Providence, RI—Anterior cruciate ligament (ACL) injuries continue to be extremely common in the young athlete population, increasing 2.3% per year for children between ages 6 and 18 years, with a current annual incidence of 200,000 injuries. Most of these injuries occur in the high school/college age range, according to a new study.

An article in The Physician and Sportsmedicine journal notes that the condition seems to be more prevalent in females than in males because of variations in levels of estrogen and progesterone. In light of that, Brown University–led researchers sought to determine the potentially protective effects of oral contraceptive pills (OCPs) on ACL tears. Background information in the articles points out that nearly one-half of athletes with ACL tears are unable to return to athletic competition and that as many as 50% develop arthritis within 10 to 20 years of their injury.

To determine the possibly protective effects of OCPs, the research team conducted a large observational study involving more than 165,000 female patients aged 14 to 49 years. Ten years of prescription and insurance information from a large national U.S. database were analyzed.

Results indicate that OCPs were most protective in young women aged 15 to 19 years, who were 63% less likely to need reconstructive surgery following ACL injury compared with age-matched controls.

“It’s likely that oral contraceptives help maintain lower and more consistent levels of estrogen and progesterone, which may lead to periodic increase in laxity and subsequent risk of tear (instead of periodic ACL weakness),” explained lead author Steven DeFroda, MD.

Patients taking OCPs who experienced an ACL tear and underwent surgery were compared with a control group of women who had surgery for an ACL tear who were not taking OCPs.

Results indicate that 569 (0.69%) ACL reconstructions occurred in the non-OCP group versus 465 (0.56%) in the OCP group. The researchers emphasize that, in the non-OCP group, patients aged 15 to 19 years accounted for 29.35% of all ACL reconstructions, but in the OCP group, that age group accounted for only 13.33%.

Among all age groups, the odds ratios for experiencing an ACL reconstruction while on OCPs was 0.82 (X2 = 0.001, 95% CI 0.72-0.92) compared with not using OCPs, the researchers calculate, adding, “This protective effect was driven primarily by the 15–19 age group (odds ratio 0.37 (X2 < 0.001, 95% CI 0.27-0.50)). The number needed to treat for OCP usage in the 15–19 age group was six patients.

“OCPs have a protective effect on ACL tear, especially in the 15–19 age group, which exhibited a 63% reduction in the rate of tear,” the authors conclude. “Consideration should be given to prescribing OCPs to younger athletes, after careful assessment of the risks of these commonly prescribed medications.

“Young athletes use oral contraceptives for a variety of reasons including regulating their menstrual cycle and/or preventing pregnancy. With careful assessment of the risks, injury risk reduction could be another way in which female athletes may benefit from their use,” DeFroda said.

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