Department of Sport and Exercise Sciences, Musculoskeletal Science and Sports Medicine Research Centre, Manchester Metropolitan University, Manchester, United Kingdom.
Manchester Institute of Sport, Manchester Metropolitan University, Manchester, United Kingdom.
PLoS One. 2023 Jan 26;18(1):e0280800. doi: 10.1371/journal.pone.0280800. eCollection 2023.
Eumenorrheic women experience cyclic variations in sex hormones attributed to the menstrual cycle (MC) which can impact anterior cruciate ligament (ACL) properties, knee laxity, and neuromuscular function. This systematic review aimed to examine the effects of the MC on ACL neuromuscular and biomechanical injury risk surrogates during dynamic tasks, to establish whether a particular MC phase predisposes women to greater ACL injury risk.
PubMed, Medline, SPORTDiscus, and Web of Science were searched (May-July 2021) for studies that investigated the effects of the MC on ACL neuromuscular and biomechanical injury risk surrogates. Inclusion criteria were: 1) injury-free women (18-40 years); 2) verified MC phases via biochemical analysis and/or ovulation kits; 3) examined neuromuscular and/or biomechanical injury risk surrogates during dynamic tasks; 4) compared ≥1 outcome measure across ≥2 defined MC phases.
Seven of 418 articles were included. Four studies reported no significant differences in ACL injury risk surrogates between MC phases. Two studies showed evidence the mid-luteal phase may predispose women to greater risk of non-contact ACL injury. Three studies reported knee laxity fluctuated across the MC; two of which demonstrated MC attributed changes in knee laxity were associated with changes in knee joint loading (KJL). Study quality (Modified Downs and Black Checklist score: 7-9) and quality of evidence were low to very low (Grading of Recommendations Assessment Development and Evaluation: very low).
It is inconclusive whether a particular MC phase predisposes women to greater non-contact ACL injury risk based on neuromuscular and biomechanical surrogates. Practitioners should be cautious manipulating their physical preparation, injury mitigation, and screening practises based on current evidence. Although variable (i.e., magnitude and direction), MC attributed changes in knee laxity were associated with changes in potentially hazardous KJLs. Monitoring knee laxity could therefore be a viable strategy to infer possible ACL injury risk.
月经周期（MC）导致女性体内性激素呈周期性变化，这可能会影响前交叉韧带（ACL）的特性、膝关节松弛度和神经肌肉功能。本系统评价旨在检查 MC 对动态任务中 ACL 神经肌肉和生物力学损伤风险替代指标的影响，以确定特定的 MC 阶段是否使女性更容易发生 ACL 损伤。
2021 年 5 月至 7 月，我们在 PubMed、Medline、SPORTDiscus 和 Web of Science 上检索了研究 MC 对 ACL 神经肌肉和生物力学损伤风险替代指标影响的文献。纳入标准为：1）无损伤女性（18-40 岁）；2）通过生化分析和/或排卵试剂盒验证 MC 阶段；3）在动态任务中检查神经肌肉和/或生物力学损伤风险替代指标；4）在至少 2 个定义的 MC 阶段比较≥1 个结果测量值。
从 418 篇文章中筛选出 7 篇。四项研究表明，MC 各阶段 ACL 损伤风险替代指标无显著差异。两项研究表明，中黄体期可能使女性更容易发生非接触性 ACL 损伤。三项研究报告膝关节松弛度在 MC 期间波动；其中两项研究表明，MC 引起的膝关节松弛度变化与膝关节负荷（KJL）的变化有关。研究质量（改良 Downs 和 Black 清单评分：7-9）和证据质量为低至极低（推荐评估、制定与评价分级：极低）。
基于神经肌肉和生物力学替代指标，尚不能确定特定的 MC 阶段是否使女性更容易发生非接触性 ACL 损伤。根据当前证据，从业者在进行身体准备、损伤缓解和筛查时应谨慎处理。尽管 MC 引起的膝关节松弛度变化具有变异性（即幅度和方向），但与潜在危险的 KJL 变化有关。因此，监测膝关节松弛度可能是推断 ACL 损伤风险的可行策略。
