Neuromuscular performance and knee laxity do not change across the menstrual cycle in female athletes

Abstract

Female athletes incur anterior cruciate ligament ruptures at a rate at least twice that of male athletes. Hypothesized factors for the increased injury risk in females include biomechanical, neuromuscular, and hormonal differences between genders. A wealth of literature exists examining these potential predispositions individually, but the interactions between these factors have not been examined extensively. Our purpose was to investigate changes in neuromuscular control and laxity at the knee across the menstrual cycle of healthy females. Fourteen female collegiate athletes with normal, documented ovulatory menstrual cycles, confirmed ovulation, and no history of serious knee injury participated. The presence and timing of ovulation was determined during a screening cycle with ovulation detection kits and during an experimental cycle with collection of daily urine samples and subsequent analysis of urinary estrone-3-glucuronide (E3G) and pregnanediol-3-glucoronide (PdG), which correlate with circulating estrogen and progesterone. Each subject had measures of knee neuromuscular performance and laxity once during the mid-follicular, ovulatory, and mid-luteal stages of her menstrual cycle. The test battery included assessments of knee flexion and extension peak torque, passive knee joint position sense, and postural control in single leg stance. Knee joint laxity was measured with an arthrometer. Analyses of variance revealed that E3G and PdG levels were significantly different across the three testing sessions, but there were no significant differences in the measures of strength, joint position sense, postural control, or laxity. No significant correlations were found between changes in E3G or PdG levels and changes in the performance and laxity measures between sessions. These results suggest that neuromuscular control and knee joint laxity do not change substantially across the menstrual cycle of females despite varying estrogen and progesterone levels.