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DOI

https://doi.org/10.25035/jsmahs.12.01.12

Abstract

CLINICAL SCENARIO Anterior cruciate ligament (ACL) injuries occur more frequently in females than males, with estimates suggesting a 2-10 greater likelihood of females to sustain this trauma.3 FIFA issued a recent call to action encouraging further investigation into why females are still predisposed to this trauma.2 ACL incident rate is highest amongst females between 14–18-years-old with approximately 227.6 exposures per 100,000 persons per year.1 Multifactorial influences are suggested as predisposing risk factors including anatomical or hormonal components.1 Growing interest in hormonal contributions has led researchers to examine how fluctuations in estrogen, progesterone, and testosterone impact ligamentous integrity.8

Estrogen receptors are present in ligamentous structures, influencing both structural and biomechanical integrity.4 The ACL appears sensitive to hormonal shifts, predisposing it to trauma. During the menstrual cycle, estrogen levels rise substantially before ovulation, contributing to increased ligamentous laxity.1,4 It has been stated that knee laxity varies throughout the menstrual cycle, with the ACL being most vulnerable during ovulation.1 Research has noted oral contraceptives, through their progestin components suppress ovulation inhibiting follicular development and rupture. Hormonal regulation reduces estrogen levels and may preserve tensile strength of the ACL. Such findings have prompted investigation of oral contraceptives to control hormone levels to reduce risk of ACL trauma.

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