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The Effect of Sex Hormones on Ligament Structure, Joint Stability and ACL Injury Risk

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Sex Hormones, Exercise and Women

Abstract

Sex hormones underlie most of the sex differences in physical characteristics that emerge after puberty, and have the potential to impact collagen metabolism, ligament remodeling, and the structural integrity of the ACL in a way that may increase the potential for ligament failure in physically active women. This chapter will examine the inherent variability in hormone profiles in women (both between women and within a woman across her menstrual cycle), and how this variability may impact ACL injury risk potential. Epidemiological studies are presented that address relative injury risk across the different phase of the menstrual cycle phase when estrogen, progesterone, testosterone, and relaxin are known to vary. Findings from basic and clinical research studies examining hormone effects on collagen metabolism, tissue remodeling, ligament mechanical properties, and knee joint laxity are presented to elucidate the underlying mechanisms through which hormones may exert their influence on injury risk potential. Because physically active females use contraceptive hormones that are known to lower and stabilize endogenous hormone levels, the potential for contraceptive hormones to positively or negatively alter ligament structural integrity and ACL injury risk is also discussed.

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Acknowledgements

Selected text is reprinted or adapted, with permission, from S.J. Shultz, 2007, Hormonal influences on ligament biology. In Understanding and preventing noncontact ACL injuries, by American Orthopaedic Society for Sports Medicine, edited by T.E. Hewett, S.J. Shultz, and L.Y. Griffin (Champaign, IL: Human Kinetics), 219-238.

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  1. Department of Kinesiology, University of North Carolina at Greensboro, 1400 Spring Garden St, Greensboro, NC, 27412, USA

    Sandra J. Shultz Ph.D., A.T.C., F.N.A.T.A.

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  1. Sandra J. Shultz Ph.D., A.T.C., F.N.A.T.A.
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Correspondence to Sandra J. Shultz Ph.D., A.T.C., F.N.A.T.A. .

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  1. Department of Nutrition, University of North Carolina, Chapel Hill, North Carolina, USA

    Anthony C. Hackney

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Shultz, S.J. (2017). The Effect of Sex Hormones on Ligament Structure, Joint Stability and ACL Injury Risk. In: Hackney, A. (eds) Sex Hormones, Exercise and Women. Springer, Cham. https://doi.org/10.1007/978-3-319-44558-8_7

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