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Date of Award
Spring 2020
Degree Name
Master of Medical Science (Physician Assistant)
Department
Physician Assistant; College of Health Sciences
First Advisor
Renee Langstaff
Abstract
Introduction: Anterior cruciate ligament (ACL) injury is the most common ligamentous knee injury, and often leads to poor outcomes in young otherwise healthy athletes. Female athletes are two to eight times more likely to sustain ACL injuries compared to male athletes. The primary function of the ACL is to prevent anterior translation of the tibia and promote knee stabilization. The tissue of the ACL is most commonly stressed during directional changes and rapid declaration. Ligamentous tissue contains estrogen and progesterone receptors making the ACL susceptible to hormonal fluctuations. Oral contraceptive pills (OCP) maintain steady hormone concentrations and eliminates ovulation. Existing research suggests that females using OCPs may be less likely to sustain an ACL injury compared to females not taking OCPs. The purpose of this investigation is to determine if OCP users are more protected against anterior cruciate ligament rupture than non oral contraceptive (NOCP) users in female athletes ages 15 to 24.
Methods: A literature search was conducted in November 2018 utilizing PubMed and Google Scholar. A total of six studies were selected including randomized control, case-control, and systematic review designs. Studies were included based upon the date of publication, specific study population, and comparison of OCP and NOCP users.
Results: Six articles were analyzed incorporating multiple study designs and study population sizes. While the methods varied, similar outcomes were supported. In general, all of the studies found that women not taking OCPs had fluctuations in their estrogen levels that correlated with measurable change in their ACL functionality. Five of the six studies suggested that ACL injuries occur most commonly during the period of preovulation. The four studies that investigates knee laxity in relation to hormone change, reported that women using OCPs maintained a stable knee joint, resulting in lower reported incidence of rupture.
Discussion: Based on this review there appears to be significant support that OCPs maintain steady hormone levels leading to a more stable knee joint, less knee laxity, and ultimately less ACL injury. While OCPs are proposed to be protective against knee injury in young female athletes, there are no current studies evaluating the prophylactic use of OCPs in this population. Considerations regarding the anticipated side effects or complications of putting young female athletes on OCPs must be investigated for this capacity.
Recommended Citation
Giovinazzo, Alexis, "The Impact of Oral Contraception on Anterior Cruciate Ligament Injury in Young Female Athletes" (2020). Capstone Showcase. 87.
https://scholarworks.arcadia.edu/showcase/2020/pa/87
Additional Files
giovinazzo, PICO presentation.mp4 (10099 kB)Presentation
Giovinazzo_PAThesis.pptx (109 kB)
Poster
The Impact of Oral Contraception on Anterior Cruciate Ligament Injury in Young Female Athletes
Introduction: Anterior cruciate ligament (ACL) injury is the most common ligamentous knee injury, and often leads to poor outcomes in young otherwise healthy athletes. Female athletes are two to eight times more likely to sustain ACL injuries compared to male athletes. The primary function of the ACL is to prevent anterior translation of the tibia and promote knee stabilization. The tissue of the ACL is most commonly stressed during directional changes and rapid declaration. Ligamentous tissue contains estrogen and progesterone receptors making the ACL susceptible to hormonal fluctuations. Oral contraceptive pills (OCP) maintain steady hormone concentrations and eliminates ovulation. Existing research suggests that females using OCPs may be less likely to sustain an ACL injury compared to females not taking OCPs. The purpose of this investigation is to determine if OCP users are more protected against anterior cruciate ligament rupture than non oral contraceptive (NOCP) users in female athletes ages 15 to 24.
Methods: A literature search was conducted in November 2018 utilizing PubMed and Google Scholar. A total of six studies were selected including randomized control, case-control, and systematic review designs. Studies were included based upon the date of publication, specific study population, and comparison of OCP and NOCP users.
Results: Six articles were analyzed incorporating multiple study designs and study population sizes. While the methods varied, similar outcomes were supported. In general, all of the studies found that women not taking OCPs had fluctuations in their estrogen levels that correlated with measurable change in their ACL functionality. Five of the six studies suggested that ACL injuries occur most commonly during the period of preovulation. The four studies that investigates knee laxity in relation to hormone change, reported that women using OCPs maintained a stable knee joint, resulting in lower reported incidence of rupture.
Discussion: Based on this review there appears to be significant support that OCPs maintain steady hormone levels leading to a more stable knee joint, less knee laxity, and ultimately less ACL injury. While OCPs are proposed to be protective against knee injury in young female athletes, there are no current studies evaluating the prophylactic use of OCPs in this population. Considerations regarding the anticipated side effects or complications of putting young female athletes on OCPs must be investigated for this capacity.