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This Article Full Text Full Text (PDF) All Versions of this Article: 35/5/793    most recent 0363546506297537v1 Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in ISI Web of Science Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Request Reprints Citing Articles Citing Articles via HighWire Citing Articles via ISI Web of Science (2) Citing Articles via Google Scholar Google Scholar Articles by Chaudhari, A. M. W. Articles by Noyes, F. R. Search for Related Content PubMed PubMed Citation Articles by Chaudhari, A. M. W. Articles by Noyes, F. R. Related Collections Injury Female Athletes Knee Biomechanics

Knee and Hip Loading Patterns at Different Phases in the Menstrual Cycle

Implications for the Gender Difference in Anterior Cruciate Ligament Injury Rates

Ajit M. W. Chaudhari, PhD^,*, Thomas N. Lindenfeld, MD, Thomas P. Andriacchi, PhD, Timothy E. Hewett, PhD^||,¶, Jennifer Riccobene, Gregory D. Myer, MS^|| and Frank R. Noyes, MD

From the Department of Orthopaedics and Sports Medicine Center, Ohio State University, Columbus, Ohio, Cincinnati Sportsmedicine Research and Education Foundation, Cincinnati, Ohio, Department of Mechanical Engineering and Department of Orthopaedic Surgery, Stanford University, Stanford, California, and the Bone & Joint Center, Veteran’s Administration Palo Alto Health Care System, Palo Alto, California, ^|| Cincinnati Children’s Hospital Research Foundation Sports Medicine Biodynamics Center and Human Performance Laboratory, Cincinnati, Ohio, and ^¶ Departments of Pediatrics, Orthopaedic Surgery, Biomedical Engineering, and Rehabilitation Sciences, University of Cincinnati College of Medicine, Cincinnati, Ohio.

^* Address correspondence to Ajit M. W. Chaudhari, PhD, OSU Sports Medicine Center, 2050 Kenny Rd, Suite 3100, Columbus, OH 43221.

Background: Menstrual cycle phase has been correlated with risk of noncontact anterior cruciate ligament injury in women. The mechanism by which hormonal cycling may affect injury rate is unknown.

Hypotheses: Jumping and landing activities performed during different phases of the menstrual cycle lead to differences in foot strike knee flexion, as well as peak knee and hip loads, in women not taking an oral contraceptive but not in women taking an oral contraceptive. Women will experience greater normalized joint loads than men during these activities.

Study Design: Controlled laboratory study.

Methods: Twenty-five women (13 using oral contraceptives) and 12 men performed repeated trials of a horizontal jump, vertical jump, and drop from a 30-cm box on the left leg. Lower limb kinematics (foot strike knee flexion) and peak externally applied moments were calculated (hip adduction moment, hip internal rotation moment, knee flexion moment, knee abduction moment). Men were tested once. Women were tested twice for each phase of the menstrual cycle (follicular, luteal, ovulatory), as determined from serum analysis. An analysis of variance was used to examine differences between phases of the menstrual cycle and between groups ( = .05).

Results: No significant differences in moments or knee angle were observed between phases in either female group or between the 2 female groups or between either female group and the male controls.

Conclusions: Variations of the menstrual cycle and the use of an oral contraceptive do not affect knee or hip joint loading during jumping and landing tasks.

Clinical Relevance: Because knee and hip joint loading is unaffected by cyclic variations in hormone levels, the observed difference in injury rates is more likely attributable to persistent differences in strength, neuromuscular coordination, or ligament properties.

Key Words: anterior cruciate ligament • injury • gender • menstrual cycle • biomechanics • knee • contraceptive

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