study. Level of evidence Level II.

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The influence of sex hormones on anterior cruciate ligament ruptures in males

Abstract: Diagnostic study, Level II.

Cited by 9 publications

References 30 publications

Generalised joint hypermobility increases ACL injury risk and is associated with inferior outcome after ACL reconstruction: a systematic review

Generalised joint hypermobility increases ACL injury risk and is associated with inferior outcome after ACL reconstruction: a systematic review

Local controlled release of corticosteroids extends surgically induced joint instability by inhibiting tissue healing

Generalized joint hypermobility does not influence 1-year patient satisfaction or functional outcome after ACL reconstruction

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