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Effect menstrual cycles phases have on ligament laxity as a risk factor for ACL injuries in female athletes: A critically appraised topic

Sons, Amber
Ford, Lauren
O’Brien, Matthew
Clinical Scenario: Women are 2-6 times at a higher risk of suffering from an Anterior Cruciate Ligament (ACL) rupture compared to men; hormonal factors are thought to predispose them to this injury. Given the ramifications of ACL injuries, prevention is critical, and clinicians are actively seeking ways to decrease the risk of ACL injuries. This critically appraised topic looked at the four unique phases of the menstrual cycle and the increase of risk ACL injury may have within each phase.
Clinical Question: In a normal menstrual cycle, what effects do each phase and hormone fluctuation play on ligament laxity regarding an increase in ACL injury risk in female athletes?
Summary of Key Findings: ACL laxity occurring in conjunction with the approximate time of ovulation phase in the menstrual cycle.
Clinical Bottom Line: There is moderate evidence to support the notion that a there a greater incidence of ACL injuries or risk in the ovulatory phase of the menstrual cycle. This phase occurs approximately in the middle of a female’s cycle, around days 13-15 and when estrogen levels typically rise. Future research can expand on studying women with menstrual dysfunction and those taking contraceptive hormone therapy as well as investigate not only cis women but transgender, gender fluid, and nonbinary women.