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Effects of menstrual-cycle hormone fluctuations on musculotendinous stiffness and knee joint laxity

  • Knee
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Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

The high risk of anterior cruciate ligament (ACL) injuries in female athletes may be related to hormonal fluctuations resulting in an increased laxity of ligaments and muscles. This study examined changes in lower limb musculotendinous stiffness (MTS) and knee laxity over the course of the menstrual cycle and investigated the interaction of warm-up on MTS. Eleven female netball players aged 16–18 years who were not using hormonal contraceptives and demonstrated regular menstrual cycles participated in this study. Test-sessions were conducted at onset of menses, mid-follicular phase, ovulation and mid-luteal phase. ACL laxity was determined at each test-session using a KT2000™ knee arthrometer. MTS was assessed prior to, and following a standardised warm-up. Repeated measures ANOVA revealed significant (< 0.05) main effects of test-session and warm-up on MTS. MTS was found to significantly decrease by 4.2% following the warm-up intervention. MTS was significantly lower at week 3 (ovulatory phase) in contrast to weeks 1 and 2 (8.7 and 4.5%, respectively). For knee laxity measures, repeated measures ANOVA revealed no significant (< 0.05) differences across the menstrual cycle. A reduction in MTS results in greater reliance on reflexive response from the contractile components of the muscle due to a decreased contribution from passive elastic structures and will also increase electromechanical delay. Given that extreme loads are applied to the knee joint within milliseconds, the contractile components cannot respond quickly enough to counteract these sudden and potentially damaging forces. These effects are augmented following a moderate warm-up. Oestrogen fluctuations had no significant effect on anterior knee laxity, however, the effects on MTS over the 28-day cycle were considerable. Future studies should use matched subjects who are using the monophasic oral contraceptive pill to investigate the effects of oestrogen supplementation on lower limb MTS.

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References

  1. Arendt E, Agel J, Dick R (1999) Anterior cruciate ligament injuries among collegiate men and women. J Athl Train 34:86–92

    PubMed  CAS  Google Scholar 

  2. Arendt E, Dick R (1995) Knee injury patterns among men and women in collegiate basketball and soccer: NCAA data and review of literature. Am J Sports Med 23:695–701

    Google Scholar 

  3. Bjordal JM, Arnoy F, Hannestad B (1997) Epidemiology of anterior cruciate ligament injuries in soccer. Am J Sports Med 25:341–345

    PubMed  CAS  Google Scholar 

  4. Ireland ML (2002) The female ACL: why is it more prone to injury? Orthop Clin North Am 33:637–651

    Article  PubMed  Google Scholar 

  5. Lindenfeld TN, Schmitt DJ, Hendy MP, et al (1994) Incidence of injury in indoor soccer. Am J Sports Med 22:364–371

    PubMed  CAS  Google Scholar 

  6. Myklebust G, Maehlum S, Holm I, et al (1998) A prospective cohort study of anterior cruciate ligament injuries in elite Norwegian team handball. Scand J Med Sci Sports 8:149–153

    Article  PubMed  CAS  Google Scholar 

  7. Malone TR, Hardaker WT, Garrett WE et al (1993) Relationship of gender to anterior cruciate ligament injuries in intercollegiate basketball players. J South Orthop Assoc 2:36–39

    Google Scholar 

  8. McNair PJ, Marshall RN, Matheson JA (1990) Important features associated with anterior cruciate ligament injury. NZ Med J 103:537–539

    CAS  Google Scholar 

  9. Noyes FR, Mooar PA, Matthews DS et al (1983) The symptomatic anterior cruciate-deficient knee. Part I: the long-term functional disability in athletically active individuals. J Bone Joint Surg Am 65:154–162

    PubMed  CAS  Google Scholar 

  10. Boden BP, Dean GS, Feagin JA et al (2000) Mechanisms of anterior cruciate ligament injury. Orthopedics 23:573–578

    PubMed  CAS  Google Scholar 

  11. Livingston LA, Graham JC (2001) The wider gynaecoid pelvis—larger Q angle—greater predisposition to ACL injury relationship: myth or reality? Clin Biomech 16:951–952

    Google Scholar 

  12. Souryal TO, Freeman TR (1993) Intercondylar notch size and anterior cruciate ligament injuries in athletes: a prospective study. Am J Sports Med 21:535–539

    PubMed  CAS  Google Scholar 

  13. Ireland ML, Ballantyne BT, Little K et al (2001) A radiographic analysis of the relationship between the size and shape of the intercondylar notch and anterior cruciate ligament injury. Knee Surg Sports Traumatol Arthrosc 9:200–205

    Article  PubMed  CAS  Google Scholar 

  14. Nicholas JA (1970) Injuries to knee ligaments: relationship to looseness and tightness in football players. JAMA 212:2236–2239

    Article  PubMed  CAS  Google Scholar 

  15. Moretz JA, Walters R, Smith L (1982) Flexibility as a predictor of knee injuries in college football players. Phys Sportsmed 10:93–97

    Google Scholar 

  16. Arnold C, Van Bell C, Rogers V et al (2002) The relationship between serum relaxin and knee joint stability in female athletes. Orthopedics 25:669–673

    PubMed  Google Scholar 

  17. Slauterback J, Fuzie SF, Smith MP et al (2002) The menstrual cycle, sex hormones and anterior cruciate ligament injury. J Athl Train 37:275–280

    Google Scholar 

  18. Huston LJ, Wojtys EM (1996) Neuromuscular performance characteristics in elite female athletes. Am J Sports Med 24:427–436

    PubMed  CAS  Google Scholar 

  19. Wojtys EM, Ashton-Miller JA, Huston LJ (2002) A gender-related difference in the contribution of the knee musculature to sagittal-plane shear stiffness in subjects with similar knee laxity. J Bone Joint Surg Am 84:10–16

    PubMed  Google Scholar 

  20. Heitz NA, Eisenman PA, Beck CL et al (1999) Hormonal changes throughout the menstrual cycle and increased anterior cruciate ligament laxity in females. J Athl Train 34:144–149

    PubMed  CAS  Google Scholar 

  21. Karageanes SJ, Blackburn K (2000) The association of the menstrual cycle with the laxity of the anterior cruciate ligament in adolescent female athletes. Clin Sports Med 10:162–168

    Article  CAS  Google Scholar 

  22. Romani W, Curl LA, Lovering R, et al (2001) The effect of endogenous estradiol levels at three phases of the menstrual cycle on anterior cruciate ligament stiffness in active females. J Athl Train 2:S62

    Google Scholar 

  23. Belanger MJ, Moore DC, Crisco JJ, et al (2004) Knee laxity does not vary with the menstrual cycle before and after exercise. Am J Sports Med 32:1150–1157

    Article  PubMed  Google Scholar 

  24. Sciore P, Frank CB, Hard DA (1998) Identification of sex hormone receptors in human and rabbit ligaments of the knee by reverse transcription polymerase chain reaction: evidence that receptors are present in tissue from both male and female subjects. J Orthop Res 16:604–610

    Article  PubMed  CAS  Google Scholar 

  25. Dragoo JL, Lee RS, Benhaim P et al (2003) Relaxin receptors in the human female anterior cruciate ligament. Am J Sports Med 31:577–583

    PubMed  Google Scholar 

  26. Liu SH, Al-Shaikh RA, Panossian V et al (1996) Primary immunolocalization of estrogen and progesterone target cells in the human anterior cruciate ligament. J Orthop Res 14:526–533

    Article  PubMed  CAS  Google Scholar 

  27. Lemione S, Garnier P, Tiffoche C et al (2003) Estrogen receptor alpha mRNA in human skeletal muscles. Med Sci Sports Exerc 35:439–443

    Article  CAS  Google Scholar 

  28. Beynnon BD, Bernstein IM, Belisle A et al (2005) The effect of estradiol and progesterone on knee and ankle joint laxity. Am J Sports Med 33:1298–1304

    Article  PubMed  Google Scholar 

  29. McNair PJ, Dombrowski EW, Hewson DJ et al (2001) Stretching and the ankle joint: viscoelastic responses to holds and continuous passive motion. Med Sci Sports Exerc 33:354–358

    Article  PubMed  CAS  Google Scholar 

  30. McNair PJ, Wood G, Marshall R (1992) Stiffness of the hamstring muscles and its relationship to function in anterior cruciate ligament deficient individuals. Clin Biomech 7:131–137

    Article  Google Scholar 

  31. Magnusson SP, Simonsen EB, Aagaard P et al (1996) Biomechanical responses to repeated stretches in human hamstring muscle in vivo. Am J Sports Med 24:622–628

    PubMed  CAS  Google Scholar 

  32. McNair PJ, Stanley SN (1996) Effects of passive stretching and jogging on the series elastic muscle stiffness and range of motion of the ankle joint. Br J Sports Med 30:313–317

    PubMed  CAS  Google Scholar 

  33. Daniel DM, Anderson AF (1992) Evaluation of treatment results. In: Finerman GAM, Noyes FR (eds) Biology and biomechanics of the traumatized synovial joint: the knee as a model. American Academy of Orthopaedic Surgeons, Rosemont, pp. 573–584

    Google Scholar 

  34. Carter C, Wilkinson J (1964) Persistent laxity and congenital dislocation of the hip. J Bone Joint Surg Br 62:40–45

    Google Scholar 

  35. Ferris DP, Farley CT (1997) Interaction of leg stiffness and surface stiffness during human hopping. J Appl Physiol 82:15–22

    PubMed  CAS  Google Scholar 

  36. Steele JR (1990) Biomechanical factors affecting performance in netball. Implications for improving performance and injury reduction. Sports Med 10:88–102

    Article  PubMed  CAS  Google Scholar 

  37. Cavagna GA (1975) Force platforms as ergometers. J Appl Physiol 39:174–179

    PubMed  CAS  Google Scholar 

  38. Romani W, Patrie J, Curl LA et al (2003) The correlations between estradiol, estrone, estriol, progesterone and sex hormone binding globulin and anterior cruciate ligament stiffness in healthy active females. J Womens Health 12:287–272

    Article  Google Scholar 

  39. Liu SH, Al-Shaikh RA, Panossian V et al (1997) Estrogen affects the cellular metabolism of the anterior cruciate ligament: a potential explanation for female athletic injury. Am J Sports Med 25:704–709

    PubMed  CAS  Google Scholar 

  40. Butler DL, Noyes FR, Grood ES (1980) Ligamentous restraints to anterior–posterior drawer in the human knee. J Bone Joint Surg Am 62:259–270

    PubMed  CAS  Google Scholar 

  41. Ellison AE, Berg EE (1985) Embryology, anatomy and function of the anterior cruciate ligament. Orthop Clin North Am 16:3–14

    PubMed  CAS  Google Scholar 

  42. Girgis FG, Marshall JL, Al-Monajem ARS (1975) The cruciate ligament of the knee joint—anatomical, functional and experimental analysis. Clin Orthop 106:216–231

    Article  PubMed  Google Scholar 

  43. Granata KP, Wilson SE, Padua DP (2002) Gender differences in active muskuloskeletal stiffness. Part 1: quantification in controlled measurements of knee joint dynamics. J Electromyogr Kinesiol 12:119–126

    Article  PubMed  Google Scholar 

  44. Wojtys EM, Huston LJ, Schock HJ et al (2003) Gender differences in muscular protection of the knee in torsion in size-matched athletes. J Bone Joint Surg Am 85:782–789

    PubMed  Google Scholar 

  45. Grillner S (1972) The role of muscle stiffness in meeting the changing postural and locomotor requirements for force development by ankle extensors. Acta Physiol Scand 86:92–108

    Article  PubMed  CAS  Google Scholar 

  46. Johannson H, Sjolander P (1993) Neurophysiology of joints. In: Wright V, Radin EL (eds) Mechanics of human joints: physiology, pathophysiology, and treatment. Marcel Dekker, New York, pp. 243–249

    Google Scholar 

  47. Kubo K, Kanehisa H, Ito M, Fukunaga T (2001) Effects of isometric training on the elasticity of human tendon structures in vivo. J Appl Physiol 91:26–32

    PubMed  CAS  Google Scholar 

  48. Wojtys EM, Huston LJ, Boynton MD et al (2002) The effect of the menstrual cycle on anterior cruciate ligament injuries in women as determined by hormone levels. Am J Sports Med 30:182–188

    PubMed  Google Scholar 

  49. Moller-Nielsen J, Hammar M (1989) Women’s soccer injuries in relation to the menstrual cycle and oral contraceptive use. Med Sci Sports Exerc 21:126–129

    PubMed  CAS  Google Scholar 

Download references

Acknowledgment

We would like to thank Sullivan and Nicolaides Laboratories, Rockhampton, Australia for all hormone analyses. None of the authors received financial support of any commercial party.

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Correspondence to E. Hohmann.

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Eiling, E., Bryant, A.L., Petersen, W. et al. Effects of menstrual-cycle hormone fluctuations on musculotendinous stiffness and knee joint laxity. Knee Surg Sports Traumatol Arthrosc 15, 126–132 (2007). https://doi.org/10.1007/s00167-006-0143-5

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  • DOI: https://doi.org/10.1007/s00167-006-0143-5

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