Knee Surgery, Sports Traumatology, Arthroscopy

, Volume 17, Issue 9, pp 1065–1069 | Cite as

Are oral contraceptive use and menstrual cycle phase related to anterior cruciate ligament injury risk in female recreational skiers?

  • Gerhard RuedlEmail author
  • Patrick Ploner
  • Ingrid Linortner
  • Alois Schranz
  • Christian Fink
  • Renate Sommersacher
  • Elena Pocecco
  • Werner Nachbauer
  • Martin Burtscher


Oral contraceptive use and menstrual cycle phase are suggested to influence the risk of anterior cruciate ligament (ACL) injuries in female athletes. However, only few data are available for recreational sports. Therefore, female recreational skiers with a non-contact ACL injury and age-matched controls completed a self-reported questionnaire relating to menstrual history, oral contraceptive use and previous knee injuries. Menstrual history data were used to group subjects into either preovulatory or postovulatory phases of menstrual cycle. Our findings suggest that oral contraceptive use did not show any protective effect against ACL injuries nor did self-reported previous knee injuries show any association with ACL injury rate in recreational alpine skiing. Analysis of menstrual history data revealed that recreational skiers in the preovulatory phase were significantly more likely to sustain an ACL injury than were skiers in the postovulatory phase.


Anterior cruciate ligament (ACL) Ski injury Risk factor Menstrual cycle phase Oral contraceptives (OC) 



The authors gratefully acknowledge the support for this study from the Tiroler Wissenschaftsfond (TWF).


  1. 1.
    Adachi N, Nawata K, Maeta M, Kurozawa Y (2008) Relationship of the menstrual cycle phase to anterior cruciate ligament injuries in teenaged female athletes. Arch Orthop Trauma Surg 128:473–478. doi: 10.1007/s00402-007-0461-1 PubMedCrossRefGoogle Scholar
  2. 2.
    Agel J, Bershadsky B, Arendt EA (2006) Hormonal therapy: ACL and ankle injury. Med Sci Sports Exerc 38:7–12. doi: 10.1249/01.mss.0000194072.13021.78 PubMedCrossRefGoogle Scholar
  3. 3.
    Arendt EA, Agel J, Dick R (1999) Anterior cruciate ligament injury patterns among collegiate men and women. J Athl Train 34:86–92PubMedGoogle Scholar
  4. 4.
    Arendt EA, Bershadsky B, Agel J (2002) Periodicity of noncontact anterior cruciate ligament injuries during the menstrual cycle. J Gend Specif Med 5:19–26PubMedGoogle Scholar
  5. 5.
    Bennell K, Crossley K (1996) Muscoloskeletal injuries in track and field: incidence, distribution and risk factors. Aust J Sci Med Sport 28:69–75PubMedGoogle Scholar
  6. 6.
    Bennell K, White S, Crossley K (1999) The oral contraceptive pill: a revolution for sportswomen? Br J Sports Med 33:231–238. doi: 10.1136/bjsm.33.4.231 PubMedCrossRefGoogle Scholar
  7. 7.
    Beynnon BD, Johnson RJ, Braun S, Sargent M (2006) The relationship between menstrual cycle phase and anterior cruciate ligament injury: a case–control study of recreational alpine skiers. Am J Sports Med 34:757–764. doi: 10.1177/0363546505282624 PubMedCrossRefGoogle Scholar
  8. 8.
    Beynnon BD, Ettlinger CF, Johnson RJ (2007) Epidemiology and mechanisms of ACL injury in alpine skiing. In: Hewett TE, Shultz SJ, Griffin LY (eds) Understanding and preventing noncontact ACL injuries. American Orthopaedic Society for Sports Medicine, Human Kinetics, Champaign, pp 183–188Google Scholar
  9. 9.
    Brynhildsen JO, Hammer J, Hammer ML (1997) Does the menstrual cycle and use of oral contraceptives influence the risk of low back pain? A prospective study among female soccer players. Scand J Med Sci Sports 7:348–353PubMedGoogle Scholar
  10. 10.
    Burtscher M, Nachbauer W (1999) Injury risk of Austrian skiers and comparison of the injury pattern of traditional and carving skiers (German). In: Österreichisches Kuratorium für Alpine Sicherheit (eds) Sicherheit im Bergland, Innsbruck, Austria, pp 107–115Google Scholar
  11. 11.
    Burtscher M, Pachinger O, Mittleman MA, Ulmer H (2000) Prior myocardial infarction is the major risk factor associated with sudden cardiac death during downhill skiing. Int J Sports Med 21:613–615. doi: 10.1055/s-2000-8481 PubMedCrossRefGoogle Scholar
  12. 12.
    Burtscher M, Gatterer H, Flatz M, Sommersacher R, Woldrich T, Ruedl G, Hotter B, Lee A, Nachbauer W (2008) Effects of modern ski equipment on the overall injury rate and the pattern of injury location in Alpine skiing. Clin J Sport Med 18:355–357. doi: 10.1097/MJT.0b013e31815fd0fe PubMedCrossRefGoogle Scholar
  13. 13.
    Heinemann K, Moehner S, Lewis M, Assmann A, Garbe E, Heinemann LA (2002) Trends of OC use 1980–1999 in a German cohort of women. Zentralbl Gynakol 124(2):128–131. doi: 10.1055/s-2002-24241 (German)PubMedCrossRefGoogle Scholar
  14. 14.
    Hewett TE (2000) Neuromuscular and hormonal factors associated with knee injuries in female athletes. Sports Med 29:313–327. doi: 10.2165/00007256-200029050-00003 PubMedCrossRefGoogle Scholar
  15. 15.
    Hewett TE, Zazulak BT, Myer GD (2007) Effects of the menstrual cycle on anterior cruciate ligament injury risk: a systematic review. Am J Sports Med 35:659–668. doi: 10.1177/0363546506295699 PubMedCrossRefGoogle Scholar
  16. 16.
    Lebrun CM (1994) The effect of the phase of menstrual cycle and the birth control pill in athletic performance. Clin Sports Med 13:419–441PubMedGoogle Scholar
  17. 17.
    Lloyd T, Triantafyllou SJ, Baker ER, Houts PS, Whiteside JA, Kalenak A, Stumpf PG (1986) Women athletes with menstrual irregularity have increased musculoskeletal injuries. Med Sci Sports Exerc 18:374–379. doi: 10.1249/00005768-198608000-00002 PubMedGoogle Scholar
  18. 18.
    Moller-Nielson J, Hammar M (1991) Sports injuries and oral contraceptive use: is there a relationship? Sports Med 12:152–160. doi: 10.2165/00007256-199112030-00002 CrossRefGoogle Scholar
  19. 19.
    Myklebust G, Maehlum S, Holm I, Bahr R (1998) A prospective cohort study of anterior cruciate ligament injuries in elite Norwegian team handball. Scand J Med Sci Sports 8:149–153PubMedCrossRefGoogle Scholar
  20. 20.
    Myklebust G, Engebretsen L, Braekken IH, Skjolberg A, Olsen OE, Bahr R (2003) Prevention of anterior cruciate ligament injuries in female team handball players: a prospective intervention study over three seasons. Clin J Sport Med 13:71–78. doi: 10.1097/00042752-200303000-00002 PubMedCrossRefGoogle Scholar
  21. 21.
    Natri A, Beynnon BD, Ettlinger CF, Johnson RJ, Shealy JE (1999) Alpine ski bindings and injuries: current findings. Sports Med 28:35–48. doi: 10.2165/00007256-199928010-00004 PubMedCrossRefGoogle Scholar
  22. 22.
    Renstrom P, Ljungqvist A, Arendt E, Beynnon B, Fukubayashi T, Garrett W, Georgoulis T, Hewett TE, Johnson R, Krosshaug T, Mandelbaum B, Micheli L, Myklebust G, Roos E, Roos H, Schamasch P, Shultz S, Werner S, Wojtys E, Engebretsen L (2008) Non-contact ACL injuries in female athletes: an International Olympic Committee current concepts statement. Br J Sports Med 42:394–412. doi: 10.1136/bjsm.2008.048934 PubMedCrossRefGoogle Scholar
  23. 23.
    Slauterbeck JR, Fuzie SF, Smith MP, Clark RJ, Xu K, Starch DW, Hardy DM (2002) The menstrual cycle, sex hormones, and anterior cruciate ligament injury. J Athl Train 37:275–278PubMedGoogle Scholar
  24. 24.
    Stevenson H, Webster J, Johnson RJ, Beynnon B (1998) Gender differences in knee injury epidemiology among competitive alpine ski racers. Iowa Orthop J 18:64–66PubMedGoogle Scholar
  25. 25.
    Wojtys EM, Huston LJ, Lindenfeld TN, Hewett TE, Greenfield ML (1998) Association between the menstrual cycle and anterior cruciate ligament injuries in female athletes. Am J Sports Med 26:614–619PubMedGoogle Scholar
  26. 26.
    Wojtys EM, Huston LJ, Boynton MD, Spindler KP, Lindenfeld TN (2002) The effect of the menstrual cycle on anterior cruciate ligament injuries in women as determined by hormone levels. Am J Sports Med 30:182–188PubMedGoogle Scholar

Copyright information

© Springer-Verlag 2009

Authors and Affiliations

  • Gerhard Ruedl
    • 1
    Email author
  • Patrick Ploner
    • 2
  • Ingrid Linortner
    • 2
  • Alois Schranz
    • 2
  • Christian Fink
    • 3
  • Renate Sommersacher
    • 4
  • Elena Pocecco
    • 1
  • Werner Nachbauer
    • 1
  • Martin Burtscher
    • 1
  1. 1.Department of Sport ScienceUniversity of InnsbruckInnsbruckAustria
  2. 2.Medalp sportclinic sölden-imstImstAustria
  3. 3.Sportsclinic AustriaInnsbruckAustria
  4. 4.Austrian Ski FederationInnsbruckAustria

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