Herzberg Simone D, Motu'apuaka Makalapua L, Lambert William, Fu Rongwei, Brady Jacqueline, Guise Jeanne-Marie
Seattle Pacific University, Seattle, Washington, USA.
Department of Obstetrics & Gynecology, Oregon Health & Science University, Portland, Oregon, USA.
Orthop J Sports Med. 2017 Jul 21;5(7):2325967117718781. doi: 10.1177/2325967117718781. eCollection 2017 Jul.
Women are at substantially greater risk for anterior cruciate ligament (ACL) injuries than are men.
To conduct a systematic review and meta-analysis of the literature to clarify the effect of the menstrual cycle and contraceptives on the laxity of and noncontact injuries to the ACL.
Systematic review; Level of evidence, 4.
Searches were conducted using MEDLINE (1946-August 2016), the Cochrane Library Database, clinical trial registries, and related reference lists. Search terms included , , , , , , , and . Investigators independently dually abstracted and reviewed study details and quality using predefined criteria and evaluated overall strength of evidence using the GRADE (Grading of Recommendations Assessment, Development and Evaluation) criteria.
Twenty-one studies totaling 68,758 participants were included: 5 on the menstrual cycle and ACL injury, 7 on hormonal contraceptives and ACL injury, as well as 13 on menstrual cycle and ligament laxity. Four of 5 studies of women not using hormonal contraception indicated that the luteal phase was the least associated with ACL injuries. The 2 largest and highest quality studies on hormonal contraceptives suggested that hormonal contraceptives may be protective against ACL injury. Six of 12 studies on ACL laxity provided quantitative data for meta-analysis, finding significantly increased laxity during the ovulatory phase compared with the follicular phase.
The literature suggests an association between hormonal fluctuations and ACL injury. Recent studies have suggested that oral contraceptives may offer up to a 20% reduction in risk of injury. The literature on ACL injuries and the menstrual cycle has more than doubled over the past decade, permitting quantitative analysis for the first time. However, the overall strength of this evidence is low. Promising potential directions for future research include long-term observational studies with ongoing hormonal assays and large interventional trials of follicular suppression, including newer hormonal methods.
女性前交叉韧带（ACL）损伤的风险显著高于男性。
对文献进行系统评价和荟萃分析，以阐明月经周期和避孕药对ACL松弛及非接触性损伤的影响。
系统评价；证据级别，4级。
使用MEDLINE（1946年至2016年8月）、Cochrane图书馆数据库、临床试验注册库及相关参考文献列表进行检索。检索词包括……（此处原文未完整给出检索词）。研究人员独立地按照预定义标准对研究细节和质量进行双重提取和审查，并使用GRADE（推荐分级评估、制定与评价）标准评估证据的总体强度。
纳入了21项研究，共68758名参与者：5项关于月经周期与ACL损伤，7项关于激素避孕药与ACL损伤，以及13项关于月经周期与韧带松弛。5项未使用激素避孕药的女性研究中有4项表明黄体期与ACL损伤的关联最小。关于激素避孕药的2项规模最大且质量最高的研究表明，激素避孕药可能对ACL损伤有保护作用。12项关于ACL松弛的研究中有6项提供了荟萃分析的定量数据，发现与卵泡期相比，排卵期的松弛度显著增加。
文献表明激素波动与ACL损伤之间存在关联。近期研究表明，口服避孕药可能使损伤风险降低多达20%。在过去十年中，关于ACL损伤与月经周期的文献增加了一倍多，首次允许进行定量分析。然而，该证据的总体强度较低。未来研究有前景的潜在方向包括进行持续激素检测的长期观察性研究以及卵泡抑制的大型干预试验，包括更新的激素方法。
