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Effect of the Oral Contraceptive Pill on Ligamentous Laxity

Martineau, Paul A. MD; Al-Jassir, Fawzi MD; Lenczner, Eric MD; Burman, Mark L. MD

Clinical Journal of Sport Medicine: September 2004 - Volume 14 - Issue 5 - p 281-286
Original Research

Objective: Women are 4 to 8 times more likely to sustain a serious knee injury than their male counterparts. Previous studies have found that female sex steroids affect ligamentous tissue properties. The hypothesis is that there exists a difference in ligamentous laxity between oral contraceptive pill (OCP) users and nonusers.

Design: Blinded, single-factor, posttest-only control group design.

Setting: McGill University Sport Medicine Clinic, Montreal, Que-bec, Canada.

Participants: One hundred twenty-seven female McGill University varsity athletes.

Interventions: Participants filled out a screening questionnaire and underwent KT-1000 measurements by 1 blinded examiner. Exclusion criteria related to underlying knee pathology, and hormonal factors were identified with the questionnaire.

Main Outcome Measurements: Independent sample, 2-tailed t tests were performed on the nondominant knee data of the OCP users and nonusers.

Results: Mean anterior translations at 67 N were 3.00 ± 1.04 mm for the OCP users and 3.86 ± 1.72 mm for the nonusers (P = 0.011); at 89 N, 3.98 ± 1.13 mm vs. 4.83 ± 1.82 mm, respectively (P = 0.018). Mean anterior translations at 67 N were 2.95 ± 0.93 mm for the non-menstruating OCP users and 3.86 ± 1.72 mm for the nonusers (P = 0.008); at 89 N, 3.88 ± 1.06 mm vs. 4.83 ± 1.82 mm, respectively (P = 0.011).

Conclusions: Oral contraceptive pill use yielded statistically significant decreases in anterior translation of the tibia as compared with nonusers. The OCP may have a role to play in the prevention of ACL injuries by prophylactically targeting 1 of the variables responsible for the increased ACL injury rates in women.

From the Division of Orthopedic Surgery, Montreal General Hospital, McGill University, Montreal, Quebec, Canada.

Received for publication August 2003; accepted May 2004.

Reprints: Paul A. Martineau, MD, Division of Orthopedic Surgery, McGill University, Montreal General Hospital, 1650 Cedar Avenue, Room B5-159, Montreal, Quebec, Canada H3G 1A4 (e-mail:

© 2004 Lippincott Williams & Wilkins, Inc.