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Hayes-Lattin M, Krivicich LM, Bragg JT, Rogerson A, Salzler MJ. Considerations for the care of transgender patients in orthopaedics and sports medicine: a narrative review. Br J Sports Med 2024; 58:1075-1082. [PMID: 38997148 DOI: 10.1136/bjsports-2023-107703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/01/2024] [Indexed: 07/14/2024]
Abstract
Orthopaedic and sports medicine clinicians can improve outcomes for transgender patients by understanding the physiological effects of gender-affirming hormone therapy (GAHT). This narrative review investigated the role of GAHT on bone mineral density, fracture risk, thromboembolic risk, cardiovascular health and ligament/tendon injury in this population. A search from the PubMed database using relevant terms was performed. Studies were included if they were levels 1-3 evidence. Due to the paucity of studies on ligament and tendon injury risk in transgender patients, levels 1-3 evidence on the effects of sex hormones in cisgender patients as well as basic science studies were included for these two topics. This review found that transgender patients on GAHT have an elevated fracture risk, but GAHT has beneficial effects on bone mineral density in transgender women. Transgender women on GAHT also have an increased risk of venous thromboembolism, stroke and myocardial infarction compared with cisgender women. Despite these elevated risks, studies have found it is safe to continue GAHT perioperatively for both transgender women and men undergoing low-risk operations. Orthopaedic and sports medicine clinicians should understand these unique health considerations for equitable patient care.
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Affiliation(s)
| | - Laura M Krivicich
- Department of Orthopaedics, Tufts Medical Center, Boston, Massachusetts, USA
| | - Jack T Bragg
- Department of Orthopaedics, Tufts Medical Center, Boston, Massachusetts, USA
| | - Ashley Rogerson
- Department of Orthopaedics, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
| | - Matthew J Salzler
- Department of Orthopaedics, Tufts Medical Center, Boston, Massachusetts, USA
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MacMillan C, Olivier B, Viljoen C, van Rensburg DCJ, Sewry N. The Association Between Menstrual Cycle Phase, Menstrual Irregularities, Contraceptive Use and Musculoskeletal Injury Among Female Athletes: A Scoping Review. Sports Med 2024:10.1007/s40279-024-02074-5. [PMID: 39215933 DOI: 10.1007/s40279-024-02074-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/02/2024] [Indexed: 09/04/2024]
Abstract
BACKGROUND The influence of menstrual cycle phases (MCPs), menstrual irregularities (MI) and hormonal contraceptive (HC) use on injury among female athletes has been scrutinised. Existing systematic reviews investigating the effect of exposures affecting the endogenous reproductive hormone status on sporting injuries are limited in terms of the types of studies included and injuries investigated. OBJECTIVE This scoping review aims to summarise the coverage of the literature related to the extent, nature and characteristics of the influence of MCP, MI and HC use on musculoskeletal injuries among athletes. It also aims to summarise key concepts and definitions in the relevant literature. Observational and experimental studies investigating the effect of MCP, MI, and HC on musculoskeletal injuries among female individuals of reproductive age were included. Studies specifically stating pregnant women, perimenopausal/postmenopausal athletes, or those using medication (other than HC) that affects reproductive hormone profiles or the musculoskeletal system were excluded. METHODS This scoping review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping reviews and JBI scoping review guidelines. Published and unpublished studies were sourced from several databases and resources. Initial keywords used included terms related to "menstrual cycle", "hormonal contraception" and "injury." Titles and abstracts of identified citations were screened independently and assessed for eligibility by two independent reviewers. Data from the included studies were extracted using a standard data extraction form. RESULTS The search yielded 10,696 articles, of which 96 met the eligibility criteria. Most studies investigated MI (77%), and 49% included MCP as a contributing injury risk factor. Publications have increased over the last two decades. Collectively, only 16% of research has been conducted in Africa, Asia and Oceania. There were no studies from South America. Seventy-five percent of the studies investigated individual versus team (25%) sport athletes. Most studies only investigated elite or professional (n = 24; 25%) level athletes. The definitions of injury, eumenorrhea and MI differ vastly among studies. Regarding MI, most studies (69%) investigated secondary amenorrhea, followed by oligomenorrhea (51%) and primary amenorrhea (43%). Concerning HC, the influence of oral contraceptive pills was mainly investigated. CONCLUSIONS Research related to MCP, MI and HC as contributing musculoskeletal injury risk factors is increasing; however, several gaps have been identified, including research from countries other than North America and Europe, the study population being non-professional/elite level athletes, athletes participating in team sports and specific injuries related to MCP, MI and HC, respectively. Differences in methodology and terminology of injury, MCP and MI hinder comparative summative research, and future research should consider current published guidelines during the study design. Identifying barriers to following standard guidelines or research investigating the most practical yet accurate methods to investigate the influence of MCP on musculoskeletal health might yield valuable insights for future research designs. CLINICAL TRIAL REGISTRATION Scoping review registration number: Open Science Framework ( https://doi.org/10.17605/OSF.IO/5GWBV ).
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Affiliation(s)
- Candice MacMillan
- Department of Physiology, Faculty of Health Sciences, University of Pretoria, South Street, Pretoria, 0083, Gauteng, South Africa.
- Sport, Exercise Medicine, and Lifestyle Institute (SEMLI), Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa.
| | - Benita Olivier
- Centre for Healthy Living Research, Oxford Institute of Allied Health Research, Department of Sport, Health Sciences and Social Work, Oxford Brookes University, Oxford, UK
- Wits Cricket Research Hub for Science, Medicine and Rehabilitation, Department of Physiotherapy, School of Therapeutic Sciences, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Carel Viljoen
- Department of Physiotherapy, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
| | | | - Nicola Sewry
- Sport, Exercise Medicine, and Lifestyle Institute (SEMLI), Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
- International Olympic Committee (IOC) Research Centre, Pretoria, South Africa
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Graves L, Lukert BP. The Role of Sex and Gender in Transgender Bone and Other Musculoskeletal Health. J Bone Joint Surg Am 2024; 106:1507-1511. [PMID: 39167064 DOI: 10.2106/jbjs.24.00119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/23/2024]
Abstract
ABSTRACT Musculoskeletal changes occur with gender-affirming hormonal therapy (GAHT) and gender-affirming surgery (GAS) used in the care of transgender adolescents and adults. Survey results have shown that orthopaedic surgeons desire to care for transgender individuals but express concern over a knowledge deficit. This article reviews the physiology and pathophysiology that may occur with GAHT and GAS. Transgender women have lower bone mineral density (BMD) prior to GAHT than cisgender men. Limited fracture data would suggest that transgender women >50 years of age have fracture rates similar to those of cisgender women. Transgender men have normal BMD prior to GAHT and are not at an increased risk for fracture compared with cisgender women. The use of puberty-blocking medications in the care of transgender youth does result in a decline in BMD, which returns to baseline with GAHT, but the effect of delaying puberty on maximal BMD and the lifetime fracture risk are unknown. At present, dual x-ray absorptiometry (DXA) is used to measure BMD and assess fracture risk. Attention should be paid to using the appropriate reference group in the interpretation of DXA for transgender individuals. Promote musculoskeletal health by ensuring appropriate calcium, vitamin D, weight-bearing activity, and a healthy lifestyle. Adherence to GAHT needs to be encouraged to avoid bone loss. Data with regard to therapy for osteoporosis in transgender patients have been lacking, but, at present, use of available therapies is expected to be effective. Information with regard to differences in other musculoskeletal health issues such as joint injuries has been lacking in transgender individuals.
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Affiliation(s)
- Leland Graves
- University of Kansas Medical Center, Kansas City, Kansas
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Barlow A, Blodgett JM, Williams S, Pedlar CR, Bruinvels G. Injury Incidence, Severity, and Type Across the Menstrual Cycle in Female Footballers: A Prospective Three Season Cohort Study. Med Sci Sports Exerc 2024; 56:1151-1158. [PMID: 38227488 DOI: 10.1249/mss.0000000000003391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2024]
Abstract
PURPOSE The aim of the study was to assess the influence of menstrual cycle phase on injury incidence, severity, and type in elite female professional footballers over three seasons. METHODS Time-loss injuries and menstrual cycle data were prospectively recorded for 26 elite female football players across three seasons. The menstrual cycle was categorized into four phases using a standardized model: menstruation (phase 1; P1), remainder of follicular phase (phase 2; P2), early luteal (phase 3; P3), and premenstrual phase (phase 4; P4). Injury incidence rates (IIR) and ratios (IIRR) were calculated for overall injuries, injury severity, type, contact vs noncontact, and game/training. RESULTS A total of 593 cycles across 13,390 d were tracked during the study, and 74 injuries from 26 players were eligible for analysis. When comparing IIR between phases (reference: P1), overall injury rates were highest in P4 (IIRR, 2.30 (95% confidence interval, 0.99-5.34; P = 0.05)). When examining rates by injury severity and type, IIR values were also highest in P4 for ≤7 d' time-loss (4.40 (0.93-20.76; P = 0.06)), muscle-specific (6.07 (1.34-27.43; P = 0.02)), and noncontact (3.05 (1.10-8.50; P = 0.03)) injuries. Muscle-specific (IIRR P3/P1, 5.07 (1.16-22.07; P = 0.03)) and ≤7 d' time-loss (4.47 (1.01-19.68; P = 0.05)) injury risk was also significantly higher in P3. Muscle injuries were the most prevalent subtype ( n = 41). No anterior cruciate ligament injuries were recorded across the monitoring period. CONCLUSIONS Injury risk was significantly elevated during the luteal phase of the menstrual cycle (P3 and P4) among elite female professional footballers. Further research is urgently needed to better understand the influence of the menstrual cycle on injury risk and to develop interventions to mitigate risk.
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Affiliation(s)
- Ally Barlow
- Centre for Health, and Injury & Illness Prevention in Sport, Department for Health, University of Bath, Bath, UNITED KINGDOM
| | - Joanna M Blodgett
- Institute of Sport, Exercise and Health, Division of Surgery and Interventional Science, University College London, UNITED KINGDOM
| | - Sean Williams
- Centre for Health, and Injury & Illness Prevention in Sport, Department for Health, University of Bath, Bath, UNITED KINGDOM
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Saito R, Shagawa M, Sugimoto Y, Hirai T, Kato K, Sekine C, Yokota H, Hirabayashi R, Ishigaki T, Akuzawa H, Togashi R, Yamada Y, Osanami H, Edama M. Changes in the mechanical properties of the thigh and lower leg muscle-tendon units during the early follicular and early luteal phases. Front Sports Act Living 2024; 6:1323598. [PMID: 38596640 PMCID: PMC11002163 DOI: 10.3389/fspor.2024.1323598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Accepted: 03/12/2024] [Indexed: 04/11/2024] Open
Abstract
Background This study aimed to determine changes in the muscle and tendon stiffness of the thigh and lower leg muscle-tendon units during the early follicular and early luteal phases, and check for possible relations between muscle and tendon stiffness in each phase. Methods The sample consisted of 15 female university students with regular menstrual cycles. The basal body temperature method, ovulation kit, and salivary estradiol concentration measurement were used to estimate the early follicular and early luteal phases. A portable digital palpation device measured muscle-tendon stiffness in the early follicular and early luteal phases. The measurement sites were the rectus femoris (RF), vastus medialis (VM), patellar tendon (PT), medial head of gastrocnemius muscle, soleus muscle, and Achilles tendon. Results No statistically significant differences in the thigh and lower leg muscle-tendon unit stiffness were seen between the early follicular and early luteal phases. Significant positive correlations were found between the stiffness of the RF and PT (r = 0.608, p = 0.016) and between the VM and PT (r = 0.737, p = 0.002) during the early luteal phase. Conclusion The present results suggest that the stiffness of leg muscle-tendon units of the anterior thigh and posterior lower leg do not change between the early follicular and early luteal phases and that tendons may be stiffer in those women who have stiffer anterior thigh muscles during the early luteal phase.
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Paschall L, Carrozzi S, Tabdanov E, Dhawan A, Szczesny SE. Cyclic loading induces anabolic gene expression in ACLs in a load-dependent and sex-specific manner. J Orthop Res 2024; 42:267-276. [PMID: 37602554 DOI: 10.1002/jor.25677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 06/28/2023] [Accepted: 07/26/2023] [Indexed: 08/22/2023]
Abstract
Anterior cruciate ligament (ACL) injuries are historically thought to be a result of a single acute overload or traumatic event. However, recent studies suggest that ACL failure may be a consequence of fatigue damage. Additionally, the remodeling response of ACLs to fatigue loading is unknown. Therefore, the objective of this study was to investigate the remodeling response of ACLs to cyclic loading. Furthermore, given that women have an increased rate of ACL rupture, we investigated whether this remodeling response is sex specific. ACLs were harvested from male and female New Zealand white rabbits and cyclically loaded in a tensile bioreactor mimicking the full range of physiological loading (2, 4, and 8 MPa). Expression of markers for anabolic and catabolic tissue remodeling, as well as inflammatory cytokines, was quantified using quantitative reverse transcription polymerase chain reaction. We found that the expression of markers for tissue remodeling of the ACL is dependent on the magnitude of loading and is sex specific. Male ACLs activated an anabolic response to cyclic loading at 4 MPa but turned off remodeling at 8 MPa. These data support the hypothesis that noncontact ACL injury may be a consequence of failed tissue remodeling and inadequate repair of microtrauma resulting from elevated loading. Compared to males, female ACLs failed to increase anabolic gene expression with loading and exhibited higher expression of catabolic genes at all loading levels, which may explain the increased rate of ACL tears in women. Together, these data provide insight into load-induced ACL remodeling and potential causes of tissue rupture.
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Affiliation(s)
- Lauren Paschall
- Department of Biomedical Engineering, The Pennsylvania State University, University Park, Pennsylvania, USA
| | - Sabrina Carrozzi
- Department of Biomedical Engineering, The Pennsylvania State University, University Park, Pennsylvania, USA
| | - Erdem Tabdanov
- Department of Pharmacology, The Penn State College of Medicine, Hershey, Pennsylvania, USA
| | - Aman Dhawan
- Department of Orthopaedics and Rehabilitation, The Pennsylvania State University, Hershey, Pennsylvania, USA
| | - Spencer E Szczesny
- Department of Biomedical Engineering, The Pennsylvania State University, University Park, Pennsylvania, USA
- Department of Orthopaedics and Rehabilitation, The Pennsylvania State University, Hershey, Pennsylvania, USA
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McGovern MM, Lowenstein NA, Matzkin EG. Sports Medicine Considerations When Caring for the Transgender Athlete. Arthrosc Sports Med Rehabil 2023; 5:100736. [PMID: 37645385 PMCID: PMC10461145 DOI: 10.1016/j.asmr.2023.04.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 04/13/2023] [Indexed: 08/31/2023] Open
Abstract
Orthopaedic surgeons and other orthopaedic care providers have expressed a desire to care for transgender patients but have a self-perceived knowledge deficit. Transgender athletes experience many psychosocial barriers to sport that are useful for clinicians to understand. Medical and surgical gender-affirming care can impact musculoskeletal physiology and pathophysiology. Transgender women (TW) have demonstrated an increased risk of insufficiency fractures and thromboembolism in patients receiving exogenous estrogen therapy. The impact of gender-affirming care on sex-based differences in athletic injuries is less well studied.
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Affiliation(s)
- Madeline M. McGovern
- Department of Orthopaedic Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Natalie A. Lowenstein
- Department of Orthopaedic Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Elizabeth G. Matzkin
- Department of Orthopaedic Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
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Ruedl G, Posch M, Tecklenburg K, Schranz A, Faulhaber M, Burtscher M. Skill-Specific Differences in Equipment-Related Risk Factors for ACL Injury in Male and Female Recreational Skiers. Orthop J Sports Med 2023; 11:23259671231155841. [PMID: 36896096 PMCID: PMC9989403 DOI: 10.1177/23259671231155841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Accepted: 11/08/2022] [Indexed: 03/11/2023] Open
Abstract
Background In recreational alpine skiing, the anterior cruciate ligament (ACL) is affected in approximately 50% of serious knee injuries. There are established sex-based and skill-based differences in ACL injury risk, but the potential impact of equipment used (eg, skis, bindings, and boots) has not been evaluated. Purpose To evaluate individual and equipment-related risk factors for an ACL injury depending on sex and skill level. Study Design Case-control study; Level of evidence, 3. Methods This was a retrospective questionnaire-based, case-control study of female and male skiers with and without ACL injuries during 6 winter seasons (from 2014-2015 to 2019-2020). Demographic data, skill level, equipment specifications, risk-taking behavior, and ownership of ski equipment were recorded. Ski geometry (ski length; sidecut radius; and widths of the tip, waist, and tail) was taken from each participant's ski. The standing heights of the front and back part of the ski binding were measured using a digital sliding caliper, and the standing height ratio was calculated. Abrasion of the ski boot sole was also measured at the toe and heel. Participants were divided by sex into less and more skilled skiers. Results A total of 1817 recreational skiers participated in this study, of whom 392 (21.6%) sustained an ACL injury. A greater standing height ratio and more abrasion at the toe of the boot sole were associated with increased ACL injury risk in both sexes, independent of the skill level. Riskier behavior increased the injury risk only in male skiers, independent of the skill level, and longer skis increased the injury risk only in less skilled female skiers. Older age, the use of rented/borrowed skis, and more abrasion at the heel of the boot sole were independent risk factors for ACL injury in the more skilled skiers of both sexes. Conclusion Individual and equipment-related risk factors for an ACL injury partly differed according to skill level and sex. Consideration of the demonstrated equipment-related factors should be implemented in order to reduce ACL injuries in recreational skiers.
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Affiliation(s)
- Gerhard Ruedl
- Department of Sport Science, Universität Innsbruck, Innsbruck, Austria
| | - Markus Posch
- Department of Sport Science, Universität Innsbruck, Innsbruck, Austria
| | | | | | - Martin Faulhaber
- Department of Sport Science, Universität Innsbruck, Innsbruck, Austria
| | - Martin Burtscher
- Department of Sport Science, Universität Innsbruck, Innsbruck, Austria
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Martínez-Fortuny N, Alonso-Calvete A, Da Cuña-Carrera I, Abalo-Núñez R. Menstrual Cycle and Sport Injuries: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:3264. [PMID: 36833966 PMCID: PMC9958828 DOI: 10.3390/ijerph20043264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 02/09/2023] [Accepted: 02/10/2023] [Indexed: 06/18/2023]
Abstract
The presence of female athletes has only increased in recent years, as has the incidence of injuries in female sports activities. These injuries are conditioned by multiple factors, including hormonal agents. It is estimated that the menstrual cycle may be related to the predisposition to suffer an injury. However, a causal relationship has not yet been established. The aim of this study was to analyse the relationship between the menstrual cycle and injuries in female sports practice. A systematic search of the scientific literature available in PubMed, Medline, Scopus, Web of Science, and Sport Discus was carried out in January 2022. With 138 articles, only eight studies were found that met the selection criteria for this study. Peak estradiol is associated with increased laxity, strength, and poor use of neuromuscular control. Thus, the ovulatory phase is associated with an increased risk of injury. In conclusion, it seems that hormonal fluctuations throughout the menstrual cycle alter values such as laxity, strength, body temperature, and neuromuscular control, among others. This fact causes women to constantly adapt to hormonal variations, which exposes them to a higher risk of injury.
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Affiliation(s)
| | - Alejandra Alonso-Calvete
- Facultade de Fisioterapia, Universidade de Vigo, 36005 Pontevedra, Spain
- REMOSS Research Group, Universidade de Vigo, 36005 Pontevedra, Spain
| | - Iria Da Cuña-Carrera
- Facultade de Fisioterapia, Universidade de Vigo, 36005 Pontevedra, Spain
- Fisioterapia Clínica (FS1) Research Group, Instituto de Investigación Sanitaria Galicia Sur (IIS Galicia Sur), SERGAS-UVIGO, 36005 Pontevedra, Spain
| | - Rocío Abalo-Núñez
- Facultade de Fisioterapia, Universidade de Vigo, 36005 Pontevedra, Spain
- Fisioterapia Clínica (FS1) Research Group, Instituto de Investigación Sanitaria Galicia Sur (IIS Galicia Sur), SERGAS-UVIGO, 36005 Pontevedra, Spain
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Shagawa M, Maruyama S, Sekine C, Yokota H, Hirabayashi R, Togashi R, Yamada Y, Osanami H, Sato D, Edama M. Knee Laxity in the Menstrual Cycle after Anterior Cruciate Ligament Reconstruction: A Case Series. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:2277. [PMID: 36767641 PMCID: PMC9915399 DOI: 10.3390/ijerph20032277] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 01/23/2023] [Accepted: 01/25/2023] [Indexed: 06/18/2023]
Abstract
The aim of this study was to compare anterior knee laxity (AKL), genu recurvatum (GR), and muscle stiffness between reconstructed and contralateral sides in females who underwent anterior cruciate ligament (ACL) reconstruction during early follicular and ovulatory phases. AKL was measured as an anterior displacement of the tibia using a KS measure. GR was measured as the range of motion of knee hyperextension using a hyperextension apparatus. Muscle stiffness was measured for semitendinosus (ST) and biceps femoris long head (BF) using a MyotonPRO. The study investigated eighteen knees in nine females (Age, 20.4 ± 1.5 years; BMI, 21.5 ± 1.5) with normal menstrual cycles at least 1 year after reconstruction using hamstring autograft. E2 (Estradiol) concentration did not differ between the two phases, but AKL on the reconstructed side was lower during the ovulatory phase (8.3 [5.9-9.3] mm) than during the early follicular phase (9.4 [7.3-9.7] mm) (p = 0.044, r = 0.756), whereas there was no significant difference between the two phases on the contralateral side. AKL side-to-side difference, GR, and muscle stiffness (ST and BF) on both sides did not differ in either phase. These results indicate that AKL may behave differently on the reconstructed and contralateral sides during the menstrual cycle.
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Affiliation(s)
- Mayuu Shagawa
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, 1398 Shimami-cho, Kita-ku, Niigata 950-3198, Japan
| | - Sae Maruyama
- Albirex Niigata Inc. 5-1923-23, Higashiko, Seiro-machi, Kitakanbara-gun, Niigata 957-0101, Japan
| | - Chie Sekine
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, 1398 Shimami-cho, Kita-ku, Niigata 950-3198, Japan
| | - Hirotake Yokota
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, 1398 Shimami-cho, Kita-ku, Niigata 950-3198, Japan
| | - Ryo Hirabayashi
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, 1398 Shimami-cho, Kita-ku, Niigata 950-3198, Japan
| | - Ryoya Togashi
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, 1398 Shimami-cho, Kita-ku, Niigata 950-3198, Japan
| | - Yuki Yamada
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, 1398 Shimami-cho, Kita-ku, Niigata 950-3198, Japan
| | - Haruki Osanami
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, 1398 Shimami-cho, Kita-ku, Niigata 950-3198, Japan
| | - Daisuke Sato
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, 1398 Shimami-cho, Kita-ku, Niigata 950-3198, Japan
| | - Mutsuaki Edama
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, 1398 Shimami-cho, Kita-ku, Niigata 950-3198, Japan
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Edama M, Ohya T, Maruyama S, Shagawa M, Sekine C, Hirabayashi R, Yokota H, Ishigaki T, Akuzawa H, Togashi R, Yamada Y, Takabayashi T. Relationship between Changes in Foot Arch and Sex Differences during the Menstrual Cycle. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 20:ijerph20010509. [PMID: 36612829 PMCID: PMC9819586 DOI: 10.3390/ijerph20010509] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 12/25/2022] [Accepted: 12/26/2022] [Indexed: 06/01/2023]
Abstract
This study investigated the relationship between changes in foot characteristics and sex differences during the menstrual cycle in healthy male and female university students. We examined 10 female subjects and 14 male subjects. The menstrual cycle was divided into the three phases: the early follicular phase, ovulatory phase, and luteal phase via basal body temperature, an ovulation kit, and salivary estradiol and progesterone concentration measurements. Foot characteristics required for the calculation of the arch height index (AHI) were measured using a three-dimensional foot scanner under conditions of 10% and 50% weight-bearing loads. Arch height at 50% of foot length and truncated foot length were measured, and AHI was calculated by dividing arch height by truncated foot length. Arch height flexibility (AHF) was defined as the change in arch height from 10% weight-bearing load to 50% weight-bearing load. AHI was significantly lower in females than in males in the early follicular and ovulatory phases but did not differ significantly between males and females in each phase. AHF did not differ significantly between males and females in each phase. AHI and AHF showed no periodic fluctuation, suggesting that sex differences in AHF may be absent.
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Affiliation(s)
- Mutsuaki Edama
- Athlete Support Medical Center, Niigata University of Health and Welfare, Niigata 950-3198, Japan
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Niigata 950-3198, Japan
| | - Tae Ohya
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Niigata 950-3198, Japan
| | - Sae Maruyama
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Niigata 950-3198, Japan
| | - Mayuu Shagawa
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Niigata 950-3198, Japan
| | - Chie Sekine
- Athlete Support Medical Center, Niigata University of Health and Welfare, Niigata 950-3198, Japan
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Niigata 950-3198, Japan
| | - Ryo Hirabayashi
- Athlete Support Medical Center, Niigata University of Health and Welfare, Niigata 950-3198, Japan
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Niigata 950-3198, Japan
| | - Hirotake Yokota
- Athlete Support Medical Center, Niigata University of Health and Welfare, Niigata 950-3198, Japan
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Niigata 950-3198, Japan
| | - Tomonobu Ishigaki
- Athlete Support Medical Center, Niigata University of Health and Welfare, Niigata 950-3198, Japan
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Niigata 950-3198, Japan
| | - Hiroshi Akuzawa
- Athlete Support Medical Center, Niigata University of Health and Welfare, Niigata 950-3198, Japan
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Niigata 950-3198, Japan
| | - Ryoya Togashi
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Niigata 950-3198, Japan
| | - Yuki Yamada
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Niigata 950-3198, Japan
| | - Tomoya Takabayashi
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Niigata 950-3198, Japan
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12
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Shultz SJ, Cruz MR, Casey E, Dompier TP, Ford KR, Pietrosimone B, Schmitz RJ, Taylor JB. Sex-Specific Changes in Physical Risk Factors for Anterior Cruciate Ligament Injury by Chronological Age and Stages of Growth and Maturation From 8 to 18 Years of Age. J Athl Train 2022; 57:830-876. [PMID: 36638346 PMCID: PMC9842121 DOI: 10.4085/1062-6050-0038.22] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
OBJECTIVE To critically assess the literature focused on sex-specific trajectories in physical characteristics associated with anterior cruciate ligament (ACL) injury risk by age and maturational stage. DATA SOURCES PubMed, CINAHL, Scopus, and SPORTDiscus databases were searched through December 2021. STUDY SELECTION Longitudinal and cross-sectional studies of healthy 8- to 18-year-olds, stratified by sex and age or maturation on ≥1 measure of body composition, lower extremity strength, ACL size, joint laxity, knee-joint geometry, lower extremity alignment, balance, or lower extremity biomechanics were included. DATA EXTRACTION Extracted data included study design, participant characteristics, maturational metrics, and outcome measures. We used random-effects meta-analyses to examine sex differences in trajectory over time. For each variable, standardized differences in means between sexes were calculated. DATA SYNTHESIS The search yielded 216 primary and 22 secondary articles. Less fat-free mass, leg strength, and power and greater general joint laxity were evident in girls by 8 to 10 years of age and Tanner stage I. Sex differences in body composition, strength, power, general joint laxity, and balance were more evident by 11 to 13 years of age and when transitioning from the prepubertal to pubertal stages. Sex differences in ACL size (smaller in girls), anterior knee laxity and tibiofemoral angle (greater in girls), and higher-risk biomechanics (in girls) were observed at later ages and when transitioning from the pubertal to postpubertal stages. Inconsistent study designs and data reporting limited the number of included studies. CONCLUSIONS Critical gaps remain in our knowledge and highlight the need to improve our understanding of the relative timing and tempo of ACL risk factor development.
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Affiliation(s)
- Sandra J. Shultz
- Department of Kinesiology, University of North Carolina, Greensboro
| | | | | | | | | | - Brian Pietrosimone
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill
| | - Randy J. Schmitz
- Department of Kinesiology, University of North Carolina, Greensboro
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13
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Howe D, Cone SG, Piedrahita JA, Collins B, Fordham LA, Griffith EH, Spang JT, Fisher MB. Sex-specific biomechanics and morphology of the anterior cruciate ligament during skeletal growth in a porcine model. J Orthop Res 2022; 40:1853-1864. [PMID: 34751996 PMCID: PMC9081289 DOI: 10.1002/jor.25207] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 09/24/2021] [Accepted: 10/23/2021] [Indexed: 02/04/2023]
Abstract
Pediatric anterior cruciate ligament (ACL) injuries are on the rise, and females experience higher ACL injury risk than males during adolescence. Studies in skeletally immature patients indicate differences in ACL size and joint laxity between males and females after the onset of adolescence. However, functional data regarding the ACL and its anteromedial and posterolateral bundles in the pediatric population remain rare. Therefore, this study uses a porcine model to investigate the sex-specific morphology and biomechanics of the ACL and its bundles throughout skeletal growth. Hind limbs from male and female Yorkshire pigs aged early youth to late adolescence were imaged using magnetic resonance imaging to measure the size and orientation of the ACL and its bundles, then biomechanically tested under anterior-posterior drawer using a robotic testing system. Joint laxity decreased (p < 0.001) while joint stiffness increased (p < 0.001) throughout skeletal growth in both sexes. The ACL was the primary stabilizer against anterior tibial loading, while the functional role of the anteromedial bundle increased with age (p < 0.001), with an earlier increase in males. ACL and posterolateral bundle cross-sectional area and ACL and anteromedial bundle length were larger in males than females during adolescence (p < 0.01 for all), while ACL and bundle sagittal angle remained similar between sexes. Additionally, in situ ACL stiffness versus cross-sectional area regressions were significant across skeletal growth (r2 = 0.75, p < 0.001 in males and r2 = 0.64, p < 0.001 in females), but not within age groups. This study has implications for age and sex-specific surgical intervention strategies and suggests the need for human studies.
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Affiliation(s)
- Danielle Howe
- Joint Department of Biomedical Engineering, North Carolina State University and the University of North Carolina- Chapel Hill; Raleigh, NC 27695,Comparative Medicine Institute, North Carolina State University; Raleigh, NC 27695
| | - Stephanie G. Cone
- Joint Department of Biomedical Engineering, North Carolina State University and the University of North Carolina- Chapel Hill; Raleigh, NC 27695,Comparative Medicine Institute, North Carolina State University; Raleigh, NC 27695,Department of Mechanical Engineering, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Jorge A. Piedrahita
- Comparative Medicine Institute, North Carolina State University; Raleigh, NC 27695,Department of Molecular Biomedical Sciences, North Carolina State University; Raleigh, NC 27695
| | - Bruce Collins
- Comparative Medicine Institute, North Carolina State University; Raleigh, NC 27695,Department of Animal Science, North Carolina State University; Raleigh, NC 27695
| | - Lynn A. Fordham
- Department of Radiology, University of North Carolina- Chapel Hill; Chapel Hill, NC 27599
| | - Emily H. Griffith
- Department of Statistics, North Carolina State University; Raleigh, NC 27695
| | - Jeffrey T. Spang
- Department of Orthopaedics, University of North Carolina- Chapel Hill; Chapel Hill, NC 27599
| | - Matthew B. Fisher
- Joint Department of Biomedical Engineering, North Carolina State University and the University of North Carolina- Chapel Hill; Raleigh, NC 27695,Comparative Medicine Institute, North Carolina State University; Raleigh, NC 27695,Department of Orthopaedics, University of North Carolina- Chapel Hill; Chapel Hill, NC 27599,Corresponding Author Contact: Address: 4130 Engineering Building III, 911 Oval Drive, CB 7115, Raleigh, NC, 27695, Telephone: 919-515-5242, Fax: 919-513-3814,
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14
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Mondini Trissino da Lodi C, Salerno M, Merli G, Brama P, Jenner F, Filardo G. Tendinopathy: sex bias starts from the preclinical development of tendon treatments. A systematic review. Biol Sex Differ 2022; 13:44. [PMID: 35908065 PMCID: PMC9338527 DOI: 10.1186/s13293-022-00453-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 07/07/2022] [Indexed: 11/23/2022] Open
Abstract
Tendinopathies are common overuse disorders that arise both in athletes and the general population. Available tendon treatments are used both for women and men without distinction. However, the existence of a sex-based difference in tendon biology is widely demonstrated. Since basic research represents the foundation for treatment development, an equal female–male representation should be pursued in preclinical studies. This systematic review quantified the current evidence by analyzing 150 studies on 8231 animals. Preclinical studies largely neglected the importance of sex, none analyzed sex-based differences, and only 4% of the studies reported disaggregated data suitable for the analysis of treatment results in males and females. There is an alarming female under-representation, in particular in the field of injective therapies. Despite the growing awareness on the importance of investigating treatments in both males and females, the investigated field proved resistant from properly designing studies including both sexes, and the lack of sex-representation remains critical. Tendinopathy has sex-specific features, with sex hormones affecting tendon metabolism, structure, biomechanical properties, and injury risk. The preclinical research on tendinopathy treatments still neglects sex-based differences, leading to translation of male data to females which may affect clinical effectiveness in women. None of the reviewed studies looked at differences between sexes, and only 4% of the studies reported disaggregated data. Besides, female animals are under-represented. The lack of sex-representation in tendinopathy research remains critical.
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Affiliation(s)
| | - Manuela Salerno
- Applied and Translational Research Center, IRCCS Istituto Ortopedico Rizzoli, 40136, Bologna, Italy
| | - Giulia Merli
- Applied and Translational Research Center, IRCCS Istituto Ortopedico Rizzoli, 40136, Bologna, Italy.
| | - Pieter Brama
- Section Veterinary Clinical Sciences, School of Veterinary Medicine, University College Dublin, 4 Dublin, Ireland
| | - Florien Jenner
- Equine Surgery Unit, University Equine Hospital, Department of Companion Animals and Horses, University of Veterinary Medicine Vienna, Veterinaerplatz, 1210, Vienna, Austria
| | - Giuseppe Filardo
- Service of Orthopaedics and Traumatology, Department of Surgery, EOC, 6900, Lugano, Switzerland.,Applied and Translational Research Center, IRCCS Istituto Ortopedico Rizzoli, 40136, Bologna, Italy.,Faculty of Biomedical Sciences, Università Della Svizzera Italiana, 6900, Lugano, Switzerland
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15
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Nagahori H, Shida N. Relationship between Muscle Flexibility and Characteristics of Muscle Contraction in Healthy Women during Different Menstrual Phases. Phys Ther Res 2022; 25:68-74. [PMID: 36118784 PMCID: PMC9437931 DOI: 10.1298/ptr.e10173] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Accepted: 05/25/2022] [Indexed: 09/22/2023]
Abstract
OBJECTIVE Skeletal muscle function is vital for preventing injury during exercise. It has been reported that skeletal muscle function fluctuates with the menstrual cycle and is considered one of the causes of injury. This study aimed to clarify the relationship between muscle flexibility and muscle contraction characteristics and their changes with the menstrual cycle. METHODS The subjects were healthy women who voluntarily participated in the study through recruitment posters. Muscle flexibility was measured with the passive knee extension (PKE) test, isokinetic knee flexor strength, and the maximum muscle strength exertion angle under two conditions of 60°/s and 120°/s in dominant hamstrings. Additionally, their correlations were analyzed and compared between the menstrual and ovulatory phases. RESULTS Sixteen subjects (mean age: 20.56 ± 0.73 years; body mass index: 20.21 ± 1.60) participated in the study. Correlation analysis showed a significant negative correlation between PKE and the maximum muscle strength exertion angle under the condition of 60°/s during the menstrual phase (r = -0.54; p = 0.03). No significant difference was observed in the two-group comparison of the variables measured during the menstrual and ovulatory phases. CONCLUSION This study confirmed that the more flexible muscles generate the maximum strength at a more contracted position during the menstrual phase in women. In the future, it is necessary to examine the relationship between the results of this study and exercise performance and injury occurrence.
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Affiliation(s)
| | - Nami Shida
- Department of Physical Therapy, Tokyo Metropolitan University, Japan
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16
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Maruyama S, Sekine C, Shagawa M, Yokota H, Hirabayashi R, Togashi R, Yamada Y, Hamano R, Ito A, Sato D, Edama M. Menstrual Cycle Changes Joint Laxity in Females—Differences between Eumenorrhea and Oligomenorrhea. J Clin Med 2022; 11:jcm11113222. [PMID: 35683609 PMCID: PMC9181714 DOI: 10.3390/jcm11113222] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 05/29/2022] [Accepted: 06/03/2022] [Indexed: 01/27/2023] Open
Abstract
The purpose of this study was to investigate the changes in anterior knee laxity (AKL), stiffness, general joint laxity (GJL), and genu recurvatum (GR) during the menstrual cycle in female non-athletes and female athletes with normal and irregular menstrual cycles. Participants were 19 female non-athletes (eumenorrhea, n = 11; oligomenorrhea, n = 8) and 15 female athletes (eumenorrhea, n = 8; oligomenorrhea, n = 7). AKL was measured as the amount of anterior tibial displacement at 67 N–133 N. Stiffness was calculated as change in (Δ)force/Δ anterior displacement. The Beighton method was used to evaluate the GJL. The GR was measured as the maximum angle of passive knee joint extension. AKL, stiffness, GJL, and GR were measured twice in four phases during the menstrual cycle. Stiffness was significantly higher in oligomenorrhea groups than in eumenorrhea groups, although no significant differences between menstrual cycle phases were evident in female non-athletes. GR was significantly higher in the late follicular, ovulation, and luteal phases than in the early follicular phase, although no significant differences between groups were seen in female athletes. Estradiol may affect the stiffness of the periarticular muscles in the knee, suggesting that GR in female athletes may change during the menstrual cycle.
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Affiliation(s)
- Sae Maruyama
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Shimami-cho 1398, Niigata City 950-3198, Japan; (S.M.); (C.S.); (M.S.); (H.Y.); (R.H.); (R.T.); (Y.Y.); (D.S.)
| | - Chie Sekine
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Shimami-cho 1398, Niigata City 950-3198, Japan; (S.M.); (C.S.); (M.S.); (H.Y.); (R.H.); (R.T.); (Y.Y.); (D.S.)
| | - Mayuu Shagawa
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Shimami-cho 1398, Niigata City 950-3198, Japan; (S.M.); (C.S.); (M.S.); (H.Y.); (R.H.); (R.T.); (Y.Y.); (D.S.)
| | - Hirotake Yokota
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Shimami-cho 1398, Niigata City 950-3198, Japan; (S.M.); (C.S.); (M.S.); (H.Y.); (R.H.); (R.T.); (Y.Y.); (D.S.)
| | - Ryo Hirabayashi
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Shimami-cho 1398, Niigata City 950-3198, Japan; (S.M.); (C.S.); (M.S.); (H.Y.); (R.H.); (R.T.); (Y.Y.); (D.S.)
| | - Ryoya Togashi
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Shimami-cho 1398, Niigata City 950-3198, Japan; (S.M.); (C.S.); (M.S.); (H.Y.); (R.H.); (R.T.); (Y.Y.); (D.S.)
| | - Yuki Yamada
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Shimami-cho 1398, Niigata City 950-3198, Japan; (S.M.); (C.S.); (M.S.); (H.Y.); (R.H.); (R.T.); (Y.Y.); (D.S.)
| | - Rena Hamano
- Department of Health and Sports, Niigata University of Health and Welfare, Shimami-cho 1398, Kita-ku, Niigata City 950-3198, Japan; (R.H.); (A.I.)
| | - Atsushi Ito
- Department of Health and Sports, Niigata University of Health and Welfare, Shimami-cho 1398, Kita-ku, Niigata City 950-3198, Japan; (R.H.); (A.I.)
| | - Daisuke Sato
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Shimami-cho 1398, Niigata City 950-3198, Japan; (S.M.); (C.S.); (M.S.); (H.Y.); (R.H.); (R.T.); (Y.Y.); (D.S.)
| | - Mutsuaki Edama
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Shimami-cho 1398, Niigata City 950-3198, Japan; (S.M.); (C.S.); (M.S.); (H.Y.); (R.H.); (R.T.); (Y.Y.); (D.S.)
- Correspondence: ; Tel./Fax: +81-25-257-4723
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17
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Devana SK, Solorzano C, Nwachukwu B, Jones KJ. Disparities in ACL Reconstruction: the Influence of Gender and Race on Incidence, Treatment, and Outcomes. Curr Rev Musculoskelet Med 2022; 15:1-9. [PMID: 34970713 PMCID: PMC8804118 DOI: 10.1007/s12178-021-09736-1] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/22/2021] [Indexed: 01/13/2023]
Abstract
PURPOSE OF REVIEW Anterior cruciate ligament (ACL) rupture is a common injury that has important clinical and economic implications. We aimed to review the literature to identify gender, racial and ethnic disparities in incidence, treatment, and outcomes of ACL injury. RECENT FINDINGS Females are at increased risk for ACL injury compared to males. Intrinsic differences such as increased quadriceps angle and increased posterior tibial slope may be contributing factors. Despite lower rates of injury, males undergo ACL reconstruction (ACLR) more frequently. There is conflicting evidence regarding gender differences in graft failure and ACL revision rates, but males demonstrate higher return to sport (RTS) rates. Females report worse functional outcome scores and have worse biomechanical metrics following ACLR. Direct evidence of racial and ethnic disparities is limited, but present. White athletes have greater risk of ACL injury compared to Black athletes. Non-White and Spanish-speaking patients are less likely to undergo ACLR after ACL tear. Black and Hispanic youth have greater surgical delay to ACLR, increased risk for loss to clinical follow-up, and less physical therapy sessions, thereby leading to greater deficits in knee extensor strength during rehabilitation. Hispanic and Black patients also have greater risk for hospital admission after ACLR, though this disparity is improving. Females have higher rates of ACL injury with inconclusive evidence on anatomic predisposition and ACL failure rate differences between genders. Recent literature has suggested inferior RTS and functional outcomes following ACLR in females. Though there is limited and mixed data on incidence and outcome differences between races and ethnic groups, recent studies suggest there may be disparities in those who undergo ACLR and time to treatment.
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Affiliation(s)
- Sai K. Devana
- Department of Orthopaedic Surgery, University of California, Los Angeles, USA
| | - Carlos Solorzano
- Department of Orthopaedic Surgery, University of California, Los Angeles, USA
| | - Benedict Nwachukwu
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York City, USA
| | - Kristofer J. Jones
- Department of Orthopaedic Surgery, University of California, Los Angeles, USA
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18
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The effect of the menstrual cycle on collagen metabolism, growth hormones and strength in young physically active women. Biol Sport 2021; 38:721-728. [PMID: 34937983 PMCID: PMC8670799 DOI: 10.5114/biolsport.2021.107314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 04/04/2021] [Accepted: 06/01/2021] [Indexed: 11/17/2022] Open
Abstract
This study aimed to investigate the effect of the menstrual cycle on strength, functioning of the GH/IGF-1 axis and collagen metabolism in physically active women. Twenty-four physically active and eumenorrheic women volunteered to participate in the study (body mass 60.3 ± 9.18 kg, age 21.8 ± 0.92 years). Blood samples were obtained between the 5th and 8th days (the follicular phase) and between the 19th and 22th days (the luteal phase) of the menstrual cycle to determine sex steroid concentrations (follicle-stimulating hormone (FSH), luteinizing hormone (LH), prolactin (PRL), oestradiol (E2) and progesterone (P)). Also insulin-like growth factor 1 (IGF-1) and collagen metabolism markers (synthesis (PICP) and breakdown (ICTP)) and maximum voluntary contraction (MVC) were measured. MVC was higher in the luteal phase 164.1 ± 34.77 [N m] (F(1.23) = 4.59; p = 0.043). The recorded collagen synthesis marker (PICP = 296.4 ± 35.61 [ng/ml]) was at the upper level of the reference range (30-300), with an insignificant decrease in the luteal phase (Z = 1.612; p = 0.107) and a significant increase in oestradiol concentration (Z = 4.286; p = 0.0001). The marker of collagen breakdown (ICTP = 4.16 ± 0.68 [μg/l]) was reduced by 6.8% in the same phase (Z = 1.764; p = 0.137). The variability of physical abilities (MVC) during the menstrual cycle showed that menstrual status should be taken into account in determination of the training loads. Increasing the load in the luteal phase seems to be favoured by a beneficial change in collagen metabolism (lower synthesis decrease, lower breakdown increase) observed in physically active women.
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19
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Shagawa M, Maruyama S, Sekine C, Yokota H, Hirabayashi R, Hirata A, Yokoyama M, Edama M. Comparison of anterior knee laxity, stiffness, genu recurvatum, and general joint laxity in the late follicular phase and the ovulatory phase of the menstrual cycle. BMC Musculoskelet Disord 2021; 22:886. [PMID: 34663291 PMCID: PMC8524894 DOI: 10.1186/s12891-021-04767-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Accepted: 10/06/2021] [Indexed: 11/10/2022] Open
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.
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Affiliation(s)
- Mayuu Shagawa
- Department of Physical Therapy, Niigata University of Health and Welfare, 1398 Shimami-cho, Kita-ku, Niigata, 950-3198, Japan
| | - Sae Maruyama
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, 1398 Niigata, Shimami-cho 1398, Kita-ku, Niigata City, 950-3198, Japan
| | - Chie Sekine
- Department of Physical Therapy, Niigata University of Health and Welfare, 1398 Shimami-cho, Kita-ku, Niigata, 950-3198, Japan
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, 1398 Niigata, Shimami-cho 1398, Kita-ku, Niigata City, 950-3198, Japan
| | - Hirotake Yokota
- Department of Physical Therapy, Niigata University of Health and Welfare, 1398 Shimami-cho, Kita-ku, Niigata, 950-3198, Japan
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, 1398 Niigata, Shimami-cho 1398, Kita-ku, Niigata City, 950-3198, Japan
| | - Ryo Hirabayashi
- Department of Physical Therapy, Niigata University of Health and Welfare, 1398 Shimami-cho, Kita-ku, Niigata, 950-3198, Japan
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, 1398 Niigata, Shimami-cho 1398, Kita-ku, Niigata City, 950-3198, Japan
| | - Arisa Hirata
- Department of Physical Therapy, Niigata University of Health and Welfare, 1398 Shimami-cho, Kita-ku, Niigata, 950-3198, Japan
| | - Mizuki Yokoyama
- Department of Physical Therapy, Niigata University of Health and Welfare, 1398 Shimami-cho, Kita-ku, Niigata, 950-3198, Japan
| | - Mutsuaki Edama
- Department of Physical Therapy, Niigata University of Health and Welfare, 1398 Shimami-cho, Kita-ku, Niigata, 950-3198, Japan.
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, 1398 Niigata, Shimami-cho 1398, Kita-ku, Niigata City, 950-3198, Japan.
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20
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Lutz RH, DeMoss DJ, Roebuck EH, Mason T, Eiler BA. Sport-Specific Increased Risk of Anterior Cruciate Ligament Injury Following a Concussion in Collegiate Female Lacrosse. Curr Sports Med Rep 2021; 20:520-524. [PMID: 34622816 DOI: 10.1249/jsr.0000000000000839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
ABSTRACT Poor neurocognitive performance has been associated with a greater risk of musculoskeletal injury, and anterior cruciate ligament (ACL) injury prevention protocols include exercises to improve neuromuscular control. Research shows that a concussion elevates the risk for subsequent lower-extremity injury, because concussions lead to lower neurocognitive performance. Studies have been conducted using data within individual male sports, such as football and rugby, or across collegiate sports in aggregate; no study has focused on women's sports. Using 7 years of data collected by athletic training staff at Davidson College, this paper evaluates preconcussive versus postconcussive lower-extremity injury risk across five collegiate women's sports: field hockey, soccer, basketball, volleyball, and lacrosse. Using incidence rate ratios, lacrosse athletes had a five-fold increase in ACL injury risk within 365 d following a concussion. Recognizing that postconcussive ACL tear risk varies across different women's sports is important in informing sport-specific concussion return to play protocols.
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Affiliation(s)
- Robert H Lutz
- Department of Sports Medicine, Davidson College, Davidson, NC
| | - Deidra J DeMoss
- Department of Sports Medicine, Davidson College, Davidson, NC
| | - Emily H Roebuck
- Department of Sports Medicine, Davidson College, Davidson, NC
| | - Tommy Mason
- Department of Sports Medicine, Davidson College, Davidson, NC
| | - Brian A Eiler
- Department of Psychology, Davidson College, Davidson, NC
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21
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Mercer NP, Gianakos AL, Mercurio AM, Kennedy JG. Clinical Outcomes of Peroneal Tendon Tears: A Systematic Review. J Foot Ankle Surg 2021; 60:1008-1013. [PMID: 33785239 DOI: 10.1053/j.jfas.2021.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 02/25/2021] [Accepted: 03/03/2021] [Indexed: 02/03/2023]
Abstract
The purpose of this study was to provide an overview of the available evidence on peroneal tendon tears and the outcomes after surgical intervention. A systematic review of the literature was performed using MEDLINE, Embase, and Cochrane. Criteria for inclusion were clinical studies reporting outcomes after treatment for peroneal tendon tear within the last 10 years. Nine studies evaluating 336 patients (146 males/190 females) and 336 ankles were included in this review. The mean age of included patients was 46.3 years (range, 46-56.9 years). The weighted mean follow-up was 23.82 months (range 9.2-78 months. Five surgical interventions were reported: primary repair with tenodesis, primary repair without tenodesis, FDL tendon transfer, FHL tendon transfer, and allograft reconstruction. Four studies recorded the AOFAS score, with a weighted mean preoperative score of 69.58 and a weighted mean postoperative score of 88.82. Six studies measured the VAS score showing an improvement from a mean weighted preoperative score of 4.68 to a mean weighted postoperative score of 1.2. FAAM score was measured in 3 studies, which showed an improvement from 41.1 preoperatively to 84.4 postoperatively. The average overall complication rate was 38.7% (130/336) with the most commonly reported minor complication being ankle pain, which made up 46.2% of all minor complications (56/121). Primary repair without tenodesis was associated with a higher complication rate compared to any other surgical intervention (p=.001176). The current systematic review showed that overall clinical outcomes were positive in lieu of the different modalities of surgical intervention for peroneal tendon tears.
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Affiliation(s)
| | - Arianna L Gianakos
- Department of Orthopedic Surgery, Robert Wood Johnson Barnabas Health, Jersey City Medical Center, Jersey City, NJ
| | - Angela M Mercurio
- Department of Orthopedic Surgery, Robert Wood Johnson Barnabas Health, Jersey City Medical Center, Jersey City, NJ
| | - John G Kennedy
- Department of Orthopaedic Surgery, NYU Langone Health, New York, NY.
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22
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Lago-Fuentes C, Padrón-Cabo A, Fernández-Villarino M, Mecías-Calvo M, Muñoz-Pérez I, García-Pinillos F, Rey E. Follicular phase of menstrual cycle is related to higher tendency to suffer from severe injuries among elite female futsal players. Phys Ther Sport 2021; 52:90-96. [PMID: 34450561 DOI: 10.1016/j.ptsp.2021.08.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 08/14/2021] [Accepted: 08/16/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To describe the injury incidence according to each phase of menstrual cycle (MC) in professional futsal players along two consecutive season and, secondly, to compare the injury incidence and frequency between different phases of the MC. DESIGN Prospective cohort study. SETTINGS Elite futsal players. PARTICIPANTS 179 players. MAIN OUTCOME MEASURE Players were registered along two consecutive seasons. RESULTS 191 injuries were reported throughout both seasons. The injury incidence was 30.63 days-off during the follicular phase, 23.6 during ovulatory phase and 17.59 days-off in luteal phase, showing higher incidence during the follicular phase. No statistical differences (p > 0.05) were reported for any variable comparing among the three phases of MC. CONCLUSIONS This study suggests the relevance to track the MC, but reduces its possible relationship or influence on the injury distribution during each phase of the MC. The knowledge of injury incidence, burden and etiology is a key factor to design injury prevention programs with the focus on the most common injuries, where MC could be included as a complementary factor.
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Affiliation(s)
- Carlos Lago-Fuentes
- Facultad de Ciencias de la Salud, Universidad Europea del Atlántico, Spain; Faculty of Education and Sport Sciences, University of Vigo, Pontevedra, Spain.
| | - Alexis Padrón-Cabo
- Faculty of Education and Sport Sciences, University of Vigo, Pontevedra, Spain
| | | | - Marcos Mecías-Calvo
- Facultad de Ciencias de la Salud, Universidad Europea del Atlántico, Spain; Centro de Investigación y Tecnología Industrial de Cantabria (CITICAN), Santander, Spain
| | - Iker Muñoz-Pérez
- Facultad de Ciencias de la Salud, Universidad Europea del Atlántico, Spain; Sport Training, Runnea, Barakaldo, Spain
| | - Felipe García-Pinillos
- Department of Physical Education and Sports, University of Granada, Granada, Spain; Department of Physical Education, Sports and Recreation, Universidad de La Frontera, Temuco, Chile
| | - Ezequiel Rey
- Faculty of Education and Sport Sciences, University of Vigo, Pontevedra, Spain
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23
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Randell RK, Clifford T, Drust B, Moss SL, Unnithan VB, De Ste Croix MBA, Datson N, Martin D, Mayho H, Carter JM, Rollo I. Physiological Characteristics of Female Soccer Players and Health and Performance Considerations: A Narrative Review. Sports Med 2021; 51:1377-1399. [PMID: 33844195 PMCID: PMC8222040 DOI: 10.1007/s40279-021-01458-1] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/22/2021] [Indexed: 12/18/2022]
Abstract
Female soccer has seen a substantial rise in participation, as well as increased financial support from governing bodies over the last decade. Thus, there is an onus on researchers and medical departments to develop a better understanding of the physical characteristics and demands, and the health and performance needs of female soccer players. In this review, we discuss the current research, as well as the knowledge gaps, of six major topics: physical demands, talent identification, body composition, injury risk and prevention, health and nutrition. Data on female talent identification are scarce, and future studies need to elucidate the influence of relative age and maturation selection across age groups. Regarding the physical demands, more research is needed on the pattern of high-intensity sprinting during matches and the contribution of soccer-specific movements. Injuries are not uncommon in female soccer players, but targeting intrinsically modifiable factors with injury prevention programmes can reduce injury rates. The anthropometric and physical characteristics of female players are heterogeneous and setting specific targets should be discouraged in youth and sub-elite players. Menstrual cycle phase may influence performance and injury risk; however, there are few studies in soccer players. Nutrition plays a critical role in health and performance and ensuring adequate energy intake remains a priority. Despite recent progress, there is considerably less research in female than male soccer players. Many gaps in our understanding of how best to develop and manage the health and performance of female soccer players remain.
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Affiliation(s)
- Rebecca K Randell
- Gatorade Sports Science Institute, Life Sciences R&D, PepsiCo, Leicester, UK.
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK.
| | - Thomas Clifford
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
| | - Barry Drust
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK
| | - Samantha L Moss
- Gatorade Sports Science Institute, Life Sciences R&D, PepsiCo, Leicester, UK
- Department of Sport and Exercise Sciences, University of Chester, Chester, UK
| | - Viswanath B Unnithan
- Institute of Clinical Exercise and Health Science, Division of Sport and Exercise, School of Health and Life Sciences, University of the West of Scotland, Hamilton, Scotland, UK
| | | | - Naomi Datson
- Institute of Sport, University of Chichester, Chichester, UK
| | - Daniel Martin
- School of Sport and Exercise Science, University of Lincoln, Lincoln, UK
| | - Hannah Mayho
- Sports Science Department, Manchester City Football Club, Manchester, UK
| | - James M Carter
- Gatorade Sports Science Institute, Life Sciences R&D, PepsiCo, Leicester, UK
| | - Ian Rollo
- Gatorade Sports Science Institute, Life Sciences R&D, PepsiCo, Leicester, UK
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
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24
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Edama M, Inaba H, Hoshino F, Natsui S, Maruyama S, Omori G. The relationship between the female athlete triad and injury rates in collegiate female athletes. PeerJ 2021; 9:e11092. [PMID: 33868810 PMCID: PMC8034341 DOI: 10.7717/peerj.11092] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Accepted: 02/20/2021] [Indexed: 11/24/2022] Open
Abstract
Background This study aimed to clarify the relationship between the triad risk assessment score and the sports injury rate in 116 female college athletes (average age, 19.8 ± 1.3 years) in seven sports at the national level of competition; 67 were teenagers, and 49 were in their 20s. Methods Those with menstrual deficiency for >3 months or <6 menses in 12 months were classified as amenorrheic athletes. Low energy availability was defined as adolescent athletes having a body weight <85% of ideal body weight, and for adult athletes in their 20s, a body mass index ≤17.5 kg/m2. Bone mineral density (BMD) was measured on the heel of the right leg using an ultrasonic bone densitometer. Low BMD was defined as a BMD Z-score <−1.0. The total score for each athlete was calculated. The cumulative risk assessment was defined as follows: low risk (a total score of 0–1), moderate risk (2–5), and high risk (6). The injury survey recorded injuries referring to the injury survey items used by the International Olympic Committee. Results In swimming, significantly more athletes were in the low-risk category than in the moderate and high-risk categories (p = 0.004). In long-distance athletics, significantly more athletes were in the moderate-risk category than in the low and high-risk categories (p = 0.004). In the moderate and high-risk categories, significantly more athletes were in the injury group, whereas significantly more athletes in the low-risk category were in the non-injury group (p = 0.01). Significantly more athletes at moderate and high-risk categories had bone stress fractures and bursitis than athletes at low risk (p = 0.023). Discussion These results suggest that athletes with relative energy deficiency may have an increased injury risk.
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Affiliation(s)
- Mutsuaki Edama
- Athlete Support Research Center, Niigata University of Health and Welfare, Niigata, Japan, Niigata, Niigata, Japan.,Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Niigata, Japan, Niigata, Niigata, Japan
| | - Hiromi Inaba
- Athlete Support Research Center, Niigata University of Health and Welfare, Niigata, Japan, Niigata, Niigata, Japan.,Department of Health and Nutrition, Niigata University of Health and Welfare, Niigata, Japan, Niigata, Japan
| | - Fumi Hoshino
- Department of Health and Nutrition, Niigata University of Health and Welfare, Niigata, Japan, Niigata, Japan
| | - Saya Natsui
- Department of Health and Nutrition, Niigata University of Health and Welfare, Niigata, Japan, Niigata, Japan
| | - Sae Maruyama
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Niigata, Japan, Niigata, Niigata, Japan
| | - Go Omori
- Athlete Support Research Center, Niigata University of Health and Welfare, Niigata, Japan, Niigata, Niigata, Japan.,Department of Health and Sports, Niigata University of Health and Welfare, Niigata, Japan, Niigata, Niigata, Japan
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25
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Maruyama S, Yamazaki T, Sato Y, Suzuki Y, Shimizu S, Ikezu M, Kaneko F, Matsuzawa K, Hirabayashi R, Edama M. Relationship Between Anterior Knee Laxity and General Joint Laxity During the Menstrual Cycle. Orthop J Sports Med 2021; 9:2325967121993045. [PMID: 33855094 PMCID: PMC8010836 DOI: 10.1177/2325967121993045] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Accepted: 11/13/2020] [Indexed: 11/17/2022] Open
Abstract
Background Anterior cruciate ligament (ACL) injury has been reported to have a higher incidence in women than in men. Purpose/Hypothesis The purpose was to examine the relationship of anterior knee laxity (AKL), stiffness, and generalized joint laxity (GJL) with respect to the menstrual cycle. It was hypothesized that AKL and GJL would increase during the ovulation phase, when estrogen levels are high. Study Design Descriptive laboratory study. Methods A total of 15 female university students aged >20 years and with normal menstrual cycles were evaluated. AKL was measured as anterior tibial displacement of the femur after application of 44-, 89-, and 133-N loads to the tibia. Stiffness was calculated as Δ force/Δ displacement at loads between 44 and 89 N and between 89 and 133 N. The University of Tokyo joint laxity test was used for evaluation of GJL. The participants' menstrual cycle was divided into the early follicular, late follicular, ovulation, and luteal phases using the basal body temperature method and an ovulation kit; AKL and GJL were measured once during each phase. Participants were also stratified according to the presence or absence of genu recurvatum (GR). Results There was no significant difference in AKL, stiffness, or GJL among the menstrual phases. In the GR group, AKL values at 89 N and 133 N were significantly higher in the ovulation phase than in the early follicular phase (P = .025 and P =.018, respectively); there were no significant differences in AKL among the phases in the non-GR group. In addition, the GR group in the ovulation phase had significantly higher AKL values at 44 N, 89 N, and 133 N compared with the non-GR group (P = .013, P = .005, and P = .010, respectively). There were no significant differences in GJL among the phases in the GR or non-GR groups. Conclusion Women with GR may have increased AKL in the ovulation phase when compared with the early follicular phase, which may be a risk factor for ACL injury. Clinical Relevance The results of this study suggest that the ovulation phase may be related to the greater incidence of ACL injuries in women.
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Affiliation(s)
- Sae Maruyama
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Niigata, Japan
| | - Tomomi Yamazaki
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Niigata, Japan
| | - Yuuki Sato
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Niigata, Japan
| | - Yukako Suzuki
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Niigata, Japan
| | - Sohei Shimizu
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Niigata, Japan
| | - Masahiro Ikezu
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Niigata, Japan
| | - Fumiya Kaneko
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Niigata, Japan
| | - Kanta Matsuzawa
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Niigata, Japan
| | - Ryo Hirabayashi
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Niigata, Japan
| | - Mutsuaki Edama
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Niigata, Japan
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26
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A preliminary study exploring the change in ankle joint laxity and general joint laxity during the menstrual cycle in cis women. J Foot Ankle Res 2021; 14:21. [PMID: 33761990 PMCID: PMC7988940 DOI: 10.1186/s13047-021-00459-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Accepted: 03/03/2021] [Indexed: 11/21/2022] Open
Abstract
Background The purpose of the present study was to examine the relationship between ankle joint laxity and general joint laxity (GJL) in relation to the menstrual cycle, which was divided into four phases based on basal body temperature and ovulation, assessed using an ovulation kit. Methods Participants were 14 female college students (21–22 years) with normal menstrual cycles (cis gender). Anterior drawer stress to a magnitude of 120 N was applied for all participants. Anterior talofibular ligament (ATFL) length was measured as the linear distance (mm) between its points of attachment on the lateral malleolus and talus using ultrasonography. Data on ATFL length from each subject were used to calculate each subject’s normalized length change with anterior drawer stress (AD%). The University of Tokyo method was used for evaluation of GJL. AD% and GJL were measured once in each menstrual phase. Results There was no statistically significant difference between AD% in each phase. GJL score was significantly higher in the ovulation and luteal phases compared with the early follicular phase. AD% and GJL showed a positive correlation with each other in the ovulation phase. Conclusions Although it is unclear whether estrogen receptors are present in the ATFL, the present study suggests that women with high GJL scores might be more sensitive to the effects of estrogen, resulting in ATFL length change in the ovulation phase.
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27
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Gensemer C, Burks R, Kautz S, Judge DP, Lavallee M, Norris RA. Hypermobile Ehlers-Danlos syndromes: Complex phenotypes, challenging diagnoses, and poorly understood causes. Dev Dyn 2021; 250:318-344. [PMID: 32629534 PMCID: PMC7785693 DOI: 10.1002/dvdy.220] [Citation(s) in RCA: 46] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 06/24/2020] [Accepted: 06/28/2020] [Indexed: 12/14/2022] Open
Abstract
The Ehlers-Danlos syndromes (EDS) are a group of heritable, connective tissue disorders characterized by joint hypermobility, skin hyperextensibility, and tissue fragility. There is phenotypic and genetic variation among the 13 subtypes. The initial genetic findings on EDS were related to alterations in fibrillar collagen, but the elucidation of the molecular basis of many of the subtypes revealed several genes not involved in collagen biosynthesis or structure. However, the genetic basis of the hypermobile type of EDS (hEDS) is still unknown. hEDS is the most common type of EDS and involves generalized joint hypermobility, musculoskeletal manifestations, and mild skin involvement along with the presence of several comorbid conditions. Variability in the spectrum and severity of symptoms and progression of patient phenotype likely depend on age, gender, lifestyle, and expression domains of the EDS genes during development and postnatal life. In this review, we summarize the current molecular, genetic, epidemiologic, and pathogenetic findings related to EDS with a focus on the hypermobile type.
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Affiliation(s)
- Cortney Gensemer
- Department of Regenerative Medicine and Cell Biology, Medical University of South Carolina, Charleston, South Carolina
| | - Randall Burks
- Department of Regenerative Medicine and Cell Biology, Medical University of South Carolina, Charleston, South Carolina
| | - Steven Kautz
- Department of Health Sciences and Research, Medical University of South Carolina, Charleston, South Carolina
| | - Daniel P. Judge
- Department of Medicine, Division of Cardiology, Medical University of South Carolina, Charleston, South Carolina
| | - Mark Lavallee
- Department of Family Medicine, Wellspan Health, York, Pennsylvania
| | - Russell A. Norris
- Department of Regenerative Medicine and Cell Biology, Medical University of South Carolina, Charleston, South Carolina
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28
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Martin D, Timmins K, Cowie C, Alty J, Mehta R, Tang A, Varley I. Injury Incidence Across the Menstrual Cycle in International Footballers. Front Sports Act Living 2021; 3:616999. [PMID: 33733235 PMCID: PMC7956981 DOI: 10.3389/fspor.2021.616999] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Accepted: 01/20/2021] [Indexed: 11/18/2022] Open
Abstract
Objectives: This study aimed to assess how menstrual cycle phase and extended menstrual cycle length influence the incidence of injuries in international footballers. Methods: Over a 4-year period, injuries from England international footballers at training camps or matches were recorded, alongside self-reported information on menstrual cycle characteristics at the point of injury. Injuries in eumenorrheic players were categorized into early follicular, late follicular, or luteal phase. Frequencies were also compared between injuries recorded during the typical cycle and those that occurred after the cycle would be expected to have finished. Injury incidence rates (per 1,000 person days) and injury incidence rate ratios were calculated for each phase for all injuries and injuries stratified by type. Results: One hundred fifty-six injuries from 113 players were eligible for analysis. Injury incidence rates per 1,000 person-days were 31.9 in the follicular, 46.8 in the late follicular, and 35.4 in the luteal phase, resulting in injury incidence rate ratios of 1.47 (Late follicular:Follicular), 1.11 (Luteal:Follicular), and 0.76 (Luteal:Late follicular). Injury incident rate ratios showed that muscle and tendon injury rates were 88% greater in the late follicular phase compared to the follicular phase, with muscle rupture/tear/strain/cramps and tendon injuries/ruptures occurring over twice as often during the late follicular phase compared to other phases 20% of injuries were reported as occurring when athletes were “overdue” menses. Conclusion: Muscle and tendon injuries occurred almost twice as often in the late follicular phase compared to the early follicular or luteal phase. Injury risk may be elevated in typically eumenorrheic women in the days after their next menstruation was expected to start.
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Affiliation(s)
- Dan Martin
- School of Sport and Exercise Science, University of Lincoln, Lincoln, United Kingdom
| | - Kate Timmins
- School of Sport and Exercise Science, University of Lincoln, Lincoln, United Kingdom
| | | | - Jon Alty
- The Football Association, London, United Kingdom
| | - Ritan Mehta
- The Football Association, London, United Kingdom
| | - Alicia Tang
- The Football Association, London, United Kingdom
| | - Ian Varley
- Department of Sport and Exercise Science, Nottingham Trent University, Nottingham, United Kingdom
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29
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Somerson JS, Isby IJ, Hagen MS, Kweon CY, Gee AO. The Menstrual Cycle May Affect Anterior Knee Laxity and the Rate of Anterior Cruciate Ligament Rupture: A Systematic Review and Meta-Analysis. JBJS Rev 2020; 7:e2. [PMID: 31490339 DOI: 10.2106/jbjs.rvw.18.00198] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
BACKGROUND Women have a higher risk of anterior cruciate ligament (ACL) tears than men, the causes of which are multifactorial. The menstrual cycle and its hormonal effect on the knee may contribute to knee laxity and ACL injury. This work reviewed published studies examining the effects of the phases of the menstrual cycle on anterior knee laxity and the rate of ACL tears. METHODS A systematic review with meta-analysis and meta-regression was performed. Studies with data comparing the menstrual cycle phase with ACL injury or anterior knee laxity were included for analysis. Data with regard to patient demographic characteristics, anterior knee laxity, ACL injury, and menstrual cycle phases were extracted from the included studies. RESULTS In this study, 1,308 search results yielded 396 articles for review, of which 28 met inclusion criteria. Nineteen studies of knee laxity with 573 combined subjects demonstrated a mean increase in laxity (and standard deviation) of 0.40 ± 0.29 mm in the ovulatory phase compared with the follicular phase and a mean increase in laxity of 0.21 ± 0.21 mm in the luteal phase compared with the follicular phase. Nine studies examining ACL tears with 2,519 combined subjects demonstrated a decreased relative risk (RR) of an ACL tear in the luteal phase compared with the follicular and ovulatory phases combined (RR, 0.72 [95% confidence interval, 0.56 to 0.89]). There were no differences in ACL tear risk between any of the other phases. CONCLUSIONS An increased risk of an ACL tear does not appear to be associated with periods of increased laxity in this meta-analysis. Although this suggests that hormonal effects on an ACL tear may not be directly related to increases in knee laxity, the methodologic heterogeneity between published studies limits the conclusions that can be drawn and warrants further investigation. LEVEL OF EVIDENCE Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Jeremy S Somerson
- Department of Orthopaedic Surgery and Rehabilitation, University of Texas Medical Branch, Galveston, Texas
| | - Ian J Isby
- Department of Orthopaedics and Sports Medicine, University of Washington, Seattle, Washington
| | - Mia S Hagen
- Department of Orthopaedics and Sports Medicine, University of Washington, Seattle, Washington
| | - Christopher Y Kweon
- Department of Orthopaedics and Sports Medicine, University of Washington, Seattle, Washington
| | - Albert O Gee
- Department of Orthopaedics and Sports Medicine, University of Washington, Seattle, Washington
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30
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Ground Reaction Forces Are Predicted with Functional and Clinical Tests in Healthy Collegiate Students. J Clin Med 2020; 9:jcm9092907. [PMID: 32916814 PMCID: PMC7563648 DOI: 10.3390/jcm9092907] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 08/31/2020] [Accepted: 09/07/2020] [Indexed: 12/26/2022] Open
Abstract
Increased vertical and posterior ground reaction forces (GRFs) are associated with anterior cruciate ligament (ACL) injury. If a practical means to predict these forces existed, ACL injury risk could be attenuated. Forty-two active college-age individuals (21 females, 20.66 ± 1.46 y, 70.70 ± 2.36 cm, 82.20 ± 7.60 kg; 21 males, 21.57 ± 1.28 y, 65.52 ± 1.87 cm, 64.19 ± 9.05 kg) participated in this controlled laboratory study. GRFs were ascertained by having the subjects perform a unilateral landing task onto a force plate. Several clinical measures (Fat Free Mass (FFM), dorsiflexion passive range of motion (DPROM), isometric peak force of the lateral hip rotators, knee flexor/extensor peak force ratio (H:Q), the completion of the overhead deep squat), two functional tests (Margaria–Kalamen, Single Leg Triple Hop (SLTH)), and sex served as the predictor variables. Regression models to predict the GRFs normalized to the FFM (nGRFz, nGRFy) were generated. nGRFz was best predicted with a linear regression equation that included SLTH and DPROM (adjusted R2 = 0.274; p = 0.001). nGRFy was best predicted with a linear regression equation that included H:Q, FFM, and DPROM (adjusted R2 = 0.476; p < 0.001). Simple clinical measures and functional tests explain a small to moderate amount of the variance associated with the FFM normalized vertical and posterior GRFs in active college-age individuals.
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31
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Sex Differences in Lower Limb Proprioception and Mechanical Function Among Healthy Adults. Motor Control 2020; 24:571-587. [PMID: 32866946 DOI: 10.1123/mc.2020-0015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Revised: 06/01/2020] [Accepted: 06/05/2020] [Indexed: 11/18/2022]
Abstract
Twenty-four healthy adults, including 12 females and 12 males, participated in the study. Each female participant completed three trials in three different phases of one menstrual cycle, which included follicular, ovulatory, and luteal phases. The study aimed to investigate whether there is any difference in joint kinetic sense, neuromuscular coordination, and isokinetic muscle strength (a) between healthy males and females at different phases of the menstrual cycle and (b) between females at different phases of the menstrual cycle. The outcome measures included the number of jumps in the square-hop test and ankle and knee proprioception, which were assessed by an electric-driven movable frame rotated at 0.4 deg/s and isokinetic muscle strength measured by a computerized dynamometer (Biodex). For the square-hop test (p = .006), ankle dorsiflexion/plantar flexion (p < .05), knee flexion/extension (p < .05), the relative peak torque of the isokinetic muscle strength at the 60° and 180° knee flexion/extension (p < .001), and the 30° and 120° ankle plantar flexion/dorsiflexion (p < .05) between females and males showed significant differences. For the females at different phases of the menstrual cycle, significant differences were found on ankle dorsiflexion (p = .003), plantar flexion (p = .023), knee extension (p = .029), the square-hop test (p = .036), and relative peak torque of isokinetic muscle strength at 180° knee flexion (p = .029). This study demonstrated that there are sex differences in lower limb proprioception and mechanical function. Females at ovulatory and luteal phases have better lower limb proprioception than at the follicular phase.
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32
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Ellenberger L, Oberle F, Lorenzetti S, Frey WO, Snedeker JG, Spörri J. Dynamic knee valgus in competitive alpine skiers: Observation from youth to elite and influence of biological maturation. Scand J Med Sci Sports 2020; 30:1212-1220. [DOI: 10.1111/sms.13657] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Revised: 02/15/2020] [Accepted: 03/10/2020] [Indexed: 01/13/2023]
Affiliation(s)
- Lynn Ellenberger
- Sports Medical Research Group Department of Orthopaedics Balgrist University Hospital University of Zurich Zurich Switzerland
- University Center for Prevention and Sports Medicine Balgrist University Hospital University of Zurich Zurich Switzerland
| | - Felix Oberle
- Sports Medical Research Group Department of Orthopaedics Balgrist University Hospital University of Zurich Zurich Switzerland
- University Center for Prevention and Sports Medicine Balgrist University Hospital University of Zurich Zurich Switzerland
| | - Silvio Lorenzetti
- Swiss Federal Institute of Sport Magglingen (SFISM) Magglingen Switzerland
| | - Walter O. Frey
- University Center for Prevention and Sports Medicine Balgrist University Hospital University of Zurich Zurich Switzerland
| | - Jess G. Snedeker
- Biomechanics Laboratory Department of Orthopaedics Balgrist University Hospital University of Zurich Zurich Switzerland
- Institute for Biomechanics ETH Zurich Zurich Switzerland
| | - Jörg Spörri
- Sports Medical Research Group Department of Orthopaedics Balgrist University Hospital University of Zurich Zurich Switzerland
- University Center for Prevention and Sports Medicine Balgrist University Hospital University of Zurich Zurich Switzerland
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33
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Bisciotti GN, Chamari K, Cena E, Bisciotti A, Bisciotti A, Corsini A, Volpi P. Anterior cruciate ligament injury risk factors in football. J Sports Med Phys Fitness 2019; 59:1724-1738. [PMID: 31062538 DOI: 10.23736/s0022-4707.19.09563-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
INTRODUCTION Anterior cruciate ligament (ACL) lesion represents one of the most dramatic injuries in a football (soccer) player's career. There are many injury risk factors related to intrinsic (non-modifiable) and/or extrinsic (modifiable) factors of ACL injury. EVIDENCE ACQUISITION Research of the studies was conducted until September 2018 without publication data limitation or language restriction on the following databases: PubMed/MEDLINE, Scopus, ISI, EXCERPTA. EVIDENCE SYNTHESIS To date, evidence from the literature suggests that the risk of ACL injury is multifactorial and involves biomechanical, anatomical, hormonal, and neuromuscular factors. Despite this relative complexity, the mechanisms of injury are well known and rationally classified into two categories: mechanisms of injury based on contact or on non-contact with another player, with the non-contact injury mechanisms clearly prevailing over the mechanisms of contact injury. One of the most frequent biomechanical risk factors, associated with ACL non-contact injury, is represented by the valgus knee in the pivoting and cutting movements and in the landing phase after jumping. Gender-related risk factors show female populations to have a higher predisposition to ACL injury than males However, there are still some theoretical and practical aspects that need further investigation such as; genetic risks together with the role of estrogen and progesterone receptors in female populations, and the in-vivo interaction shoe-playing surface. In particular, the genetic risk factors of ACL lesion seem to be an interesting and promising field of investigation, where considerable progress has still to be made. CONCLUSIONS This narrative review provides an insight into the risk factors of ACL injury that could be used by practitioners for preventing injury in football (soccer).
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Affiliation(s)
- Gian Nicola Bisciotti
- Qatar Orthopedic and Sport Medicine Hospital, FIFA Center of Excellence, Doha, Qatar -
| | - Karim Chamari
- Qatar Orthopedic and Sport Medicine Hospital, FIFA Center of Excellence, Doha, Qatar
| | - Emanuele Cena
- Qatar Orthopedic and Sport Medicine Hospital, FIFA Center of Excellence, Doha, Qatar
| | | | | | | | - Piero Volpi
- FC Internazionale Milano, Milan, Italy.,Unit of Traumatology, Department of Knee Orthopedic and Sports, Humanitas Research Hospital, Rozzano, Milan, Italy
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Tanaka MJ, Szymanski LM, Dale JL, Dixit S, Jones LC. Team Approach: Treatment of Injuries in the Female Athlete: Multidisciplinary Considerations for Women's Sports Medicine Programs. JBJS Rev 2019; 7:e7. [PMID: 30672778 DOI: 10.2106/jbjs.rvw.18.00011] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Miho J Tanaka
- Departments of Orthopaedic Surgery (M.J.T., S.D., and L.C.J.), Gynecology and Obstetrics (L.M.S.), and Physical Medicine and Rehabilitation (J.L.D.), Johns Hopkins University, Baltimore, Maryland
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Posch M, Ruedl G, Schranz A, Tecklenburg K, Burtscher M. Is ski boot sole abrasion a potential ACL injury risk factor for male and female recreational skiers? Scand J Med Sci Sports 2019; 29:736-741. [PMID: 30664258 PMCID: PMC6850459 DOI: 10.1111/sms.13391] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Revised: 12/07/2018] [Accepted: 01/16/2019] [Indexed: 11/28/2022]
Abstract
Objectives To evaluate the potential impact of ski boot sole abrasion on the ACL injury risk of recreational skiers. Methods During the past two winter seasons 2016/17 and 2017/18, this retrospective case‐control study was conducted in one Austrian ski area. Among a cohort of 148 ACL‐injured (51.4% females) and 455 uninjured recreational skiers (43.3% females), age, sex, height, weight, and self‐reported skill level were collected by questionnaire, ski length and sidecut radius were notated and sole abrasion of the toe and heel piece of the ski boot was measured using a digital caliper. Results ACL‐injured skiers showed a higher proportion of female (51.4% vs 43.3%, P < 0.001) and less skilled skiers (48.6% vs 20.9%, P < 0.001), and ski length to height ratio was higher (94.7 ± 3.7 vs 93.8 ± 5.0%, P = 0.019) compared to uninjured skiers. ACL‐injured skiers used ski boots of greater abrasion at the toe (4.8 ± 1.8 vs 2.4 ± 2.5 mm, P < 0.001) and heel piece (5.4 ± 1.8 vs 3.3 ± 2.3 mm, P < 0.001) compared to controls. Multivariate regression analysis revealed, beside female sex (OR 6.0, 95% CI, 3.1‐11.5, P < 0.001), lower skill level (OR 3.2, 95% CI, 1.9‐5.4, P < 0.001) and ski length to height ratio (OR 1.1, 95% CI, 1.0‐1.2, P < 0.001), sole abrasion at the toe (OR 1.8, 95% CI, 1.5‐2.1, P < 0.001) and heel piece (OR 1.4, 95% CI, 1.2‐1.6, P < 0.001) to be independently associated with an ACL injury among recreational alpine skiers. Conclusions Based on the underlying findings, ski boot sole abrasion was found to be an independent risk factor and may contribute to an increased ACL injury risk.
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Affiliation(s)
- Markus Posch
- Department of Sport Science, University of Innsbruck, Innsbruck, Austria
| | - Gerhard Ruedl
- Department of Sport Science, University of Innsbruck, Innsbruck, Austria
| | | | | | - Martin Burtscher
- Department of Sport Science, University of Innsbruck, Innsbruck, Austria
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Chidi-Ogbolu N, Baar K. Effect of Estrogen on Musculoskeletal Performance and Injury Risk. Front Physiol 2019; 9:1834. [PMID: 30697162 PMCID: PMC6341375 DOI: 10.3389/fphys.2018.01834] [Citation(s) in RCA: 126] [Impact Index Per Article: 25.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Accepted: 12/06/2018] [Indexed: 12/14/2022] Open
Abstract
Estrogen has a dramatic effect on musculoskeletal function. Beyond the known relationship between estrogen and bone, it directly affects the structure and function of other musculoskeletal tissues such as muscle, tendon, and ligament. In these other musculoskeletal tissues, estrogen improves muscle mass and strength, and increases the collagen content of connective tissues. However, unlike bone and muscle where estrogen improves function, in tendons and ligaments estrogen decreases stiffness, and this directly affects performance and injury rates. High estrogen levels can decrease power and performance and make women more prone for catastrophic ligament injury. The goal of the current work is to review the research that forms the basis of our understanding how estrogen affects muscle, tendon, and ligament and how hormonal manipulation can be used to optimize performance and promote female participation in an active lifestyle at any age.
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Affiliation(s)
- Nkechinyere Chidi-Ogbolu
- Biomedical Engineering Graduate Group, University of California, Davis, Davis, CA, United States
| | - Keith Baar
- Biomedical Engineering Graduate Group, University of California, Davis, Davis, CA, United States.,Department of Neurobiology, Physiology and Behavior, University of California, Davis, Davis, CA, United States.,Department of Physiology and Membrane Biology, University of California, Davis, Davis, CA, United States
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Vaishya R, Esin ARI, Agarwal AK, Vijay V. Bilateral simultaneous anterior cruciate ligament reconstruction: A case series and review of the literature. J Clin Orthop Trauma 2019; 10:576-580. [PMID: 31061593 PMCID: PMC6492310 DOI: 10.1016/j.jcot.2018.08.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2018] [Accepted: 08/09/2018] [Indexed: 11/30/2022] Open
Abstract
Bilateral ACL rupture is a relatively uncommon injury with an incidence of 2-4%. Most bilateral ACL rupture occurs at two different times, but few cases of single-staged bilateral ACL ruptures have also been reported. There have been reports of both single-staged, and two-staged reconstruction of bilateral ACL ruptures in the literature but without a clear consensus. We present a series of five bilateral ACL rupture cases managed by single-staged arthroscopic ACL reconstruction, using quadrupled hamstring grafts. All of them were young males, with an average age of 26.8 years (Range: 19-39 years). Three out of five of these cases (60%) had sustained the injury to both the knees simultaneously while playing sports. All the five patients had generalized joint laxity with significant hyperextension of their knees. All the ten knees (in five patients) were clinically stable, at their last follow-ups. None of the knees had any early or late complications. A single-staged bilateral ACL reconstruction is a safe, reproducible, and cost-effective procedure for patients with a bilateral ACL deficient knee, in experienced hands.
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Affiliation(s)
| | | | - Amit Kumar Agarwal
- Corresponding author. Indraprastha Apollo Hospitals, Delhi- Mathura Road, New Delhi 110076, India.
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Current topics in women’s sports medicine: evaluation and treatment of the female athlete. CURRENT ORTHOPAEDIC PRACTICE 2019. [DOI: 10.1097/bco.0000000000000711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Miller EK, Tanaka MJ, LaPorte DM, Humbyrd CJ. Pregnancy-Related Ligamentous Laxity Mimicking Dynamic Scapholunate Instability: A Case Report. JBJS Case Connect 2018; 7:e54. [PMID: 29252884 DOI: 10.2106/jbjs.cc.16.00268] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
CASE A 29-year-old woman presented with spontaneous, isolated, total palmar scaphoid subluxation in the left hand approximately 6 weeks postpartum. She had a positive Watson scaphoid shift test, with an easily subluxable and reducible scaphoid unilaterally. She was diagnosed with scapholunate ligamentous laxity with dynamic instability. Approximately 4 months after stopping lactation, she had complete resolution of the scapholunate subluxation; there was no recurrence of symptoms over the next 5 years of follow-up. CONCLUSION Women can have manifestations of pregnancy and lactation-related ligamentous laxity, including scapholunate instability, which may spontaneously resolve upon cessation of lactation.
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Affiliation(s)
- Emily K Miller
- Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, Maryland
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Pfeiffer TR, Burnham JM, Hughes JD, Kanakamedala AC, Herbst E, Popchak A, Shafizadeh S, Irrgang JJ, Debski RE, Musahl V. An Increased Lateral Femoral Condyle Ratio Is a Risk Factor for Anterior Cruciate Ligament Injury. J Bone Joint Surg Am 2018; 100:857-864. [PMID: 29762281 DOI: 10.2106/jbjs.17.01011] [Citation(s) in RCA: 75] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND The purpose of this study was to examine the relationship between distal femoral morphology and anterior cruciate ligament (ACL) injury, ACL reconstruction (ACLR) failure, and contralateral ACL injury. It was hypothesized that increased posterior femoral condylar depth, quantified as the lateral femoral condyle ratio, would correlate with increased risk of primary ACL injuries, ACLR failures, and contralateral ACL injuries. METHODS The charts of consecutive patients who underwent arthroscopic knee surgery at an academic medical center from 2012 to 2016 with minimum follow-up of 24 months were retrospectively reviewed. Patients were stratified into 4 groups: (1) a control group of patients with no ACL injury, (2) patients with primary ACL injury, (3) patients with failed ACLR, and (4) patients with previous ACL injury and subsequent contralateral ACL injury. With use of lateral radiographs, the ratio of posterior femoral condylar depth to total condylar length was defined as the lateral femoral condyle ratio. Differences between study groups were identified with use of analysis-of-variance (ANOVA) and post-hoc testing with significance set at p < 0.05. Receiver operating characteristic (ROC) curve analysis was performed to determine the optimal cutoff for detecting increased risk of ACL injury. RESULTS Two hundred patients met the inclusion criteria. The mean lateral femoral condyle ratios (and standard deviations) were 61.2% ± 2.4% in the control group, 64.2% ± 3.8% in the primary ACL injury group, 64.4% ± 3.6% in the failed ACLR group, and 66.9% ± 4.3% in the contralateral ACL injury group. Patients who had a primary ACL injury, failed ACLR, or contralateral ACL injury had significantly higher ratios compared with the control group (p < 0.008). ROC curve analysis demonstrated that a lateral femoral condyle ratio of >63% was associated with an increased risk for ACL injury, with a sensitivity of 77% and a specificity of 72%. CONCLUSIONS The data from this study show that increased posterior femoral condylar depth, quantified as the lateral femoral condyle ratio, is associated with an increased risk of ACL injury, including primary and contralateral ACL injuries. The data from this study may help clinicians to identify patients at a greater risk of ACL injury. LEVEL OF EVIDENCE Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Thomas R Pfeiffer
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.,Department of Orthopaedic Surgery, Trauma Surgery and Sports Medicine, Cologne Merheim Medical Center, Witten/Herdecke University, Cologne, Germany
| | - Jeremy M Burnham
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Jonathan D Hughes
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Ajay C Kanakamedala
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Elmar Herbst
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.,Department of Orthopaedic Sports Medicine, Technical University Munich, Munich, Germany
| | - Adam Popchak
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Sven Shafizadeh
- Department of Orthopaedic Surgery, Trauma Surgery and Sports Medicine, Cologne Merheim Medical Center, Witten/Herdecke University, Cologne, Germany
| | - James J Irrgang
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Richard E Debski
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Volker Musahl
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
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Promsri A, Haid T, Federolf P. How does lower limb dominance influence postural control movements during single leg stance? Hum Mov Sci 2018; 58:165-174. [DOI: 10.1016/j.humov.2018.02.003] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2017] [Revised: 02/05/2018] [Accepted: 02/06/2018] [Indexed: 10/17/2022]
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Legerlotz K, Bey ME, Götz S, Böhlke N. Constant performance in balance and proprioception tests across the menstrual cycle - a pilot study in well trained female ice hockey players on hormonal contraception. Health Sci Rep 2018; 1:e18. [PMID: 30623036 PMCID: PMC6266417 DOI: 10.1002/hsr2.18] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2017] [Revised: 10/04/2017] [Accepted: 10/16/2017] [Indexed: 12/22/2022] Open
Abstract
INTRODUCTION It has yet to be explained why female athletes appear to suffer more often from non-contact ligament injuries during the first half of the menstrual cycle. Fluctuations in balance, caused by impaired proprioception due to increased fluid retention, may be relevant factors contributing to this anomaly in distribution. The aim of this study was therefore to uncover relationships between dynamic stability, proprioception and fluid retention in association with the menstrual cycle as a possible explanation for the observed changes in injury rates. METHODS Nine healthy, female, well trained ice hockey players on hormonal contraception with regular cycles were tested at least twelve times during one menstrual cycle. Bioimpedance analysis was applied to investigate body composition and fluid distribution. A joint position sense test was performed to characterize changes in proprioception, while unexpected perturbations on a balance board were used to obtain measures for dynamic postural control. RESULTS No distinct changes in proprioception, dynamic stability and fluid retention were identified across the menstrual cycle in this population. Weak correlations were found between parameters for dynamic stability and proprioception. CONCLUSION Variations in proprioception, dynamic stability and fluid retention seem unlikely to be major contributors to injury risk peaks, at least in this population of healthy trained athletes using hormonal contraception.
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Affiliation(s)
- Kirsten Legerlotz
- Department of Training and Movement SciencesHumboldt UniversityBerlinGermany
| | - Marie Elena Bey
- Department of Training and Movement SciencesHumboldt UniversityBerlinGermany
| | - Susann Götz
- Division of Training and Movement ScienceUniversity of PotsdamPotsdamGermany
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Herzberg SD, Motu'apuaka ML, Lambert W, Fu R, Brady J, Guise JM. The Effect of Menstrual Cycle and Contraceptives on ACL Injuries and Laxity: A Systematic Review and Meta-analysis. Orthop J Sports Med 2017; 5:2325967117718781. [PMID: 28795075 PMCID: PMC5524267 DOI: 10.1177/2325967117718781] [Citation(s) in RCA: 98] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Women are at substantially greater risk for anterior cruciate ligament (ACL) injuries than are men. PURPOSE To conduct a systematic review and meta-analysis of the literature to clarify the effect of the menstrual cycle and contraceptives on the laxity of and noncontact injuries to the ACL. STUDY DESIGN Systematic review; Level of evidence, 4. METHODS Searches were conducted using MEDLINE (1946-August 2016), the Cochrane Library Database, clinical trial registries, and related reference lists. Search terms included athletic injuries, knee injuries, ligaments, joint instability, menstrual cycle, ovulation, hormones, and contraceptives. Investigators independently dually abstracted and reviewed study details and quality using predefined criteria and evaluated overall strength of evidence using the GRADE (Grading of Recommendations Assessment, Development and Evaluation) criteria. RESULTS Twenty-one studies totaling 68,758 participants were included: 5 on the menstrual cycle and ACL injury, 7 on hormonal contraceptives and ACL injury, as well as 13 on menstrual cycle and ligament laxity. Four of 5 studies of women not using hormonal contraception indicated that the luteal phase was the least associated with ACL injuries. The 2 largest and highest quality studies on hormonal contraceptives suggested that hormonal contraceptives may be protective against ACL injury. Six of 12 studies on ACL laxity provided quantitative data for meta-analysis, finding significantly increased laxity during the ovulatory phase compared with the follicular phase. CONCLUSION The literature suggests an association between hormonal fluctuations and ACL injury. Recent studies have suggested that oral contraceptives may offer up to a 20% reduction in risk of injury. The literature on ACL injuries and the menstrual cycle has more than doubled over the past decade, permitting quantitative analysis for the first time. However, the overall strength of this evidence is low. Promising potential directions for future research include long-term observational studies with ongoing hormonal assays and large interventional trials of follicular suppression, including newer hormonal methods.
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Affiliation(s)
- Simone D Herzberg
- Seattle Pacific University, Seattle, Washington, USA.,Department of Obstetrics & Gynecology, Oregon Health & Science University, Portland, Oregon, USA
| | - Makalapua L Motu'apuaka
- School of Public Health, Oregon Health & Science University, Portland, Oregon, USA.,Scientific Resource Center for the Evidence-Based Practice Center (EPC) Program, Portland VA Research Foundation, Portland, Oregon, USA
| | - William Lambert
- School of Public Health, Oregon Health & Science University, Portland, Oregon, USA
| | - Rongwei Fu
- School of Public Health, Oregon Health & Science University, Portland, Oregon, USA.,Department of Medical Informatics & Clinical Epidemiology, Oregon Health & Science University, Portland, Oregon, USA
| | - Jacqueline Brady
- Department of Orthopaedics and Rehabilitation, Oregon Health & Science University, Portland, Oregon, USA
| | - Jeanne-Marie Guise
- Department of Obstetrics & Gynecology, Oregon Health & Science University, Portland, Oregon, USA.,School of Public Health, Oregon Health & Science University, Portland, Oregon, USA.,Scientific Resource Center for the Evidence-Based Practice Center (EPC) Program, Portland VA Research Foundation, Portland, Oregon, USA.,Department of Medical Informatics & Clinical Epidemiology, Oregon Health & Science University, Portland, Oregon, USA.,Department of Emergency Medicine, Oregon Health & Science University, Portland, Oregon, USA
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Balachandar V, Marciniak JL, Wall O, Balachandar C. Effects of the menstrual cycle on lower-limb biomechanics, neuromuscular control, and anterior cruciate ligament injury risk: a systematic review. Muscles Ligaments Tendons J 2017; 7:136-146. [PMID: 28717621 DOI: 10.11138/mltj/2017.7.1.136] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Anterior cruciate ligament (ACL) injury has a devastating impact on physical and psychological disability. Rates of ACL rupture are significantly greater in females than males during the same sports. Hormonal mechanisms have been proposed but are complex and poorly understood. This systematic review evaluates the effects of menstrual cycle on: 1) lower-limb biomechanics, 2) neuromuscular control, and 3) ACL injury risk. METHODS The MEDLINE, CINAHL, SPORTSDiscus, Web of Science, and Google Scholar databases were searched from inception to August 2016 for studies investigating the effects of the menstrual cycle on lower-limb biomechanics, neuromuscular control, and ACL injury risk in females. Three independent reviewers assessed each paper for inclusion and two assessed for quality. RESULTS Seventeen studies were identified. There is strong evidence that: 1) greatest risk of ACL injury is within the pre-ovulatory phase of the menstrual cycle, and 2) females with greater ACL laxity in the pre-ovulatory phase experience greater knee valgus and greater tibial external rotation during functional activity. CONCLUSION Females are at greatest risk of ACL injury during the pre-ovulatory phase of the menstrual cycle through a combination of greater ACL laxity, greater knee valgus, and greater tibial external rotation during functional activity. LEVEL OF EVIDENCE Ib.
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Affiliation(s)
- Vivek Balachandar
- Leeds General Infirmary, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | | | - Owen Wall
- Leeds General Infirmary, Leeds Teaching Hospitals NHS Trust, Leeds, UK
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Baker LA, Kirkpatrick B, Rosa GJM, Gianola D, Valente B, Sumner JP, Baltzer W, Hao Z, Binversie EE, Volstad N, Piazza A, Sample SJ, Muir P. Genome-wide association analysis in dogs implicates 99 loci as risk variants for anterior cruciate ligament rupture. PLoS One 2017; 12:e0173810. [PMID: 28379989 PMCID: PMC5381864 DOI: 10.1371/journal.pone.0173810] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2016] [Accepted: 02/26/2017] [Indexed: 01/28/2023] Open
Abstract
Anterior cruciate ligament (ACL) rupture is a common condition that can be devastating and life changing, particularly in young adults. A non-contact mechanism is typical. Second ACL ruptures through rupture of the contralateral ACL or rupture of a graft repair is also common. Risk of rupture is increased in females. ACL rupture is also common in dogs. Disease prevalence exceeds 5% in several dog breeds, ~100 fold higher than human beings. We provide insight into the genetic etiology of ACL rupture by genome-wide association study (GWAS) in a high-risk breed using 98 case and 139 control Labrador Retrievers. We identified 129 single nucleotide polymorphisms (SNPs) within 99 risk loci. Associated loci (P<5E-04) explained approximately half of phenotypic variance in the ACL rupture trait. Two of these loci were located in uncharacterized or non-coding regions of the genome. A chromosome 24 locus containing nine genes with diverse functions met genome-wide significance (P = 3.63E-0.6). GWAS pathways were enriched for c-type lectins, a gene set that includes aggrecan, a gene set encoding antimicrobial proteins, and a gene set encoding membrane transport proteins with a variety of physiological functions. Genotypic risk estimated for each dog based on the risk contributed by each GWAS locus showed clear separation of ACL rupture cases and controls. Power analysis of the GWAS data set estimated that ~172 loci explain the genetic contribution to ACL rupture in the Labrador Retriever. Heritability was estimated at 0.48. We conclude ACL rupture is a moderately heritable highly polygenic complex trait. Our results implicate c-type lectin pathways in ACL homeostasis.
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Affiliation(s)
- Lauren A. Baker
- Comparative Orthopaedic Research Laboratory, School of Veterinary Medicine, University of Wisconsin-Madison, Madison, Wisconsin, United States of America
| | - Brian Kirkpatrick
- Department of Animal Sciences, College of Agricultural and Life Sciences, University of Wisconsin-Madison, Madison, Wisconsin, United States of America
| | - Guilherme J. M. Rosa
- Department of Animal Sciences, College of Agricultural and Life Sciences, University of Wisconsin-Madison, Madison, Wisconsin, United States of America
| | - Daniel Gianola
- Department of Animal Sciences, College of Agricultural and Life Sciences, University of Wisconsin-Madison, Madison, Wisconsin, United States of America
| | - Bruno Valente
- Department of Animal Sciences, College of Agricultural and Life Sciences, University of Wisconsin-Madison, Madison, Wisconsin, United States of America
- Department of Dairy Sciences, College of Agricultural and Life Sciences, University of Wisconsin-Madison, Madison, Wisconsin, United States of America
| | - Julia P. Sumner
- Department of Veterinary Clinical Sciences, School of Veterinary Medicine, Louisiana State University, Baton Rouge, Louisiana, United States of America
| | - Wendy Baltzer
- Department of Clinical Sciences, College of Veterinary Medicine, Oregon State University, Corvalis, Oregon, United States of America
| | - Zhengling Hao
- Comparative Orthopaedic Research Laboratory, School of Veterinary Medicine, University of Wisconsin-Madison, Madison, Wisconsin, United States of America
| | - Emily E. Binversie
- Comparative Orthopaedic Research Laboratory, School of Veterinary Medicine, University of Wisconsin-Madison, Madison, Wisconsin, United States of America
| | - Nicola Volstad
- Comparative Orthopaedic Research Laboratory, School of Veterinary Medicine, University of Wisconsin-Madison, Madison, Wisconsin, United States of America
| | - Alexander Piazza
- Comparative Orthopaedic Research Laboratory, School of Veterinary Medicine, University of Wisconsin-Madison, Madison, Wisconsin, United States of America
| | - Susannah J. Sample
- Comparative Orthopaedic Research Laboratory, School of Veterinary Medicine, University of Wisconsin-Madison, Madison, Wisconsin, United States of America
| | - Peter Muir
- Comparative Orthopaedic Research Laboratory, School of Veterinary Medicine, University of Wisconsin-Madison, Madison, Wisconsin, United States of America
- * E-mail:
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Abstract
PURPOSE OF REVIEW As anterior cruciate ligament (ACL) injury is becoming increasingly prevalent in the population of active children and young adolescents, it is crucial to be aware of both the modifiable and nonmodifiable factors that place this population at increased ACL injury risk. Historically, there has not been a definitive consensus on all of these risk factors-particularly the nonmodifiable ones. RECENT FINDINGS The present review has accumulated the most recent evidence for the nonmodifiable risk factors in ACL injury focusing particularly on female gender, generalized joint laxity, knee recurvatum, increased lateral tibial slope, decreased intercondylar notch width, structural lower extremity valgus, limb length discrepancy, family history, and history of contralateral knee ACL injury. SUMMARY Physicians should be aware of the nonmodifiable risk factors for ACL tears in active children and adolescents and should also encourage avoidance of modifiable risk factors in this population. Young athletes with nonmodifiable risk factors are at a particularly increased risk of recurrent injury following ACL reconstruction (ACLR). We believe that a primary extra-articular augmentation via iliotibial band tenodesis at the same time of ACLR may decrease the rate of reinjury for the high risk athlete with multiple nonmodifiable risk factors.
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Ruedl G, Helle K, Tecklenburg K, Schranz A, Fink C, Burtscher M. Factors associated with self-reported failure of binding release among ACL injured male and female recreational skiers: a catalyst to change ISO binding standards? Br J Sports Med 2016; 50:37-40. [PMID: 26702016 DOI: 10.1136/bjsports-2015-095482] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND Female recreational skiers have twice the rate of knee injuries and three time the rate of ACL injuries compared with their male counterparts. Female skiers suffering from a knee injury reported a significantly higher proportion of failure of binding release than knee injured male skiers. PURPOSE To evaluate factors associated with failure of binding release among ACL injured male and female recreational skiers. STUDY DESIGN Cohort study. METHODS Among a cohort of 498 recreational skiers (68% females) suffering from an ACL injury (complete rupture or partial rupture), age, sex, height, weight, self-reported skill level and self-reported risk taking behaviour, gear origin, ski length, date of last binding adjustment, perceived speed at the moment of injury, type of fall, and failure of binding release of the ski of the injured knee, were collected by questionnaire. RESULTS Failure of binding release was reported within 78% of cases and was significantly higher for females compared to males (83 vs 66%, p<0.001) with an adjusted OR of 2.7 (95% CI 1.7 to 4.4). A higher perceived speed at the moment of injury was significantly associated with a decreasing proportion of failure of binding release. A slow perceived speed was independently associated with failure of binding release (adjusted OR 2.0; 95% CI 1.2 to 3.5). There was a significantly higher proportion of failure of binding release during backward falling compared to forward falling (87 vs 72%, p=0.002); similarly, a higher proportion of failure of binding release occurred in cases of complete rupture compared with a partial tear of the ACL (81 vs 64%, p=0.001), respectively. CONCLUSIONS Among this cohort of ACL-injured skiers, failure of binding release was significantly associated with female sex, a slow perceived speed at the moment of injury and complete rupture of the ACL.
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Affiliation(s)
- Gerhard Ruedl
- Department of Sport Science, University of Innsbruck, Innsbruck, Austria
| | | | | | | | - Christian Fink
- Gelenkpunkt-Center for Sports and Joint Surgery, Innsbruck, Austria Research Unit for Orthopedic Sports Medicine and Injury Prevention, UMIT/ISAG, Hall in Tirol, Austria
| | - Martin Burtscher
- Department of Sport Science, University of Innsbruck, Innsbruck, Austria
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48
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Lopes OV, Gomes JLE, de Freitas Spinelli L. Range of motion and radiographic analysis of the hip in patients with contact and non-contact anterior cruciate ligament injury. Knee Surg Sports Traumatol Arthrosc 2016; 24:2868-2873. [PMID: 25677502 DOI: 10.1007/s00167-015-3532-9] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2013] [Accepted: 02/04/2015] [Indexed: 10/24/2022]
Abstract
PURPOSE To compare the range of motion (ROM) and radiography of the hip joints in male patients with contact anterior cruciate ligament (ACL) injury and non-contact ACL injury. METHODS ROM of the ipsilateral hip was evaluated in 35 male patients with contact ACL injury (contact group) and compared to that of 45 male patients with a non-contact ACL injury (non-contact group). Radiographic evaluation of hip joints was also performed to assess the presence of cam and pincer-type deformity . RESULTS ROM of the hip joint was statistically higher in patients with contact ACL injury. The average sum of hip rotation in the non-contact group was 66.1 ± 8.4° compared to 79.4 ± 10.6° for the contact group (p < 0.001). Seventy-seven per cent of patients in the non-contact group had a sum of hip rotation <70° and 93 % had <80°, compared to17.1 and 42.9 % in the contact group (p < 0.001). Prevalence of cam or pincer deformity was similar in the groups. Cam or pincer deformity was not more frequent in patients with limited ROM of the hip. CONCLUSION Individuals with contact ACL injury had greater ROM of the hip joints than those with non-contact ACL injury. The presence of cam or pincer deformity was similar in both groups and was not related to decreased ROM of the hip joints. These findings may assist the surgeons to identify new risk factors for non-contact ACL injury and, additionally, develop prevention program of injury. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Osmar Valadão Lopes
- Instituto de Ortopedia e Traumatologia de Passo Fundo, Passo Fundo, RS, Brazil.
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49
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Dehghan F, Soori R, Dehghan P, Gholami K, Muniandy S, Azarbayjani MA, Yusof A. Changes in Knee Laxity and Relaxin Receptor Isoforms Expression (RXFP1/RXFP2) in the Knee throughout Estrous Cycle Phases in Rodents. PLoS One 2016; 11:e0160984. [PMID: 27513858 PMCID: PMC4981442 DOI: 10.1371/journal.pone.0160984] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2015] [Accepted: 07/28/2016] [Indexed: 12/31/2022] Open
Abstract
The changes in knee laxity and relaxin receptor expression at different phases of rodent estrous cycle are not known. Here, changes in the parameter were investigated in rats at different phases of the estrous cycle. Estrous cycle phases of intact female rats were determined by cytological examination of the vaginal smear. Following phase identification, blood was collected for serum hormone analyses. Knee passive range of motion (ROM) was determined by using a digital miniature goniometer. The animals were then sacrificed and patellar tendon, collateral ligaments and hamstring muscles were harvested for relaxin/insulin-like family peptide receptor 1 and 2 (RXFP1/RXFP2) analyses. Knee passive ROM was the highest at proestrus followed by diestrus and the lowest at estrus. Estrogen level was the highest at proestrus while progesterone and relaxin levels were the highest at diestrus. A strong correlation was observed between relaxin and progesterone levels. At proestrus, expression of RXFP1 and RXFP2 proteins and mRNAs were the highest at proestrus followed by diestrus and estrus. The finding shows that higher level of progesterone and relaxin in diestrus might be responsible for higher laxity of knee joint in rats.
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Affiliation(s)
- Firouzeh Dehghan
- Department of Exercise Physiology, Faculty of Physical Education and Sport Sciences, University of Tehran, Tehran, Iran
- Department of exercise science, Sports Center, University of Malaya, Kuala Lumpur, 50603, Malaysia
- * E-mail:
| | - Rahman Soori
- Department of Exercise Physiology, Faculty of Physical Education and Sport Sciences, University of Tehran, Tehran, Iran
| | - Parvin Dehghan
- Health Deputy, Babol University of Medical Sciences, Babol, Iran
| | - Khadijeh Gholami
- Department of Physiology, Faculty of Medicine, University of Malaya, Kuala Lumpur, 50603, Malaysia
| | - Sekaran Muniandy
- Department of Molecular Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, 50603, Malaysia
| | - Mohammad Ali Azarbayjani
- Department of Physical Education and Sports Sciences, Central Tehran Branch, Islamic Azad University, Tehran, Iran
| | - Ashril Yusof
- Department of exercise science, Sports Center, University of Malaya, Kuala Lumpur, 50603, Malaysia
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50
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Vacek PM, Slauterbeck JR, Tourville TW, Sturnick DR, Holterman LA, Smith HC, Shultz SJ, Johnson RJ, Tourville KJ, Beynnon BD. Multivariate Analysis of the Risk Factors for First-Time Noncontact ACL Injury in High School and College Athletes: A Prospective Cohort Study With a Nested, Matched Case-Control Analysis. Am J Sports Med 2016; 44:1492-501. [PMID: 27217522 PMCID: PMC6533630 DOI: 10.1177/0363546516634682] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Multivariate analysis that identifies the combination of risk factors associated with anterior cruciate ligament (ACL) trauma is important because it provides insight into whether a variable has a direct causal effect on risk or an indirect effect that is mediated by other variables. It can also reveal risk factors that might not be evident in univariate analyses; if a variable's effect is moderated by other variables, its association with risk may be apparent only after adjustment for the other variables. Most important, multivariate analyses can identify combinations of risk factors that are more predictive of risk than individual risk factors. HYPOTHESIS A diverse combination of risk factors predispose athletes to first-time noncontact ACL injury, and these relationships are different for male and female athletes. STUDY DESIGN Case-control study; Level of evidence, 3. METHODS Athletes competing in organized sports at the high school and college levels participated in this study. Data from injured subjects (109 suffering an ACL injury) and matched controls (227 subjects) from the same athletic team were analyzed with multivariate conditional logistic regression to examine the effects of combinations of variables (demographic characteristics, joint laxity, lower extremity alignment, strength, and personality traits) on the risk of suffering their first ACL injury and to construct risk models. RESULTS For male athletes, increases in anterior-posterior displacement of the tibia relative to the femur (knee laxity), posterior knee stiffness, navicular drop, and a decrease in standing quadriceps angle were jointly predictive of suffering an ACL injury. For female athletes the combined effects of having a parent who had suffered an ACL injury and increases in anterior-posterior knee laxity and body mass index were predictive of ACL injury. CONCLUSION Multivariate models provided more information about ACL injury risk than individual risk factors. Both male and female risk models included increased anterior-posterior knee laxity as a predictor of ACL injury but were otherwise dissimilar.
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Affiliation(s)
- Pamela M Vacek
- Department of Medical Biostatistics, University of Vermont, Burlington, Vermont, USA
| | - James R Slauterbeck
- McClure Musculoskeletal Research Center, Department of Orthopaedics and Rehabilitation, University of Vermont, Burlington, Vermont, USA
| | - Timothy W Tourville
- Department of Rehabilitation and Movement Science, University of Vermont, Burlington, Vermont, USA
| | - Daniel R Sturnick
- McClure Musculoskeletal Research Center, Department of Orthopaedics and Rehabilitation, University of Vermont, Burlington, Vermont, USA
| | - Leigh-Ann Holterman
- Department of Medical Biostatistics, University of Vermont, Burlington, Vermont, USA
| | - Helen C Smith
- McClure Musculoskeletal Research Center, Department of Orthopaedics and Rehabilitation, University of Vermont, Burlington, Vermont, USA
| | - Sandra J Shultz
- Department of Kinesiology, University of North Carolina at Greensboro, Greensboro, North Carolina, USA
| | - Robert J Johnson
- McClure Musculoskeletal Research Center, Department of Orthopaedics and Rehabilitation, University of Vermont, Burlington, Vermont, USA
| | - Kelly J Tourville
- Department of Rehabilitation and Movement Science, University of Vermont, Burlington, Vermont, USA
| | - Bruce D Beynnon
- McClure Musculoskeletal Research Center, Department of Orthopaedics and Rehabilitation, University of Vermont, Burlington, Vermont, USA
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