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Published in: Knee Surgery, Sports Traumatology, Arthroscopy 2/2007

01-02-2007 | Knee

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

Authors: E. Eiling, A. L. Bryant, W. Petersen, A. Murphy, E. Hohmann

Published in: Knee Surgery, Sports Traumatology, Arthroscopy | Issue 2/2007

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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.
Literature
1.
go back to reference Arendt E, Agel J, Dick R (1999) Anterior cruciate ligament injuries among collegiate men and women. J Athl Train 34:86–92PubMed Arendt E, Agel J, Dick R (1999) Anterior cruciate ligament injuries among collegiate men and women. J Athl Train 34:86–92PubMed
2.
go back to reference 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 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
3.
go back to reference Bjordal JM, Arnoy F, Hannestad B (1997) Epidemiology of anterior cruciate ligament injuries in soccer. Am J Sports Med 25:341–345PubMed Bjordal JM, Arnoy F, Hannestad B (1997) Epidemiology of anterior cruciate ligament injuries in soccer. Am J Sports Med 25:341–345PubMed
4.
go back to reference Ireland ML (2002) The female ACL: why is it more prone to injury? Orthop Clin North Am 33:637–651PubMedCrossRef Ireland ML (2002) The female ACL: why is it more prone to injury? Orthop Clin North Am 33:637–651PubMedCrossRef
5.
go back to reference Lindenfeld TN, Schmitt DJ, Hendy MP, et al (1994) Incidence of injury in indoor soccer. Am J Sports Med 22:364–371PubMed Lindenfeld TN, Schmitt DJ, Hendy MP, et al (1994) Incidence of injury in indoor soccer. Am J Sports Med 22:364–371PubMed
6.
go back to reference 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 8:149–153PubMedCrossRef 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 8:149–153PubMedCrossRef
7.
go back to reference 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 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
8.
go back to reference McNair PJ, Marshall RN, Matheson JA (1990) Important features associated with anterior cruciate ligament injury. NZ Med J 103:537–539 McNair PJ, Marshall RN, Matheson JA (1990) Important features associated with anterior cruciate ligament injury. NZ Med J 103:537–539
9.
go back to reference 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 65:154–162PubMed 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 65:154–162PubMed
10.
go back to reference Boden BP, Dean GS, Feagin JA et al (2000) Mechanisms of anterior cruciate ligament injury. Orthopedics 23:573–578PubMed Boden BP, Dean GS, Feagin JA et al (2000) Mechanisms of anterior cruciate ligament injury. Orthopedics 23:573–578PubMed
11.
go back to reference 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 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
12.
go back to reference Souryal TO, Freeman TR (1993) Intercondylar notch size and anterior cruciate ligament injuries in athletes: a prospective study. Am J Sports Med 21:535–539PubMed Souryal TO, Freeman TR (1993) Intercondylar notch size and anterior cruciate ligament injuries in athletes: a prospective study. Am J Sports Med 21:535–539PubMed
13.
go back to reference 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 9:200–205PubMedCrossRef 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 9:200–205PubMedCrossRef
14.
go back to reference Nicholas JA (1970) Injuries to knee ligaments: relationship to looseness and tightness in football players. JAMA 212:2236–2239PubMedCrossRef Nicholas JA (1970) Injuries to knee ligaments: relationship to looseness and tightness in football players. JAMA 212:2236–2239PubMedCrossRef
15.
go back to reference Moretz JA, Walters R, Smith L (1982) Flexibility as a predictor of knee injuries in college football players. Phys Sportsmed 10:93–97 Moretz JA, Walters R, Smith L (1982) Flexibility as a predictor of knee injuries in college football players. Phys Sportsmed 10:93–97
16.
go back to reference Arnold C, Van Bell C, Rogers V et al (2002) The relationship between serum relaxin and knee joint stability in female athletes. Orthopedics 25:669–673PubMed Arnold C, Van Bell C, Rogers V et al (2002) The relationship between serum relaxin and knee joint stability in female athletes. Orthopedics 25:669–673PubMed
17.
go back to reference 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 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
18.
go back to reference Huston LJ, Wojtys EM (1996) Neuromuscular performance characteristics in elite female athletes. Am J Sports Med 24:427–436PubMed Huston LJ, Wojtys EM (1996) Neuromuscular performance characteristics in elite female athletes. Am J Sports Med 24:427–436PubMed
19.
go back to reference 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 84:10–16PubMed 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 84:10–16PubMed
20.
go back to reference 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 34:144–149PubMed 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 34:144–149PubMed
21.
go back to reference 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 10:162–168CrossRef 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 10:162–168CrossRef
22.
go back to reference 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 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
23.
go back to reference 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 32:1150–1157PubMedCrossRef 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 32:1150–1157PubMedCrossRef
24.
go back to reference 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 16:604–610PubMedCrossRef 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 16:604–610PubMedCrossRef
25.
go back to reference Dragoo JL, Lee RS, Benhaim P et al (2003) Relaxin receptors in the human female anterior cruciate ligament. Am J Sports Med 31:577–583PubMed Dragoo JL, Lee RS, Benhaim P et al (2003) Relaxin receptors in the human female anterior cruciate ligament. Am J Sports Med 31:577–583PubMed
26.
go back to reference 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 14:526–533PubMedCrossRef 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 14:526–533PubMedCrossRef
27.
go back to reference Lemione S, Garnier P, Tiffoche C et al (2003) Estrogen receptor alpha mRNA in human skeletal muscles. Med Sci Sports Exerc 35:439–443CrossRef Lemione S, Garnier P, Tiffoche C et al (2003) Estrogen receptor alpha mRNA in human skeletal muscles. Med Sci Sports Exerc 35:439–443CrossRef
28.
go back to reference 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 33:1298–1304PubMedCrossRef 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 33:1298–1304PubMedCrossRef
29.
go back to reference 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 33:354–358PubMedCrossRef 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 33:354–358PubMedCrossRef
30.
go back to reference 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 7:131–137CrossRef 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 7:131–137CrossRef
31.
go back to reference Magnusson SP, Simonsen EB, Aagaard P et al (1996) Biomechanical responses to repeated stretches in human hamstring muscle in vivo. Am J Sports Med 24:622–628PubMed Magnusson SP, Simonsen EB, Aagaard P et al (1996) Biomechanical responses to repeated stretches in human hamstring muscle in vivo. Am J Sports Med 24:622–628PubMed
32.
go back to reference 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 30:313–317PubMed 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 30:313–317PubMed
33.
go back to reference 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 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
34.
go back to reference Carter C, Wilkinson J (1964) Persistent laxity and congenital dislocation of the hip. J Bone Joint Surg Br 62:40–45 Carter C, Wilkinson J (1964) Persistent laxity and congenital dislocation of the hip. J Bone Joint Surg Br 62:40–45
35.
go back to reference Ferris DP, Farley CT (1997) Interaction of leg stiffness and surface stiffness during human hopping. J Appl Physiol 82:15–22PubMed Ferris DP, Farley CT (1997) Interaction of leg stiffness and surface stiffness during human hopping. J Appl Physiol 82:15–22PubMed
36.
go back to reference Steele JR (1990) Biomechanical factors affecting performance in netball. Implications for improving performance and injury reduction. Sports Med 10:88–102PubMedCrossRef Steele JR (1990) Biomechanical factors affecting performance in netball. Implications for improving performance and injury reduction. Sports Med 10:88–102PubMedCrossRef
37.
go back to reference Cavagna GA (1975) Force platforms as ergometers. J Appl Physiol 39:174–179PubMed Cavagna GA (1975) Force platforms as ergometers. J Appl Physiol 39:174–179PubMed
38.
go back to reference 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 12:287–272CrossRef 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 12:287–272CrossRef
39.
go back to reference 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 25:704–709PubMed 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 25:704–709PubMed
40.
go back to reference Butler DL, Noyes FR, Grood ES (1980) Ligamentous restraints to anterior–posterior drawer in the human knee. J Bone Joint Surg Am 62:259–270PubMed Butler DL, Noyes FR, Grood ES (1980) Ligamentous restraints to anterior–posterior drawer in the human knee. J Bone Joint Surg Am 62:259–270PubMed
41.
go back to reference Ellison AE, Berg EE (1985) Embryology, anatomy and function of the anterior cruciate ligament. Orthop Clin North Am 16:3–14PubMed Ellison AE, Berg EE (1985) Embryology, anatomy and function of the anterior cruciate ligament. Orthop Clin North Am 16:3–14PubMed
42.
go back to reference Girgis FG, Marshall JL, Al-Monajem ARS (1975) The cruciate ligament of the knee joint—anatomical, functional and experimental analysis. Clin Orthop 106:216–231PubMedCrossRef Girgis FG, Marshall JL, Al-Monajem ARS (1975) The cruciate ligament of the knee joint—anatomical, functional and experimental analysis. Clin Orthop 106:216–231PubMedCrossRef
43.
go back to reference 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 12:119–126PubMedCrossRef 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 12:119–126PubMedCrossRef
44.
go back to reference 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 85:782–789PubMed 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 85:782–789PubMed
45.
go back to reference 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 86:92–108PubMedCrossRef 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 86:92–108PubMedCrossRef
46.
go back to reference 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 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
47.
go back to reference 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 91:26–32PubMed 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 91:26–32PubMed
48.
go back to reference 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 30:182–188PubMed 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 30:182–188PubMed
49.
go back to reference Moller-Nielsen J, Hammar M (1989) Women’s soccer injuries in relation to the menstrual cycle and oral contraceptive use. Med Sci Sports Exerc 21:126–129PubMed Moller-Nielsen J, Hammar M (1989) Women’s soccer injuries in relation to the menstrual cycle and oral contraceptive use. Med Sci Sports Exerc 21:126–129PubMed
Metadata
Title
Effects of menstrual-cycle hormone fluctuations on musculotendinous stiffness and knee joint laxity
Authors
E. Eiling
A. L. Bryant
W. Petersen
A. Murphy
E. Hohmann
Publication date
01-02-2007
Publisher
Springer-Verlag
Published in
Knee Surgery, Sports Traumatology, Arthroscopy / Issue 2/2007
Print ISSN: 0942-2056
Electronic ISSN: 1433-7347
DOI
https://doi.org/10.1007/s00167-006-0143-5

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