Anterior cruciate ligament tear during the menstrual cycle in female recreational skiers

• Published in: Orthopaedics & traumatology, surgery & research surgery & research, 2013-09, Vol.99 (5), p.571-575
• Main Authors: Lefevre, N, Bohu, Y, Klouche, S, Lecocq, J, Herman, S
• Format: Article
• Language: English
• Subjects: ACL; Adult; Anterior Cruciate Ligament Injuries; Athletic Injuries - epidemiology; Athletic Injuries - etiology; Cohort Studies; Female; Female skiers; Follow-Up Studies; Humans; Incidence; Injury risk; Knee Injuries - epidemiology; Knee Injuries - etiology; Knee Injuries - physiopathology; Menstrual Cycle; Orthopedics; Prospective Studies; Recreation; Risk Assessment; Skiing - injuries; Surgery
• ISSN: 1877-0568; 1877-0568
• DOI: 10.1016/j.otsr.2013.02.005

Summary Introduction Women run a 4-8-fold greater risk of anterior cruciate ligament (ACL) tear than men, and especially during the pre-ovulation stage of their cycle. The main study objective was to describe the distribution of ACL lesions according to menstrual cycle in a large population of female recreational skiers. Materials and methods A prospective study was conducted during the 2010–11 ski season on women sustaining ACL tear during skiing. Patients filled out a questionnaire during consultation with the mountain physician, including date of last menstrual period (LMP) and contraceptive method. Fifty-seven of the 229 patients with diagnosed ACL tear were excluded from analysis, 41 being post-menopausal (mean age, 47 ± 9 years), and 16 having irregular cycles or LMP > 30 days. One hundred and seventy-two patients (mean age, 34 ± 8.7 years) were thus included. Results Fifty-eight women (33.72%) were in follicular phase, 63 (36.63%) in ovulatory phase and 51 (29.65%) in luteal phase; difference with respect to the theoretic distribution regardless of menstrual phase was highly significant: χ2 = 48.32; P = 0.00001. Fifty-three of the 172 women (30.8%) were taking oral contraceptives. ACL tear was 2.4-fold more frequent in pre-ovulatory than post-ovulatory phase, whether in women using oral or other contraceptives: 85/119 (71.4%) vs. 36/53 (67.9%); P = 0.64. Conclusion ACL tear risk in skiing in women is not constant over the menstrual cycle, being 2.4–fold more frequent in pre-ovulatory (follicular and ovulatory) than post-ovulatory phase (luteal). Oral contraception seems not to exert any protective effect. Level of evidence Level IV. Retrospective cohort study.