Prospective Correlation Between Serum Relaxin Concentration and Anterior Cruciate Ligament Tears Among Elite Collegiate Female Athletes

Dragoo, Jason L.; Castillo, Tiffany N.; Braun, Hillary J.; Ridley, Bethany A.; Kennedy, Allison; Golish, S. Raymond

doi:10.1177/0363546511413378

Cited by 115 publications

(131 citation statements)

References 25 publications

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“…We were able to measure serum relaxin in generally low levels, and not all subjects had measurable relaxin levels. Dragoo et al noted detectable relaxin levels in 46 of 128 female athletes (36%) with an average relaxin level of 5.7 pg/mL in those without ACL tear and 12.1 pg/mL in those with tears [13]. Physiologic levels of circulating relaxin have been defined based on the pregnant female, but there is limited information on normal levels in postmenopausal women or older men, who made up the majority of our cohort.…”

Section: Discussionmentioning

confidence: 83%

Relationship of Relaxin Hormone and Thumb Carpometacarpal Joint Arthritis

Wolf

Scher

Etchill

et al. 2014

Clinical Orthopaedics &Amp; Related Research

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Background The female predominance in thumb carpometacarpal (CMC) joint arthritis has led to speculation that reproductive hormones or hypermobility are responsible. Evidence shows that patients with pathologic laxity have a higher rate of thumb CMC arthritis. Relaxin hormone increases laxity in the pelvic ligaments through upregulation of matrix metalloproteases (MMPs). It is thus a hormone of interest in the development of thumb CMC arthritis. Questions/purposes Our goals were to identify demographic and hormonal factors associated with joint laxity in patients with CMC arthritis and to evaluate the relationship among serum relaxin, relaxin receptors, and MMPs in the anterior oblique ligament (AOL) of the thumb. We hypothesized that serum relaxin was correlated with joint laxity as well as with relaxin receptors and MMPs in the AOL. MethodsForty-nine patients undergoing thumb CMC arthroplasty underwent laxity examination, blood draw, and AOL sampling. Ligaments were analyzed for relaxin receptor and MMPs 1 and 3 using quantitative reversetranscriptase polymerase chain reaction. Results Women demonstrated more joint laxity than men (p \ 0.001). RNA analysis confirmed relaxin receptors in the AOL as well as MMPs 1 and 3. There was a significant correlation between serum relaxin and MMP-1 (p = 0.04). Detectable serum relaxin was negatively correlated with relaxin receptors in the AOL (p = 0.02). Conclusions Further studies are needed to evaluate the role of laxity and sex hormones in thumb CMC arthritis.

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Section: Discussionmentioning

confidence: 83%

Relationship of Relaxin Hormone and Thumb Carpometacarpal Joint Arthritis

Wolf

Scher

Etchill

et al. 2014

Clinical Orthopaedics &Amp; Related Research

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“…45,46 The percentages of those participants with no complete cycle appeared to be similar in athletes (14 of 74, 19%) and nonathletes (3 of 24, 12%), (P ¼ .47). Those percentages are much higher than the 4.75% of anovulatory athletic women recently reported by Dragoo et al 43 Of similar concern are the 29 participants (30%) with cycles shorter than 24 days or longer than 35 days. Cycles longer than 35 days are more likely to cause concern because high physical activity levels or poor nutritional states 5 (or both) can lengthen the cycle before the cycle is interrupted completely.…”

Section: Discussionmentioning

confidence: 55%

“…The concern that led to the development of these hypotheses was that the physical activity level of teenage female athletes was altering their hormonal balance in a way that made them more susceptible to anterior cruciate ligament (ACL) injury. In a recent, 5-year study of 143 female collegiate athletes, Dragoo et al 43 demonstrated a relationship between circulating relaxin, a collagenolytic hormone that participates in the remodeling process of the ACL, and the risk of ACL injury. When relaxin was detectable in the serum, 14 of 46 athletes (30%) tore their ACLs during their collegiate career; however, little is known about the cyclicity of relaxin, estrogen, and progesterone in normally menstruating women.…”

Section: Discussionmentioning

confidence: 99%

Athletic Activity and Hormone Concentrations in High School Female Athletes

Wojtys¹,

Jannausch²,

Kreinbrink

et al. 2015

Journal of Athletic Training

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Context: Physical activity may affect the concentrations of circulating endogenous hormones in female athletes. Understanding the relationship between athletic and physical activity and circulating female hormone concentrations is critical.Objective: To test the hypotheses that (1) the estradiolprogesterone profile of high school adolescent girls participating in training, conditioning, and competition would differ from that of physically inactive, age-matched adolescent girls throughout a 3-month period; and (2) athletic training and conditioning would alter body composition (muscle, bone), leading to an increasingly greater lean-body-mass to fat-body-mass ratio with accompanying hormonal changes.Design: Cohort study. Settings: Laboratory and participants' homes. Patients or Other Participants: A total of 106 adolescent girls, ages 14-18 years, who had experienced at least 3 menstrual cycles in their lifetime.Main Outcome Measure(s): Participants were prospectively monitored throughout a 13-week period, with weekly physical activity assessments and 15 urine samples for estrogen, luteinizing hormone, creatinine, and progesterone concentrations. Each girl underwent body-composition measurements before and after the study period.Results: Seventy-four of the 98 girls (76%) who completed the study classified themselves as athletes. Body mass index, body mass, and fat measures remained stable, and 17 teenagers had no complete menstrual cycle during the observation period. Mean concentrations of log(estrogen/creatinine) were slightly greater in nonathletes who had cycles of ,24 or .35 days. Mean log(progesterone/creatinine) concentrations in nonathletes were less in the first half and greater in the second half of the cycle, but the differences were not statistically significant.Conclusions: A moderate level of athletic or physical activity did not influence urine concentrations of estrogen, progesterone, or luteinizing hormones. However, none of the participants achieved high levels of physical activity. A significant number (17%) of girls in both activity groups were amenorrheic during the 3-month study period.Key Words: menstrual cycle, estrogen, anterior cruciate ligament, exercise physiology Key PointsUrine concentrations of estrogen and progesterone in high school females were not altered by level of physical or athletic activity. A significant number of both athletic and nonathletic young women were amenorrheic and probably anovulatory during the 3-month study period. Athletic training and conditioning did not alter body composition over the course of the study.

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“…Furthermore, combined administration of oestrogen and cyclic loading in pigs inhibited the mRNA expressions of collagen I, III and biglycan, whereas either oestrogen administration or cyclic loading alone increased the gene expression of only collagen I or collagen I and III, respectively [67]. Recent evidence showed that elite female athletes with ACL injury have higher serum relaxin concentration (SRC) than those without ACL tears; those with an SRC greater than 6.0 pg/mL showed over 4-fold increased risk of ACL tear [68]. Accordingly, results from these studies support a hypothesis that an increase in female hormones can be a risk factor of ACL injury.…”

Section: Hormonal Cycle and Ligamentous Laxitymentioning

confidence: 99%

The Mechanism of Non-contact Anterior Cruciate Ligament Injury in Female Athletes: Is the Injury Mechanism Different between the Genders?

Gamada¹,

Kubota²

2014

Int J Phys Med Rehabil

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ACL injury is one of the most frequent and costly injuries in sports, and is a major risk factor for early knee osteoarthritis. Although female gender is a major risk factor for ACL injury, differences in the injury mechanism between males and females have not yet been determined. The goal of this review was to determine whether there is any evidence of gender differences in the mechanisms of ACL injury. MRI studies demonstrated that the location of bone bruises after ACL injury was similar between genders and that males demonstrated more extensive damage in the joint, suggesting the involvement of higher energy but not a difference in injury mechanism. Video analyses of the process of ACL injury has shown common body positions at the time of injury, but failed to reveal differences in the joint motions between genders. Therefore, the mechanism of ACL injury is likely to be similar across genders.

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Prospective Correlation Between Serum Relaxin Concentration and Anterior Cruciate Ligament Tears Among Elite Collegiate Female Athletes

Abstract: Females with higher serum relaxin levels may be at increased risk for anterior cruciate ligament tears. Further investigation of the clinical utility of SRC testing is warranted.

Cited by 115 publications

References 25 publications

Relationship of Relaxin Hormone and Thumb Carpometacarpal Joint Arthritis

Relationship of Relaxin Hormone and Thumb Carpometacarpal Joint Arthritis

Athletic Activity and Hormone Concentrations in High School Female Athletes

The Mechanism of Non-contact Anterior Cruciate Ligament Injury in Female Athletes: Is the Injury Mechanism Different between the Genders?

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