Gray Aaron M, Gugala Zbigniew, Baillargeon Jacques G
1Department of Orthopaedic Surgery and Rehabilitation, University of Texas Medical Branch, Galveston, TX; 2Department of Preventive Medicine and Community Health, University of Texas Medical Branch, Galveston, TX.
Med Sci Sports Exerc. 2016 Apr;48(4):648-54. doi: 10.1249/MSS.0000000000000806.
INTRODUCTION/PURPOSE: Anterior cruciate ligament injuries often incur major consequences for athletes. Elevated estrogen levels are likely increase the risk for injury. This risk may be partially or fully mitigated by the use of oral contraceptives. The purpose of this study was to determine if women undergoing anterior cruciate ligament surgical reconstruction were less likely to use oral contraceptives than matched noninjured population.
This is a case-control study utilizing national insurance claims data from 2002 TO 2012. Participants included women age 15-39 yr. Cases were defined as those receiving surgical reconstruction of the anterior cruciate ligament between 2002 and 2012. Controls were matched 3/1 to cases. Exposure to oral contraceptives was defined as the presence of any prescription fill for oral contraceptives during the previous 12 months to index date. Conditional multivariate logistic regression was used to estimate adjusted odds ratios for the use of oral contraceptives.
Women age 15-19 yr undergoing surgical repair of the anterior cruciate ligament were 18% less likely to use oral contraceptives than matched controls (adjusted odds ratio, 0.82; 95% CI, 0.75-0.91; P < 0.0001). Cases among two older age groups, 25-29 and 30-34 yr, were more likely to use oral contraceptives than controls with adjusted odds ratios of 1.15 (95% CI, 1.02-1.30; P < 0.05) and 1.16 (95% CI, 1.04-1.31; P < 0.05), respectively.
The use of oral contraceptives potentially modifies anterior cruciate ligament injury risk in young women. Despite reports that athletes, who are more prone to anterior cruciate ligament injury, use oral contraceptives at about twice the rate of nonathletes, these data suggest that women ages 15-19 yr undergoing anterior cruciate ligament reconstruction used oral contraceptives at a lower rate than the general population.
引言/目的：前交叉韧带损伤通常会给运动员带来严重后果。雌激素水平升高可能会增加受伤风险。口服避孕药的使用可能会部分或完全降低这种风险。本研究的目的是确定接受前交叉韧带手术重建的女性使用口服避孕药的可能性是否低于匹配的未受伤人群。
这是一项病例对照研究，利用了2002年至2012年的国家保险理赔数据。参与者为15至39岁的女性。病例定义为2002年至2012年间接受前交叉韧带手术重建的女性。对照组与病例的匹配比例为3比1。口服避孕药的暴露定义为在索引日期前12个月内有任何口服避孕药的处方配药记录。使用条件多变量逻辑回归来估计口服避孕药使用的调整优势比。
接受前交叉韧带手术修复的15至19岁女性使用口服避孕药的可能性比匹配的对照组低18%（调整优势比，0.82；95%置信区间，0.75 - 0.91；P < 0.0001）。在另外两个年龄较大的组，即25至29岁和30至34岁的病例中，使用口服避孕药的可能性比对照组更高，调整优势比分别为1.15（95%置信区间，1.02 - 1.30；P < 0.05）和1.16（95%置信区间，1.04 - 1.31；P < 0.05）。
口服避孕药的使用可能会改变年轻女性前交叉韧带损伤的风险。尽管有报道称更容易发生前交叉韧带损伤的运动员使用口服避孕药的比例约为非运动员的两倍，但这些数据表明，接受前交叉韧带重建的15至19岁女性使用口服避孕药的比例低于一般人群。
