Somerson Jeremy S, Isby Ian J, Hagen Mia S, Kweon Christopher Y, Gee Albert O
Department of Orthopaedic Surgery and Rehabilitation, University of Texas Medical Branch, Galveston, Texas.
Department of Orthopaedics and Sports Medicine, University of Washington, Seattle, Washington.
JBJS Rev. 2019 Sep;7(9):e2. doi: 10.2106/JBJS.RVW.18.00198.
Women have a higher risk of anterior cruciate ligament (ACL) tears than men, the causes of which are multifactorial. The menstrual cycle and its hormonal effect on the knee may contribute to knee laxity and ACL injury. This work reviewed published studies examining the effects of the phases of the menstrual cycle on anterior knee laxity and the rate of ACL tears.
A systematic review with meta-analysis and meta-regression was performed. Studies with data comparing the menstrual cycle phase with ACL injury or anterior knee laxity were included for analysis. Data with regard to patient demographic characteristics, anterior knee laxity, ACL injury, and menstrual cycle phases were extracted from the included studies.
In this study, 1,308 search results yielded 396 articles for review, of which 28 met inclusion criteria. Nineteen studies of knee laxity with 573 combined subjects demonstrated a mean increase in laxity (and standard deviation) of 0.40 ± 0.29 mm in the ovulatory phase compared with the follicular phase and a mean increase in laxity of 0.21 ± 0.21 mm in the luteal phase compared with the follicular phase. Nine studies examining ACL tears with 2,519 combined subjects demonstrated a decreased relative risk (RR) of an ACL tear in the luteal phase compared with the follicular and ovulatory phases combined (RR, 0.72 [95% confidence interval, 0.56 to 0.89]). There were no differences in ACL tear risk between any of the other phases.
An increased risk of an ACL tear does not appear to be associated with periods of increased laxity in this meta-analysis. Although this suggests that hormonal effects on an ACL tear may not be directly related to increases in knee laxity, the methodologic heterogeneity between published studies limits the conclusions that can be drawn and warrants further investigation.
Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
女性前交叉韧带（ACL）撕裂的风险高于男性，其原因是多因素的。月经周期及其激素对膝关节的影响可能导致膝关节松弛和ACL损伤。本研究回顾了已发表的研究，探讨月经周期各阶段对膝关节前侧松弛度和ACL撕裂发生率的影响。
进行了一项系统评价，并进行荟萃分析和荟萃回归。纳入比较月经周期阶段与ACL损伤或膝关节前侧松弛度的数据的研究进行分析。从纳入的研究中提取有关患者人口统计学特征、膝关节前侧松弛度、ACL损伤和月经周期阶段的数据。
在本研究中，1308条检索结果产生396篇文章供审查，其中28篇符合纳入标准。19项关于膝关节松弛度的研究，共573名受试者，结果显示与卵泡期相比，排卵期膝关节松弛度平均增加（及标准差）0.40±0.29mm，与卵泡期相比，黄体期膝关节松弛度平均增加0.21±0.21mm。9项关于ACL撕裂的研究，共2519名受试者，结果显示与卵泡期和排卵期总和相比，黄体期ACL撕裂的相对风险（RR）降低（RR，0.72[95%置信区间，0.56至0.89]）。其他任何阶段之间的ACL撕裂风险均无差异。
在这项荟萃分析中，ACL撕裂风险增加似乎与松弛度增加的时期无关。虽然这表明激素对ACL撕裂的影响可能与膝关节松弛度增加没有直接关系，但已发表研究之间的方法学异质性限制了可得出的结论，需要进一步研究。
预后III级。有关证据水平的完整描述，请参阅作者指南。
