Relationship between Sex Hormones and Anterior Knee Laxity across the Menstrual Cycle

Abstract Background One risk factor for anterior cruciate ligament (ACL) injury may be fluctuations in female hormones. This study examined variability in joint laxity, as a risk factor for ACL injury, during the menstrual cycle. Methods Subjects were 15 female university students with regular menstrual cycles. We measured estradiol (E2) concentration, anterior knee laxity (AKL), stiffness, genu recurvatum (GR), and general joint laxity (GJL) during the late follicular and ovulatory phases. AKL was measured as anterior tibial displacement of the femur after application of 44-, 89-, and 133-N loads on the tibia. Stiffness was calculated as Δforce/Δdisplacement at loads of 44–89 N and between 89 and 133 N. GR was measured prone, with the base of the patella distal to the edge of the bed. The University of Tokyo joint laxity test was used to evaluate GJL. Results E2 concentration was significantly higher in the ovulatory phase than in the late follicular phase (p = 0.018), AKL and stiffness did not differ significantly between phases, and GR and GJL were significantly higher in the ovulatory phase than in the late follicular phase (p = 0.011, 0.031). Conclusion These findings suggest that E2 concentrations may affect GR and GJL during the menstrual cycle.

Download Full-text

A comparison of cyclic variations in anterior knee laxity, genu recurvatum, and general joint laxity across the menstrual cycle

Journal of Orthopaedic Research® ◽

10.1002/jor.21145 ◽

2010 ◽

Vol 28 (11) ◽

pp. 1411-1417 ◽

Cited By ~ 26

Author(s):

Sandra J. Shultz ◽

Beverly J. Levine ◽

Anh-Dung Nguyen ◽

Hyunsoo Kim ◽

Melissa M. Montgomery ◽

...

Keyword(s):

Menstrual Cycle ◽

Knee Laxity ◽

Joint Laxity ◽

Anterior Knee Laxity ◽

Genu Recurvatum ◽

Cyclic Variations ◽

Anterior Knee

Download Full-text

Absolute serum hormone levels predict the magnitude of change in anterior knee laxity across the menstrual cycle

Journal of Orthopaedic Research® ◽

10.1002/jor.20021 ◽

2006 ◽

Vol 24 (2) ◽

pp. 124-131 ◽

Cited By ~ 31

Author(s):

Sandra J. Shultz ◽

Bruce M. Gansneder ◽

Todd C. Sander ◽

Susan E. Kirk ◽

David H. Perrin

Keyword(s):

Menstrual Cycle ◽

Knee Laxity ◽

Hormone Levels ◽

Anterior Knee Laxity ◽

Serum Hormone ◽

Anterior Knee

Download Full-text

Anterior Knee Stiffness Changes in Laxity “Responders” Versus “Nonresponders” Across the Menstrual Cycle

Journal of Athletic Training ◽

10.4085/1062-6050-47.6.07 ◽

2013 ◽

Vol 48 (1) ◽

pp. 39-46 ◽

Cited By ~ 1

Author(s):

Randy J. Schmitz ◽

Sandra J. Shultz

Keyword(s):

Menstrual Cycle ◽

Knee Laxity ◽

Displacement Curve ◽

Anterior Knee Laxity ◽

Passive Restraint ◽

Load Displacement ◽

Cyclic Changes ◽

Anterior Knee ◽

Knee Joint Loading ◽

University Laboratory

Context Although changes in anterior knee laxity (AKL) across the menstrual cycle have been reported, the effects of cyclic knee laxity changes on the underlying characteristics of the load-displacement (stiffness) curve generated during anterior loading of the tibia relative to the femur are relatively unknown. Objective To describe the anterior load-displacement curve during anterior loading of the tibia relative to the femur using incremental stiffnesses and to compare underlying stiffness measures between days of the cycle when AKL is at its minimum and maximum. Design Descriptive laboratory study. Setting University laboratory. Patients or Other Participants Fifty-seven recreationally active women. Main Outcome Measure(s) Anterior knee laxity and 6 incremental stiffness measures (N/mm) were obtained with an instrumented knee arthrometer on days 1–6 of menses and days 0–8 postovulation during 2 consecutive menstrual cycles. Participants were then classified in tertiles based on the maximum change (difference between maximum and minimum) in AKL, and incremental stiffness was compared on days of minimum versus maximum laxity between the lowest (<1.24 mm cyclic laxity change = laxity “nonresponders” [n = 19]) and highest (>1.75 mm cyclic laxity change = laxity “responders” [n = 19]) tertiles. Results All participants displayed decreasing stiffness initially (0–20 N > 20–40 N and 40–60 N), followed by incrementally increasing stiffness (40–60 N < 60–80 N < 80–100 N < 100–130 N) (P ≤ .05). Responders demonstrated decreased stiffness between the days of minimum and maximum AKL at the 10–130-N increment versus the 0–20-N and 20–40-N increments (P ≤ .05); nonresponders had no change in stiffness. Conclusions Participants who experienced larger magnitudes of cyclic changes in AKL also experienced decreases in terminal (100–130 N) stiffness during anterior knee joint loading. Decreases in incremental stiffness at higher anterior directed loads may adversely affect passive restraint systems, resulting in altered arthrokinematics during functional activity.

Download Full-text