Hormone-Informed ACL-Injury Prevention for Women Athletes

Abstract

The aim of this study was to assess the reduction of risk of anterior cruciate ligament (ACL) injury among competitive female athletes by using menstrual cycle phase monitoring and adjusting training to control it. One season was followed in a longitudinal cohort of 120 athletes (soccer, basketball, volleyball; aged 1628), in which participants were assigned to either a Phase-Monitored Training Adjustment (PMTA) group or a control group. Self-tracking and salivary measurements of estradiol, progesterone and relaxin confirmed the menstrual phases. Peak knee valgus, knee flexion, vertical ground reaction force and training loads (% acute:chronic workload ratio; ACWR) were measured. Biomechanical deviation was associated with hormonal peaks in the ovulatory phase, although in PMTA athletes, deviation was less (valgus +4.2 vs. +7.1 degrees, p < 0.01) and the number of high ACWR weeks (13 vs. 22 percent, p = 0.03 ) less common. Injuries to the ACL were experienced in 2 PMTA and 6 controls (RR = 0.33, p = 0.04). On the model Injury Risk Index, injury risk was predicted with 0.87 AUC. Specific phases of interventions were useful in minimizing the risk indicators of injuries.