Effects of the menstrual cycle on lower-limb biomechanics, neuromuscular control, and anterior cruciate ligament injury risk: a systematic review

Abstract

SummaryObjective: 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.

Differences and mechanisms underpinning a change in the knee flexion moment while running in stability and neutral footwear among young females

“…Information regarding menarche informed the appropriate time for biomechanical testing [13] as fluctuating estradiol levels in girls during and post-puberty may influence lower limb biomechanics [25, 26]. Participants who indicated that they had experienced menarche, but were not using a monophasic OCP, were tested within the first 7 days of their menstrual cycle (i.e., early follicular phase).…”

Multi-Location External Workload Profile in Women’s Basketball Players. A Case Study at the Semiprofessional-Level

“…These aspects affect the trunk and hip flexion angles as well as hip adduction and internal rotation during sports movements, making women players prone to lower limb injuries [ 36 , 37 ]. So, the trunk, hip and knee joints need to be considered in women’s basketball players due to the high rate of anterior cruciate ligament injuries and the effect of external variables such as fatigue and the menstrual cycle on this injury process [ 38 , 39 ]. Therefore, the injury prevention protocols, training tasks and recovery programs should focus on the lower limbs in comparison with the upper limbs.…”

Multiscale modeling of knee ligament biomechanics

“…It has been reported that hormonal levels and the associated modification in the collagen content are to be considered factors related to the increased risk of incidence of knee ligament injuries in the female population. [65][66][67][68] These ovarian hormones alter collagen metabolism by generating enzymes that cleave and denature tropocollagen molecules. In addition, the effect of advanced glycation end products (AGEs), a phenomenon observed in the elderly and diabetic populations as responsible for the increased risk of ligament injuries, 69,70 could be a potential target using the proposed model.…”