Date of Award

Spring 2020

Degree Name

Master of Medical Science (Physician Assistant)

Department

Physician Assistant; College of Health Sciences

First Advisor

Lisa Murphy

Abstract

ABSTRACT

Introduction: Anterior Cruciate Ligament (ACL) injuries are an upsetting setback for many athletes that require a long and costly recovery process. The injury rates are four times greater in women than men. Preventative measures that help to prevent ACL injuries are limited to stretching and strengthening. Therefore, this review aims to investigate if oral contraceptive [I] usage provides a possible new avenue for prevention of ACL injury [O] in young female athletes (ages 18-30) [P] compared to those that do not take oral contraceptives [C].

Methods: A literature review was performed though PubMed, Google Scholar, SCOPUS Database, and ClinicalKey in October 2018. A total of eight articles were found that consisted of retrospective cohort studies, case control studies, and controlled laboratory studies. These studies were selected based on population age, population sex, publication date, and intervention. The design, methods, and outcomes of these studies were then compared and discussed further.

Results: The results from each of the studies reveal statistically significant differences in percentage of ACL tears and joint laxity between OCP users and non-OCP users. While the evidence did further explain and fill in the gaps on OCP’s effect on ACL tissues, the evidence was not sufficient to back the idea of utilizing OCPs safely for ACL prevention. Many confounding variables need to be analyzed and further studied in order for this to be brought into clinical practice, but the means to do it are available with the evidence presented in these articles. Three studies found increased risk of ACL tears in non-OCP users, while one found no statistically significant difference. Two articles found decreased anterior tibial translation in OCP users compared to non-users. Two studies found increased degradation of collagen fibers in non-OCP users compared to users.

Discussion: While there were different measures studied, they all lend support to OCP use being a preventative measure in ACL tears. In some studies, there was limited sample populations, while in others there was failure to collect crucial demographic and comorbid characteristics. Both of these decrease external validity. Lack of standardizing a length of treatment with OCP, type of OCP, and comorbid conditions limit the findings from having a high clinical significance. The efficacy of OCP as a preventative measure in ACL tears is not entirely ready for clinical practice, yet. However, there is much room for future research direction and growth. The findings do lend support to a promising future in utilizing OCPs as a preventative measure in ACL injury.

Conclusion: ACL injury has been linked to increased risk in females, and further, an increased risk at specific days in a menstrual cycle and in females who are not on OCPs. Little evidence, however, has been collected directly investigating ACL composition and tear rate in OCP users vs nonusers. The eight studies in this review found significant differences in ACL laxity, tear, and composition between OCP users and non-users. However, insufficient evidence was gathered due to confounding variables and lack of standardization between studies, which prevent this from being utilized in a clinical setting. Future research can investigate and expand upon the findings presented in this review and can seek to address where OCP usage might have a place in prevention of ACL tears in the future.

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Oral Contraceptives as Possible ACL Injury Prevention Method

ABSTRACT

Introduction: Anterior Cruciate Ligament (ACL) injuries are an upsetting setback for many athletes that require a long and costly recovery process. The injury rates are four times greater in women than men. Preventative measures that help to prevent ACL injuries are limited to stretching and strengthening. Therefore, this review aims to investigate if oral contraceptive [I] usage provides a possible new avenue for prevention of ACL injury [O] in young female athletes (ages 18-30) [P] compared to those that do not take oral contraceptives [C].

Methods: A literature review was performed though PubMed, Google Scholar, SCOPUS Database, and ClinicalKey in October 2018. A total of eight articles were found that consisted of retrospective cohort studies, case control studies, and controlled laboratory studies. These studies were selected based on population age, population sex, publication date, and intervention. The design, methods, and outcomes of these studies were then compared and discussed further.

Results: The results from each of the studies reveal statistically significant differences in percentage of ACL tears and joint laxity between OCP users and non-OCP users. While the evidence did further explain and fill in the gaps on OCP’s effect on ACL tissues, the evidence was not sufficient to back the idea of utilizing OCPs safely for ACL prevention. Many confounding variables need to be analyzed and further studied in order for this to be brought into clinical practice, but the means to do it are available with the evidence presented in these articles. Three studies found increased risk of ACL tears in non-OCP users, while one found no statistically significant difference. Two articles found decreased anterior tibial translation in OCP users compared to non-users. Two studies found increased degradation of collagen fibers in non-OCP users compared to users.

Discussion: While there were different measures studied, they all lend support to OCP use being a preventative measure in ACL tears. In some studies, there was limited sample populations, while in others there was failure to collect crucial demographic and comorbid characteristics. Both of these decrease external validity. Lack of standardizing a length of treatment with OCP, type of OCP, and comorbid conditions limit the findings from having a high clinical significance. The efficacy of OCP as a preventative measure in ACL tears is not entirely ready for clinical practice, yet. However, there is much room for future research direction and growth. The findings do lend support to a promising future in utilizing OCPs as a preventative measure in ACL injury.

Conclusion: ACL injury has been linked to increased risk in females, and further, an increased risk at specific days in a menstrual cycle and in females who are not on OCPs. Little evidence, however, has been collected directly investigating ACL composition and tear rate in OCP users vs nonusers. The eight studies in this review found significant differences in ACL laxity, tear, and composition between OCP users and non-users. However, insufficient evidence was gathered due to confounding variables and lack of standardization between studies, which prevent this from being utilized in a clinical setting. Future research can investigate and expand upon the findings presented in this review and can seek to address where OCP usage might have a place in prevention of ACL tears in the future.

 
 

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