title: Anterior cruciate ligament tear during the menstrual cycle in female recreational skiers.
abstract: BACKGROUND
  Women run a 4-8-fold greater risk of anterior cruciate ligament (ACL) tear than men, and especially during the pre-ovulation stage of their cycle. The main study objective was to describe the distribution of ACL lesions according to menstrual cycle in a large population of female recreational skiers.
  
  
  METHODS
  A prospective study was conducted during the 2010-11 ski season on women sustaining ACL tear during skiing. Patients filled out a questionnaire during consultation with the mountain physician, including date of last menstrual period (LMP) and contraceptive method. Fifty-seven of the 229 patients with diagnosed ACL tear were excluded from analysis, 41 being post-menopausal (mean age, 47 ± 9 years), and 16 having irregular cycles or LMP>30 days. One hundred and seventy-two patients (mean age, 34 ± 8.7 years) were thus included.
  
  
  RESULTS
  Fifty-eight women (33.72%) were in follicular phase, 63 (36.63%) in ovulatory phase and 51 (29.65%) in luteal phase; difference with respect to the theoretic distribution regardless of menstrual phase was highly significant: χ(2)=48.32; P=0.00001. Fifty-three of the 172 women (30.8%) were taking oral contraceptives. ACL tear was 2.4-fold more frequent in pre-ovulatory than post-ovulatory phase, whether in women using oral or other contraceptives: 85/119 (71.4%) vs. 36/53 (67.9%); P=0.64.
  
  
  CONCLUSIONS
  ACL tear risk in skiing in women is not constant over the menstrual cycle, being 2.4-fold more frequent in pre-ovulatory (follicular and ovulatory) than post-ovulatory phase (luteal). Oral contraception seems not to exert any protective effect.
  
  
  METHODS
  Level IV. Retrospective cohort study.
authors.affiliation: Paris V Sports Medicine Private Hospital, 75005 Paris, France. docteurlefevre@sfr.fr
authors.forename: N
authors.initials: N
authors.lastname: Lefevre
authors.forename: Y
authors.initials: Y
authors.lastname: Bohu
authors.forename: S
authors.initials: S
authors.lastname: Klouche
authors.forename: J
authors.initials: J
authors.lastname: Lecocq
authors.forename: S
authors.initials: S
authors.lastname: Herman
mesh_terms: D000328:Adult; D000070598:Anterior Cruciate Ligament Injuries; D001265:Athletic Injuries / Q000453:epidemiology / Q000209:etiology; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D007718:Knee Injuries / Q000453:epidemiology* / Q000209:etiology / Q000503:physiopathology; D008597:Menstrual Cycle; D011446:Prospective Studies; D011998:Recreation; D018570:Risk Assessment; D012865:Skiing / Q000293:injuries*
keywords: ACL; Female skiers; Injury risk; Menstrual cycle