Everyone in the sports medicine community is aware that, due to a combination of hormonal and physiological reasons, women are far more prone to female ACL injury, but the truth is far more jaw-dropping: women are actually eight to ten times more likely to suffer from an ACL injury than men. The knock-on effects are ruinous: recent studies have concluded that nearly half of women sports participants are forced to abandon their athletic careers, and between 20 and 50% of female athletes go on to develop arthritis within ten to twenty years.
So, it goes without saying that the race is on to bridge the gap between the sexes when it comes to an ACL injury, and the latest development comes right out of the left field: the potential benefits of the contraceptive pill.
Could the Pill cure your ACL ills?
According to a study recently published in America’s Physician and Sportsmedicine journal, female athletes are being advised to go on the pill to avoid career-ending injuries – with the apparent protective effect of the drug particularly potent in teenage sportswomen.
The study, conducted by a research team from Brown University in Rhode Island, compared rates of injury among 82,874 sportswomen taking oral contraceptives during the 12 months prior to the injury, and compared it with the same number of women not on the pill. According to the findings, a total of 465 women in the oral contraceptive group required surgical reconstruction of the ACL over the ten-year period of the study, compared to 569 in the control group. Which means that out of the entire study group, the women who were using oral contraceptive were 18% less likely to damage their ACL.
More surprisingly, when the data on female athletes aged 15 to 19 were analysed, the conclusion was that a whopping 63% of women in that group using the pill were less likely to suffer an ACL injury.
So, what’s the reason for this?
The research team at Brown believe that the lower and more stable hormonal levels that are brought on by the pill help to keep the ligaments firmer. “Young athletes use oral contraceptives for a variety of reasons, including regulating their menstrual cycle and/or preventing pregnancy,” said Dr Steven DeFroda, leader of Brown’s research team. “It’s likely that oral contraceptives help maintain lower and more consistent levels of oestrogen and progesterone, which may lead to a periodic increase in laxity and subsequent risk of tear.”
Of course, it needs pointing out that this is an observational study, so no firm conclusions can be drawn about cause and effect – and the authors point to several limitations, such as not assessing participation in particular sports or their activity level which may explain why some women tore their ACLs and others did not.
They also note that the study did not distinguish between athletic, recreational, or accidental ACL injuries, and only looked at women with injuries that were managed with surgery. So, while it’s an interesting potential solution to the rampant levels of ACL injuries in women, a study which tracks athletes over time to see whether those who take oral contraceptives have fewer ACL injuries than others will be needed.