Effect of menstrual cycle phase, menstrual irregularities, and hormonal contraceptive use on anterior knee laxity and non-contact anterior cruciate ligament injury occurrence in women: a protocol for a systematic review and meta-analysis. [Protocol]

N�d�lec, Elisa; Foli, Elvis; Shultz, Sandra J.; Swinton, Paul A.; Dolan, Eimear; Enright, Kevin; Piasecki, Jessica; Matthews, Joseph J.; Sale, Craig; Elliott-Sale, Kirsty Jayne

Abstract

Exercising women report three to six times more ACL tears than men, which happen, in the majority of cases, with a non-contact mechanism. This sex disparity has, in part, been attributed to the differences in reproductive hormone profiles between men and women. Many studies have shown that anterior knee (AK) laxity and the rate of non-contact ACL injuries vary across the menstrual cycle, but these data are inconsistent. Similarly, several studies have investigated the potential protective effect of hormonal contraceptives on non-contact ACL injuries, but their conclusions are also variable. The purpose of this systematic review and meta-analysis is to, identify, evaluate and summarise the effects of endogenous and exogenous ovarian hormones on AK laxity (primary outcome) and the occurrence of non-contact ACL injuries (secondary outcome) in women. We will perform a systematic search for all observational studies conducted on this topic. Studies will be retrieved by searching electronic databases, clinical trial registers, author’s personal files and cross-referencing selected studies. Risk of bias will be assessed using the Newcastle Ottawa Quality Assessment Scale for Cohort and Case–Control Studies. Certainty in the cumulative evidence will be assessed using the Grading of Recommendations Assessment, Development and Evaluation approach. The meta-analyses will use a Bayesian approach to address specific research questions in a more intuitive and probabilistic manner. This review is registered on the international database of prospectively registered systematic reviews (PROSPERO; CRD42021252365).

Citation

NÉDÉLEC, E., FOLI, E., SHULTZ, S.J., SWINTON, P.A., DOLAN, E., ENRIGHT, K., PIASECKI, J., MATTHEWS, J.J., SALE, C. and ELLIOTT-SALE, K.J. 2021. Effect of menstrual cycle phase, menstrual irregularities, and hormonal contraceptive use on anterior knee laxity and non-contact anterior cruciate ligament injury occurrence in women: a protocol for a systematic review and meta-analysis. [Protocol]. BMJ Open Sport and exercise medicine [online], 7, e001170. Available from: https://doi.org/10.1136/bmjsem-2021-001170

• Other Type: Protocol
• Acceptance Date: Oct 6, 2021
• Online Publication Date: Oct 29, 2021
• Publication Date: Oct 31, 2021
• Deposit Date: Oct 20, 2021
• Publicly Available Date: Oct 20, 2021
• Publisher: BMJ Publishing Group
• DOI: https://doi.org/10.1136/bmjsem-2021-001170
• Keywords: Anterior cruciate ligament; Anterior knee; Menstrual cycle; Menstrual irregularities; Hormonal contraceptives; Oral contraceptive pills; Laxity; Injury
• Public URL: https://rgu-repository.worktribe.com/output/1500018
• Additional Information: This protocol has also been registered with the PROSPERO database: NÉDÉLEC, E., FOLI, E., SHULTZ, S.J., SWINTON, P.A., DOLAN, E., ENRIGHT, K., PIASECKI, J., MATTHEWS, J.J., SALE, C. and ELLIOTT-SALE, K.J. 2021. The effect of menstrual cycle phase, menstrual irregularities, and hormonal contraceptive use on anterior knee laxity and non-contact anterior cruciate ligament injury occurrence in women: a protocol for a systematic review and meta-analysis. [Protocol]. PROSPERO [online], item number CRD42021252365. Available from: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021252365