Wednesday, February 27, 2008
I got a lot of good information from this source.
Monday, February 11, 2008
I really enjoy this reading i love how it keeps us guess on where they are and why they are there and everything else about it.
New Research Suggest Hormones Put Females at Higher Risk of ACL Injury
DALLAS (December 4, 2001) - A new study commissioned by the National Athletic Trainers' Association Research and Education Foundation found that gender specific differences account for the high occurrence of ACL injuries in females. Results of the study were presented at the NATA Annual Meeting and Clinical Symposia in June and an abstract was recently published in the Journal of Athletic Training, the quarterly scientific publication of the National Athletic Trainers' Association.
The study found that females are more prone to knee laxity and ACL graft failure after ligament reconstruction. This suggests that the type of hormone (testosterone in males vs. estrogen or progesterone in females) or the nature of exposure to it (sustained in males vs. cyclic in females) could affect the remodeling capabilities of the ACL and thereby alter the mechanical properties of the ligament. Therefore, female hormones produce episodic shifts in the balance of remodeling toward net tissue degradation, while no such shift occurs in males.
The study was conducted at Texas Tech University Health Sciences Center by Stephen Fuzie, ATC, and James Slauterbeck, MD. "This is the first report correlating ACL injury to cycle day with confirmation of the actual hormonal level," said Fuzie. "It is our opinion that the clustering of injury early in the follicular phase of the menstrual cycle is a result of hormone changes within the ligament that occur following the rise of both progesterone and estrogen levels in the luteal phase."
A key component to the hypothesis was to identify a period of time during the menstrual cycle where a disproportionate number of ACL injuries occur. Also, the study was designed to determine if ACL injury occurs randomly or is clustered around a specific phase of the menstrual cycle and to confirm the injury date and menstrual history by estrogen and progesterone measurements taken from saliva.
A total of 37 female athletes - 25 college and 12 high school - were evaluated at the time of ACL injury over a three-year period. A questionnaire was filled out and a physical exam, MRI or surgery confirmed ACL injury. The correlations between saliva and serum estrogen and progesterone were 73 percent and 72 percent, respectively. Twenty-six of the 37 athletes injured their ACLs during the follicular phase of the menstrual cycle. Most ACL injuries occurred during the early part of the follicular phase of the cycle and decreased as the cycle progressed.
The Foundation, affiliated with the National Athletic Trainers' Association (NATA), is dedicated to enhancing healthcare for the physically active through funding and support of research and education. NATA's 21,000-plus certified athletic trainers are experts in providing quality healthcare and applying the latest research and techniques in the evaluation, treatment and rehabilitation of injuries.
This article showed a more in depth research where they monitored girls in sports and when they tore their acl and how it relates to the time in their cycle... this helped to understand the timing a bit more.
by Sheila Dwyer, Knee1 Staff
Doctors have long wondered why women are eight times more likely than men to injure their anterior cruciate ligament (ACL) when playing sports. Mounting evidence suggests that biology could be partly to blame.
Results from a study on women and ACL tears were presented at the recent annual meeting of the American Orthopaedic Society for Sports Medicine in Colorado. Dr. Edward Wojtys of the University of Michigan headed up the study, which revealed that women are three times more likely to tear the ACL during ovulation than at other times of the month.
“Women are up to eight times more likely to sustain this knee injury than men—and now there is mounting evidence that hormonal activity, particularly the increase in estrogen seen mid-cycle, may play a role in increasing the risk of this injury,” Wojtys told HealthScout.
The study involved 65 women between the ages of 18 and 38 with acute ACL injuries. Researchers tracked their hormone levels through urine samples taken within 24 hours of injury. Through measurement of estrogen, progesterone, and lutenizing hormone metabolites, researchers concluded that women were at a greater risk of ACL injury during days 10 through 14 of the menstrual cycle (ovulation) and at a lesser risk during days 15 through the end of the cycle.
Experts involved with the study do not believe that ACL injuries in women can be blamed entirely on hormones. Because women sustain ACL injuries throughout the menstrual cycle, hormones are most likely only part of the answer.
“There are a variety of intrinsic factors involved here—hormonal, anatomic, muscle factors—plus we can’t forget training differences in men and women, with women generally taking up sports at a later age than men,” Dr. Elliott Hershman of Lenox Hill Hospital in New York told HealthScout.
The study also showed that birth control pills might have a positive, protective effect on the knees. Fourteen of the women involved in the study were taking oral contraceptives at the time of injury. Their rate of mid-cycle ACL injury was significantly lower than that of women who were not taking birth control pills.
Dr. Wojtys cautions against misreading the results of the study: “We don’t want this material to press the panic button. This research does not justify pulling young ladies out of sports or putting young women on oral contraceptives to prevent ligament injuries.”
ACL injury is damage to the ligament that provides stability to the knee. It usually results from a twisting or impact injury. It can be an incomplete injury (sprain), partial tear (avulsion), or a complete tear. If an athlete’s muscles are not properly conditioned, jumping or cutting motions may cause a serious ACL injury.
This article not only told me all the information that the others did as well it also informed me how birth control can help with this situation and eating properly and those kind of things can help in maybe preventing these injuries
Dr. Kurt Spindler and colleagues were honored recently for a study to be published in the American Journal of Sports Medicine.
“The Effect of the Menstrual Cycle on ACL Injuries in Women as Determined by Hormone Levels,” was presented at the 27th annual meeting of the American Orthopaedic Society for Sports Medicine this past summer. The study won the O’Donoghue Sports Injury Research Award, presented annually to the best overall clinical research paper.
It has been proven that women are more susceptible to tear their anterior cruciate ligament (ACL) than men are; but the reasons are unknown. The study finds that women are nearly three times more likely to injure their ACL during ovulation than during other times of their menstrual cycle, according to Spindler, vice chairman of Orthopaedics and director of Sports Medicine at Vanderbilt University Medical Center, and research colleagues.
“Females have an increased frequency, or in other words a greater risk to tear their ACL at mid-cycle around ovulation,” Spindler said. “Yet, we don’t know why.”
Spindler and four researchers from across the country evaluated 65 women over three years to determine menstrual cycle phase at the time of injury. The cycle phase was determined by hormone and metabolite measurements obtained through urine samples within 24 hours of the injury.
According to the researchers, young women involved in organized sports are expected to suffer more than 30,000 serious knee injuries per year. The number of injuries in recreational sports is even greater.
The reason why more women seem to tear their ACL during ovulation is still a mystery to researchers. More studies will have to be done to determine why more tears occur during ovulation other than the two other stages, Spindler said.
This article i read told me more about research done over the effects of the menstrual cycle on tearing your acl. i got alot of simple information from this one
this is the article
Publication: The American Journal of Sports Medicine
Publication Date: 01-MAR-02
Format: Online - approximately 5832 words
Delivery: Immediate Online Access
Author: Wojtys, Edward M. ; Huston, Laura J. ; Boynton, Melbourne D. ; Spindler, Kurt P. ; Lindenfeld, Thomas N.
Female athletes at the high school and collegiate level in the United States are expected to suffer over 30,000 serious knee injuries per year. (15,26) In recreational sports, the number of injuries is even greater. (11) Unfortunately, the consequences of these injuries will last beyond the recreational, high school, or collegiate sports seasons, and for many athletes, the effects last for years to come. (9)
Why women are two to eight times more likely to sustain ACL tears, depending on the sport and the level of competition, continues to be a challenging question for clinical and basic science researchers. (1,2,13) Sex differences in anatomy, neuromuscular performance, and hormonal profile are active areas of investigation. With the ever-increasing levels of sports participation among women and the understandable desire of female athletes to remain physically active, it is imperative that answers to this problem be found.
Our previous work has suggested that more ACL tears occur during the ovulatory phase of the menstrual cycle than would be expected if the risk were the same for every phase. (22,39,40) Because the menstrual cycle, and hormone fluctuations associated with it, is one of the most important differences between male and female athletes, we further investigated the distribution of these injuries during the cycle using hormone metabolite measurements.
Our previous questionnaire study was limited by the ability of the participants to recall the phase of the cycle at the time of injury. (39) Although the participants were consistent in their responses, they could have been consistently inaccurate. To overcome this limitation, we measured estrogen, progesterone, and luteinizing hormone metabolites in the urine within 24 hours of injury and at the start of their next menstrual cycle in 65 women with acute ACL tears. Use of this protocol allowed accurate determination of the cycle phase in which the ACL injury occurred. Our study objective was to determine whether an association exists between the menstrual cycle phase and the distribution of ACL injuries in female athletes. Our hypothesis was that menstrual cycle phase affects the susceptibility of female athletes to ACL injury. Secondarily, we wanted to use hormone confirmation to determine whether the patient's recall of cycle day at the time of injury was accurate in assessing the actual phase. In essence, we wanted to determine whether self-reported menstrual cycle phase is as accurate as laboratory determinations.
MATERIALS AND METHODS
Description of the Menstrual Cycle and Its Corresponding Phases
The menstrual cycle has been divided into three to five subsections based on the corresponding state of the ovary. (28) The most common system separates the cycle into three main phases: follicular, ovulatory, and luteal. The follicular phase, which begins on the first day of menstruation and has a mean length of 9 days, is the most variable in length. During this time, 10 to 20 follicles start to develop in the ovary. During the last half of the follicular phase, the diameter of the largest follicle increases rapidly, while the remaining follicles become atretic. Coincident with the development of the largest follicle, the concentration of luteinizing hormone rises. A surge of luteinizing hormone begins 24 hours before ovulation. Associated with this surge is a sharp peak in estrogen output, which occurs before or coincident with the surge in gonadotropins. The ovulatory phase extends over a period of about 5 days. During the last phase, known as the luteal phase (day 15 to the end of the cycle), the follicle collapses and the corpus luteum is formed if pregnancy does not occur. This phase lasts approximately 14 days. A rise in progesterone is seen during the middle of this luteal phase. Consequently, the abrupt cessation of progesterone release determines the onset of menstruation.
There is considerable variation in menstrual cycle length, but the mean length is generally 28 days. However, cycle lengths ranging from 23 to 35 days may also be considered normal if there is uniformity in the menstrual cycle range over time. (28,38) In view of the varying lengths of normal regular menstrual cycles, a defining time point in the cycle for plotting reference data has been established in the literature. (28) The luteinizing hormone peak, which can be identified by serum or urine specimens, determines when ovulation occurs and also allows accurate identification of the follicular and luteal phases.
Sample Size Justification
Preliminary studies showed a 1.6 times greater than expected incidence of ACL injuries in the late follicular/ ovulatory phase of the menstrual cycle, (39) which represented a moderate effect. To achieve 80% power to detect an effect size of 0.40 with two degrees of freedom and an alpha of 0.05, we calculated a needed sample size of 60 subjects.
Sixty-nine women who sustained acute noncontact ACL injuries were recruited for this study within the first 24 hours after injury over a 2-year period through local high schools, colleges, and surrounding areas of four test sites: University of Michigan, Vermont Orthopaedic Clinic, Vanderbilt University Medical Center, and Cincinnati Sportsmedicine and Orthopaedic Center. All participants (and their parents if subjects were younger than 18 years of age) in the study were briefed on the study, and informed consent for participation was obtained. The protocols were reviewed and approved by the Institutional Review Board for use on human subjects. The average age of these women was 28 [+ or -] 10 years (range, 15 to 46)....
NOTE: All illustrations and photos have been removed from this article.