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Moore IS, Crossley KM, Bo K, Mountjoy M, Ackerman KE, Antero JDS, Sundgot Borgen J, Brown WJ, Bolling CS, Clarsen B, Derman W, Dijkstra P, Donaldson A, Elliott-Sale KJ, Emery CA, Haakstad L, Junge A, Mkumbuzi NS, Nimphius S, Palmer D, van Poppel M, Thornton JS, Tomás R, Zondi PC, Verhagen E. Female athlete health domains: a supplement to the International Olympic Committee consensus statement on methods for recording and reporting epidemiological data on injury and illness in sport. Br J Sports Med 2023; 57:1164-1174. [PMID: 37349084 PMCID: PMC10579182 DOI: 10.1136/bjsports-2022-106620] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/18/2023] [Indexed: 06/24/2023]
Abstract
The IOC made recommendations for recording and reporting epidemiological data on injuries and illness in sports in 2020, but with little, if any, focus on female athletes. Therefore, the aims of this supplement to the IOC consensus statement are to (i) propose a taxonomy for categorisation of female athlete health problems across the lifespan; (ii) make recommendations for data capture to inform consistent recording and reporting of symptoms, injuries, illnesses and other health outcomes in sports injury epidemiology and (iii) make recommendations for specifications when applying the Strengthening the Reporting of Observational Studies in Epidemiology-Sport Injury and Illness Surveillance (STROBE-SIIS) to female athlete health data.In May 2021, five researchers and clinicians with expertise in sports medicine, epidemiology and female athlete health convened to form a consensus working group, which identified key themes. Twenty additional experts were invited and an iterative process involving all authors was then used to extend the IOC consensus statement, to include issues which affect female athletes.Ten domains of female health for categorising health problems according to biological, life stage or environmental factors that affect females in sport were identified: menstrual and gynaecological health; preconception and assisted reproduction; pregnancy; postpartum; menopause; breast health; pelvic floor health; breast feeding, parenting and caregiving; mental health and sport environments.This paper extends the IOC consensus statement to include 10 domains of female health, which may affect female athletes across the lifespan, from adolescence through young adulthood, to mid-age and older age. Our recommendations for data capture relating to female athlete population characteristics, and injuries, illnesses and other health consequences, will improve the quality of epidemiological studies, to inform better injury and illness prevention strategies.
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Affiliation(s)
- Isabel S Moore
- Cardiff School of Sport and Health Sciences, Cardiff Metropolitan University, Cardiff, UK
| | - Kay M Crossley
- La Trobe Sport and Exercise Sports Medicine Centre, La Trobe University, Bundoora, Victoria, Australia
| | - Kari Bo
- Department of Sports Medicine, Norwegian School of Sport Sciences, Oslo, Norway
- Department of Obstetrics and Gynecology, Akershus University Hospital, Lorenskog, Norway
| | - Margo Mountjoy
- Family Medicine, McMaster University Michael G DeGroote School of Medicine, Waterloo, Ontario, Canada
| | - Kathryn E Ackerman
- Wu Tsai Female Athlete Program, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | | | | | - Wendy J Brown
- Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Queensland, Australia
- School of Human Movement and Nutrition Sciences, The University of Queensland, Saint Lucia, Queensland, Australia
| | - Caroline S Bolling
- Amsterdam Collaboration on Health & Safety in Sports, Department of Orthopaedic Surgery, Amsterdam Movement Science, Amsterdam UMC Locatie AMC, Amsterdam, The Netherlands
| | - Benjamin Clarsen
- Department of Health Promotion, Norwegian Institute of Public Health, Bergen, Norway
| | - Wayne Derman
- Institute of Sport and Exercise Medicine, Department of Exercise, Sport and Lifestyle Medicine, Faculty Health Sciences Stellenbosch University, Cape Town, South Africa
| | - Paul Dijkstra
- Medical Education Department, Aspetar Qatar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
- Department for Continuing Education, University of Oxford, Oxford, UK
| | - Amber Donaldson
- Department of Sports Medicine, United States Olympic and Paralympic Committee, Colorado Springs, Colorado, USA
- U.S Coalition for the Prevention of Illness and Injury in Sport, Colorado Springs, Colorado, USA
| | | | - Carolyn A Emery
- Sport Injury Prevention Research Centre, Faculty of Kinesiology and Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Lene Haakstad
- Department of Sports Medicine, Norwegian School of Sport Sciences, Oslo, Norway
| | - Astrid Junge
- Family Medicine, McMaster University Michael G DeGroote School of Medicine, Waterloo, Ontario, Canada
- Institute of Interdisciplinary Exercise Science and Sports Medicine, MSH Medical School Hamburg, Hamburg, Germany
| | - Nonhlanhla S Mkumbuzi
- NtombiSport, Cape Town, South Africa
- Department of Rehabilitation, Midlands State University, Gweru, Midlands, Zimbabwe
- Department of Sports, Exercise, and Rehabilitation, Northumbria University, Newcastle upon Tyne, UK
- Department of Human Movement Science, Nelson Mandela University, Qheberha, South Africa
| | - Sophia Nimphius
- School of Medical and Health Sciences, Centre for Human Performance, Edith Cowan University, Perth, Western Australia, Australia
| | - Debbie Palmer
- Edinburgh Sports Medicine Research Network, Institute for Sport Physical Education and Health Sciences, University of Edinburgh, Edinburgh, UK
- School of Medicine, University of Nottingham, Nottingham, UK
| | - Mireille van Poppel
- Institute of Human Movement Science, Sport and Health, University of Graz, Graz, Austria
| | - Jane S Thornton
- Western Centre for Public Health and Family Medicine, Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ontario, Canada
- Fowler Kennedy Sports Medicine Clinic, Western University, London, Ontario, Canada
| | - Rita Tomás
- Portugal Football School, Portuguese Football Federation, Oeiras, Portugal
| | - Phathokuhle C Zondi
- High Performance Commission, Medical Advisory Committee, South African Sports Confederation and Olympic Committee, Salt Rock, South Africa
| | - Evert Verhagen
- Amsterdam Collaboration on Health & Safety in Sports, Department of Public and Occupational Health, Amsterdam Movement Science, Amsterdam UMC, Amsterdam, The Netherlands
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Liu Y, Rodeo SA, Deng XH, Song Z, Chen D, Casey E. Evaluation of sex differences in rodent anterior cruciate ligament injury. J Orthop Res 2023; 41:32-43. [PMID: 35451139 DOI: 10.1002/jor.25346] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 01/31/2022] [Accepted: 04/20/2022] [Indexed: 02/04/2023]
Abstract
The relative contributions of sex differences in anatomy, biomechanics, and hormones to the increased risk of anterior cruciate ligament (ACL) injury in female athletes remains unknown. The purpose of this study is to investigate sex differences in anatomy and biomechanics of the native and reconstructed ACL using our established murine model. A total of 140 12-week-old wild-type C57Bl/6 (70 male vs. 70 female) mice were used for this study. ACL reconstruction was performed on 120 mice who were split into four groups: Group 1 (30 males sacrificed at 14 days), Group 2 (30 females sacrificed at 14 days), Group 3 (30 males sacrificed at 28 days), and Group 4 (30 females sacrificed at 28 days). Tendon graft-to-bone healing was assessed by biomechanical, histological, and micro-CT analysis. Twenty mice were used for baseline testing. Females showed significantly higher anterior (p < 0.05) and total displacement (p < 0.05). Males demonstrated a significantly higher load-to-failure force of native ACLs compared to females (p < 0.05). There was no significant difference in load-to-failure force in the ACL autograft. There were no significant sex differences in histological analysis of graft integration or tibial slope. The increased knee laxity and reduced load-to-failure of the native ACL observed in the female mice are consistent with some of the proposed risk factors driving the increased risk of ACL injury in females. Understanding the relative contributions of factors driving sex differences in material properties of the ACL will provide insight into the sex differences in ACL injury and future prevention strategies.
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Affiliation(s)
- Yake Liu
- Hospital for Special Surgery, New York, New York, USA.,The Affiliate Hospital to Nantong University, Nantong, Jiangsu, China
| | - Scott A Rodeo
- Hospital for Special Surgery, New York, New York, USA
| | | | - Zhe Song
- Hospital for Special Surgery, New York, New York, USA
| | - Daoyun Chen
- Hospital for Special Surgery, New York, New York, USA
| | - Ellen Casey
- Hospital for Special Surgery, New York, New York, USA
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Wang CX, Kale N, Wu VJ, Stamm M, Mulcahey MK. Age, female sex, and oral contraceptive use are risk factors for anterior cruciate ligament reconstruction: A nationwide database study. Knee 2023; 40:135-142. [PMID: 36434970 DOI: 10.1016/j.knee.2022.11.011] [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: 06/04/2022] [Revised: 09/11/2022] [Accepted: 11/03/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND The purpose of this study was to investigate risk factors affecting anterior cruciate ligament (ACL) tears and outcomes following ACL reconstruction in males versus females. This study also analyzed oral contraceptive pill (OCP) use, demographics (e.g., body mass index [BMI], age group), comorbidities (e.g., diabetes, hypertension), and post-operative systemic complications (e.g., anemia, malignant hyperthermia) in patients undergoing ACL reconstruction. METHODS Medical records of patients undergoing ACL reconstruction from 2010-2018 were queried from the PearlDiver administrative claims database current procedural terminology (CPT) and international classification of disease (ICD) codes. The following information was collected using ICD-9/ICD-10 codes: concurrent use of OCPs, concomitant meniscus repair, demographics, age, comorbidities, and systemic complications. The number of ACL reconstructions in females and males were analyzed using multivariate regressions. RESULTS Of 11,498 ACL reconstructions, 5,967 (51.9%) were in females and 5,531 (48.1%) were in males. The majority of patients were ages 15-19 (24.1%) and were not obese (BMI < 30 kg/m2) (35.9%). A greater proportion of female patients undergoing ACL reconstruction were between 15-19 years old (P < 0.001) and obese (BMI > 40 kg/m2) (P < 0.001). A larger proportion of females aged 15-39 taking OCPs underwent ACL reconstruction compared to those not taking OCPs within the same age group (P < 0.001). CONCLUSION ACL tears are more common in female patients compared to males and are more commonly treated with ACL reconstruction. This study identified several factors that may be associated with the increased risk of ACL tears in females, including young age (age 15-39), obesity (BMI > 40 kg/m2), and the use of OCPs prior to ACL reconstruction, which warrant further investigation and attention from surgeons.
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Affiliation(s)
- Cindy X Wang
- Tulane University School of Medicine, United States
| | - Nisha Kale
- Tulane University School of Medicine, United States
| | - Victor J Wu
- Department of Orthopedic Surgery, McGovern Medical School, United States
| | - Michaela Stamm
- Department of Orthopaedic Surgery, Tulane University School of Medicine, United States
| | - Mary K Mulcahey
- Department of Orthopaedic Surgery, Tulane University School of Medicine, United States.
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Parker EA, Meyer AM, Garcia Fleury I, Buckwalter JA. Menstrual hormone-induced cyclic thumb CMC instability and degeneration in women: a systematic review. Biol Sex Differ 2022; 13:32. [PMID: 35725646 PMCID: PMC9208132 DOI: 10.1186/s13293-022-00438-y] [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: 02/21/2022] [Accepted: 05/30/2022] [Indexed: 12/05/2022] Open
Abstract
Background Relaxin is a hormone which peaks during the luteal phase of the menstrual cycle, and a known collagenolytic promoter that has been shown to avidly bind tissues supporting the trapeziometacarpal (TMC) joint in women. We hypothesize a causal linkage between cyclic binding of relaxin to the supporting tissues of the female TMC joint; and to the earlier onset of more severe TMC osteoarthritis (OA) commonly seen in women. Methods A systematic literature review was performed per PRISMA guidelines, qualitatively and quantitatively assessing papers regarding relaxin–TMC joint stability interactions. The primary outcome variable was TMC joint degeneration/loss of function; the “late stage” consequences of relaxin-induced instability. The secondary outcome variable was presence of early signs of relaxin-induced instability; specifically asymptomatic TMC joint laxity in young women. Results In healthy young women, menstrual cycle relaxin peaks corresponded with asymptomatic TMC joint instability. Immunohistochemical studies of TMC arthroplasty patients showed avidly increased relaxin binding to supporting tissues around the TMC joint in women but not men. Demographic analysis of patients from the TMC arthroplasty studies show a predominantly female cohort, who were on average significantly younger than the male surgical patients. Conclusions Each relaxin peak during the menstrual cycle can target receptors on the soft tissues supporting the TMC joint, including—critically—the main stabilizing ligament: the anterior oblique. The cyclic instability is typically asymptomatic for years after menarche, but causes cumulative chondral microtrauma. This likely causes the early-onset, high severity TMC joint OA clinically pervasive among female patients at orthopedic hand clinics. Further research is indicated to develop risk assessment strategies and potential interventional options before and after the onset of hormonal laxity-induced OA. It is widely recognized among hand surgeons that female patients present at a younger age for basal thumb osteoarthritis, with more severe degeneration. The little-known menstrual hormone relaxin, which peaks every ovulatory cycle, may be responsible for the female predominance of this pathology. The soft tissue support structures for the thumb are known to express relaxin receptors which, when activated, trigger lysis of collagen and other extracellular matrix components. Laxity in soft tissues supporting the thumb, such as the deep anterior oblique ligament, would result in joint instability and microtrauma. If women cyclically experience thumb instability and cumulative cartilage microtrauma from menarche through menopause, the female propensity to develop TMC arthritis is aptly justified.
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Affiliation(s)
- Emily A Parker
- Department of Orthopedics and Rehabilitation, University of Iowa Hospitals and Clinics, 200 Hawkins Drive, Iowa, IA, 52242, USA.
| | - Alex M Meyer
- Department of Orthopedics and Rehabilitation, University of Iowa Hospitals and Clinics, 200 Hawkins Drive, Iowa, IA, 52242, USA
| | - Ignacio Garcia Fleury
- Department of Orthopedics and Rehabilitation, University of Iowa Hospitals and Clinics, 200 Hawkins Drive, Iowa, IA, 52242, USA
| | - Joseph A Buckwalter
- Department of Orthopedics and Rehabilitation, University of Iowa Hospitals and Clinics, 200 Hawkins Drive, Iowa, IA, 52242, USA
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Christian RA, Lander ST, Bonazza NA, Reinke EK, Lentz TA, Dodds JA, Mulcahey MK, Ford AC, Wittstein JR. Venous Thromboembolism Prophylaxis and Hormonal Contraceptive Management Practice Patterns in the Perioperative Period for Anterior Cruciate Ligament Reconstruction. Arthrosc Sports Med Rehabil 2022; 4:e679-e685. [PMID: 35494294 PMCID: PMC9042882 DOI: 10.1016/j.asmr.2021.12.010] [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: 09/01/2021] [Accepted: 12/01/2021] [Indexed: 01/13/2023] Open
Abstract
Purpose To evaluate the venous thromboembolism (VTE) prophylaxis practices of surgeons performing anterior cruciate ligament reconstruction (ACLR) in female patients using hormonal contraceptives. Methods Our research team designed an investigational survey using branching logic that was made available to the AANA membership. The survey was designed to identify clinical decision making regarding VTE prophylaxis after ACLR in patients without risk factors for VTE, the counseling of patients about VTE risk associated with hormonal contraceptives, and the use of VTE prophylaxis after ACLR in patients taking hormonal contraceptives. Results Ninety-four respondents completed the survey. Eighty-nine respondents identified their gender (63% male and 37% female respondents). Respondents reported performing the following number of ACLRs annually: more than 50 (40%), 30 to 50 (29%), 15 to 30 (29%), and fewer than 15 (2%). Of the respondents, 62 (67%) reported that VTE developed after ACLR in their patients (male patients only, 32%; female patients only, 24%; and both male and female patients, 34%). Sixty-seven percent used chemoprophylaxis after ACLR. Surgeons who asked about hormonal contraceptive use were more likely to be women (P = .01; odds ratio [OR], 4.2). Surgeons who changed their VTE prophylaxis plan as a result of asking about hormonal contraceptive use were more likely to be women (P = .02; OR, 2.8). Surgeons who asked about hormonal contraceptive use were more likely to have female patients with VTE after ACLR (P = .03; OR, 2.9). Surgeons who changed their VTE prophylaxis plan as a result of asking about hormonal contraceptive use were more likely to have female patients with VTE after ACLR (P = .001; OR, 4.6). Conclusions There is no standard of care for VTE prophylaxis after ACLR. A surgeon’s own gender and prior clinical experience with VTE after ACLR may influence his or her likelihood to consider a patient’s hormonal contraceptive use regarding VTE risk after ACLR. Clinical Relevance The use of hormonal contraception is a risk factor for VTE in female patients undergoing ACLR. It is important to identify current practice patterns and the need for a standard of care.
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Affiliation(s)
- Robert A. Christian
- Department of Orthopaedic Surgery, Duke University, Durham, North Carolina, U.S.A
- Address correspondence to Robert A. Christian, M.D., M.B.A., 622 W 168th St, PH-11-1130, New York, NY 10032, U.S.A.
| | - Sarah T. Lander
- Department of Orthopaedic Surgery, Duke University, Durham, North Carolina, U.S.A
| | - Nicholas A. Bonazza
- Department of Orthopaedic Surgery, Duke University, Durham, North Carolina, U.S.A
| | - Emily K. Reinke
- Department of Orthopaedic Surgery, Duke University, Durham, North Carolina, U.S.A
| | - Trevor A. Lentz
- Department of Orthopaedic Surgery, Duke University, Durham, North Carolina, U.S.A
- Duke Clinical Research Institute, Duke University, Durham, North Carolina, U.S.A
| | - Julie A. Dodds
- Department of Orthopaedic Surgery, Michigan State University, East Lansing, Michigan, U.S.A
| | - Mary K. Mulcahey
- Department of Orthopaedic Surgery, Tulane University, New Orleans, Louisiana, U.S.A
| | - Anne C. Ford
- Department of Obstetrics and Gynecology, Duke University, Durham, North Carolina, U.S.A
| | - Jocelyn R. Wittstein
- Department of Orthopaedic Surgery, Duke University, Durham, North Carolina, U.S.A
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Castanier C, Bougault V, Teulier C, Jaffré C, Schiano-Lomoriello S, Vibarel-Rebot N, Villemain A, Rieth N, Le-Scanff C, Buisson C, Collomp K. The Specificities of Elite Female Athletes: A Multidisciplinary Approach. Life (Basel) 2021; 11:622. [PMID: 34206866 PMCID: PMC8303304 DOI: 10.3390/life11070622] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 06/21/2021] [Accepted: 06/23/2021] [Indexed: 12/19/2022] Open
Abstract
Female athletes have garnered considerable attention in the last few years as more and more women participate in sports events. However, despite the well-known repercussions of female sex hormones, few studies have investigated the specificities of elite female athletes. In this review, we present the current but still limited data on how normal menstrual phases, altered menstrual phases, and hormonal contraception affect both physical and cognitive performances in these elite athletes. To examine the implicated mechanisms, as well as the potential performances and health risks in this population, we then take a broader multidisciplinary approach and report on the causal/reciprocal relationships between hormonal status and mental and physical health in young (18-40 years) healthy females, both trained and untrained. We thus cover the research on both physiological and psychological variables, as well as on the Athlete Biological Passport used for anti-doping purposes. We consider the fairly frequent discrepancies and summarize the current knowledge in this new field of interest. Last, we conclude with some practical guidelines for eliciting improvements in physical and cognitive performance while minimizing the health risks for female athletes.
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Affiliation(s)
- Carole Castanier
- CIAMS, Université Paris-Saclay, 91405 Orsay, France; (C.C.); (C.T.); (S.S.-L.); (N.V.-R.); (A.V.); (N.R.); (C.L.-S.)
- CIAMS, Université d’Orléans, 45067 Orléans, France
| | | | - Caroline Teulier
- CIAMS, Université Paris-Saclay, 91405 Orsay, France; (C.C.); (C.T.); (S.S.-L.); (N.V.-R.); (A.V.); (N.R.); (C.L.-S.)
- CIAMS, Université d’Orléans, 45067 Orléans, France
| | | | - Sandrine Schiano-Lomoriello
- CIAMS, Université Paris-Saclay, 91405 Orsay, France; (C.C.); (C.T.); (S.S.-L.); (N.V.-R.); (A.V.); (N.R.); (C.L.-S.)
- CIAMS, Université d’Orléans, 45067 Orléans, France
| | - Nancy Vibarel-Rebot
- CIAMS, Université Paris-Saclay, 91405 Orsay, France; (C.C.); (C.T.); (S.S.-L.); (N.V.-R.); (A.V.); (N.R.); (C.L.-S.)
- CIAMS, Université d’Orléans, 45067 Orléans, France
| | - Aude Villemain
- CIAMS, Université Paris-Saclay, 91405 Orsay, France; (C.C.); (C.T.); (S.S.-L.); (N.V.-R.); (A.V.); (N.R.); (C.L.-S.)
- CIAMS, Université d’Orléans, 45067 Orléans, France
| | - Nathalie Rieth
- CIAMS, Université Paris-Saclay, 91405 Orsay, France; (C.C.); (C.T.); (S.S.-L.); (N.V.-R.); (A.V.); (N.R.); (C.L.-S.)
- CIAMS, Université d’Orléans, 45067 Orléans, France
| | - Christine Le-Scanff
- CIAMS, Université Paris-Saclay, 91405 Orsay, France; (C.C.); (C.T.); (S.S.-L.); (N.V.-R.); (A.V.); (N.R.); (C.L.-S.)
- CIAMS, Université d’Orléans, 45067 Orléans, France
| | - Corinne Buisson
- Département des Analyses, AFLD, 92290 Chatenay-Malabry, France;
| | - Katia Collomp
- CIAMS, Université Paris-Saclay, 91405 Orsay, France; (C.C.); (C.T.); (S.S.-L.); (N.V.-R.); (A.V.); (N.R.); (C.L.-S.)
- CIAMS, Université d’Orléans, 45067 Orléans, France
- Département des Analyses, AFLD, 92290 Chatenay-Malabry, France;
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Vaudreuil N, Roe J, Salmon L, Servien E, van Eck C. Management of the female anterior cruciate ligament: current concepts. J ISAKOS 2020. [DOI: 10.1136/jisakos-2019-000332] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Pelkowski JN, DeMatas K, McCoy RC, Ortiguera CJ. Seeing Double: A Case of ACL Tears in Monozygotic Twin Female Athletes Within 48 Hours. Cureus 2020; 12:e7244. [PMID: 32284919 PMCID: PMC7147529 DOI: 10.7759/cureus.7244] [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] [Indexed: 11/25/2022] Open
Abstract
Anterior cruciate ligament (ACL) injuries are a serious issue for young athletes. These injuries are devastating and costly, leading to significant time away from sports, and substantial financial cost. A case is presented in which monozygotic twin sisters sustained ACL injuries within 48 hours of one another. Limited research is available studying twins with ACL tears and the risk factors associated with them. This is the first reported case of monozygotic sisters that are high-level athletes with ACL tears in such close proximity to one another. Enhanced knowledge of genetic contribution to ACL injuries is important to better understand predisposing factors and to develop preventative approaches. More research is needed to support a distinct association between ACL rupture and genetic variants.
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Affiliation(s)
| | | | - Ryan C McCoy
- Physical Therapy, Mayo Clinic, Jacksonville, USA
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DeFroda SF, Bokshan SL, Worobey S, Ready L, Daniels AH, Owens BD. Oral contraceptives provide protection against anterior cruciate ligament tears: a national database study of 165,748 female patients. PHYSICIAN SPORTSMED 2019; 47:416-420. [PMID: 30913940 DOI: 10.1080/00913847.2019.1600334] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Objective: Anterior cruciate ligament (ACL) tears are more prevalent in females than males. One of the factors responsible for this may be the variation in levels of estrogen and progesterone. The purpose of this study was to determine the potentially protective effects of oral contraceptive pills (OCPs) on ACL tears.Methods: The PearlDiver database (www.pearldiverinc.com, Fort Wayne, IN) was queried for all OCP users amongst females aged 15-49. Female experiencing an ACL tear and undergoing surgery (CPT 29,888) were compared to a control group of females undergoing surgery for an ACL tear, but not on OCPs. Chi-squared testing was used to assess for significant differences in the rate of ACL reconstruction for the OCP and non-OCP users, according to age groups broken down into age intervals of 5 years.Results: There were a total 82,874 patients in both the OCP and non-OCP groups. There was a total of 569 (0.69%) ACL reconstructions in the non-OCP group and 465 (0.56%) in the OCP group (p< 0.001). In the non-OCP group, patients aged 15-19 accounted for 29.35% of all ACL reconstructions, whereas, in the OCP group, this same age group only accounted for 13.33%. Among all age groups, the odds ratios for experiencing an ACL reconstruction while on OCP was 0.82 (χ2 = 0.001, 95% CI 0.72-0.92) compared to not using OCP. This protective effect was driven primarily by the 15-19 age group (odds ratio 0.37 (χ2 < 0.001, 95% CI 0.27-0.50)). The number need to treat for OCP usage in the 15-19 age group was six patients.Conclusions: OCPs have a protective effect on ACL tear, especially in the 15-19 age group, which exhibited a 63% reduction in the rate of tear. Consideration should be given to prescribing OCPs to younger athletes, after careful assessment of the risks of these commonly prescribed medications.Level of evidence: III.
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Affiliation(s)
- Steven F DeFroda
- Department of Orthopaedic Surgery, Brown University, Warren Alpert School of Medicine, Providence, RI, USA
| | - Steven L Bokshan
- Department of Orthopaedic Surgery, Brown University, Warren Alpert School of Medicine, Providence, RI, USA
| | - Samantha Worobey
- Department of Orthopaedic Surgery, Brown University, Warren Alpert School of Medicine, Providence, RI, USA
| | - Lauren Ready
- Department of Orthopaedic Surgery, Brown University, Warren Alpert School of Medicine, Providence, RI, USA
| | - Alan H Daniels
- Department of Orthopaedic Surgery, Brown University, Warren Alpert School of Medicine, Providence, RI, USA
| | - Brett D Owens
- Department of Orthopaedic Surgery, Brown University, Warren Alpert School of Medicine, Providence, RI, USA
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10
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Wojtys EM. Healthy Kids. Sports Health 2017; 9:496-497. [PMID: 29068781 PMCID: PMC5665120 DOI: 10.1177/1941738117735616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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