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Contraceptive pill may offer protection against ACL tears

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New research has found that oral contraceptives may help lower the risk of anterior cruciate ligament (ACL) tears in women.

In an observational study involving over 165,000 female patients aged between 15 and 49, Dr Steven DeFroda and colleagues from Brown University, Rhode Island, analysed a decade of prescription and insurance information.

They compared the rates of ACL reconstruction in women taking oral contraceptives during the 12 months prior to injury (82,874), with a control group of the same age with a similar injury who were not taking oral contraceptives (82,874). A total of 465 women in the oral contraceptive group required surgical reconstruction of the ACL between 2007 and 2017 compared to 569 in the control group.

Overall, women taking oral contraceptives were 18% less likely to require reconstructive surgery following ACL injury compared to matched controls.

Oral contraceptives were most protective in young women aged 15-19 years, who were 63% less likely to need reconstructive surgery compared with age-matched controls.

Reporting their findings in The Physician and Sportsmedicine journal, the authors speculated that taking pills containing the hormones oestrogen and progesterone may suppress the hormonal surges during the menstrual cycle, leading to a lower rate of injury.

While acknowledging the potential health risks associated with the contraceptive pill, the authors concluded that the findings support the use of oral contraceptives in elite high school and college-aged athletes, especially those at higher risk of ACL tears such as soccer (football) and basketball players.

“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,” Dr DeFroda said.

A carefully controlled study that tracks athletes over time — to see whether those who take oral contraceptives have fewer ACL injuries than others — is needed to confirm the findings.