The Influence of Oral Contraceptive Hormones on Anterior Cruciate Ligament Strength
ACOG ePoster. Konopka J. Apr 27, 2018; 211838; 7H
Jaclyn Konopka
Jaclyn Konopka
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Introduction: Females are up to eight times more likely to injure anterior cruciate ligaments (ACLs) than males, and hormonal differences predispose women to ACL injury. Various hormones—including relaxin and estrogen—impact ACL strength. Oral contraceptives (OCs) alter these hormone levels; however, studies have not yet compared different OCs' influences on ACL strength.

Methods: Untreated and pregnant rats were compared to rats treated with Norethindrone only, Etynodiol Diacetate-plus-Ethinyl Estradiol, or Norgestimate-plus-Ethinyl Estradiol. OC doses adjusted for bioavailabilty and body weight were administered daily via oral gavage for four estrous cycles (20 days). Thirty-two rats were sacrificed; specimens were assessed for maximum load before failure and ultimate stress. Data were analyzed with One-Way ANOVA and post-hoc Bonferroni-Holm calculations.

Results: Ultimate stress of ACLs from Norethindrone (43.46 ± 3.47 MPa) and Etynodiol Diacetate-plus-Ethinyl Estradiol-treated rats (43.62 ± 9.70 MPa) was significantly increased when compared to untreated rats (28.20 ± 7.28 MPa) (P = .0203 and P = .0298 respectively). Maximum ACL load before failure from Norethindrone-treated rats (39.14 ± 2.75 N) was increased compared to untreated rats (33.10 ± 3.70 N) (P = .0414) and Norgestimate-plus-Ethinyl Estradiol-treated rats (31.27 ± 3.43 N) (P = .0406). Pregnant rats weren't significantly different from other rats.

Conclusion/Implications: OCs influence ACL strength differently depending on formulation. Norethindrone and Etynodiol Diacetate-plus-Ethinyl Estradiol increase ACL strength compared to Norgestimate-plus-Ethinyl Estradiol, pregnant, and untreated conditions. Formulations lacking estrogen or with high progestin:estrogen ratios, like Etynodiol Diacetate-plus-Ethinyl Estradiol, may better protect the ACL than formulations with smaller ratios, like Norgestimate-plus-Ethinyl Estradiol.
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