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Does testosterone influence ACL strength and injury rate?

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Female athletes are up to 10 times more likely than male athletes to injure the anterior cruciate ligament (ACL) in their knees.

Previous studies have linked oestrogen levels to a higher risk of ACL injury, and now new research published in the journal The Knee suggests that testosterone levels also play a role.

Scientists at Johns Hopkins Medicine found that normal male rats with natural supplies of testosterone had stronger ACLs than those that had been castrated and no longer produced the hormone.

The results indicate that testosterone may contribute to the ACL´s ability to withstand tensile loads and may be one of many factors responsible for the different ACL injury rate between men and women, explained William Romani, a physical therapist and sports medicine researcher who was a visiting faculty member in The Johns Hopkins University´s Department of Biomedical Engineering from 2009 to 2015.

Senior study author Jennifer Elisseeff, a biomedical engineer at The Johns Hopkins University, said the new finding could eventually lead to techniques that use circulating sex hormone levels to identify athletes at higher risk for ACL injury who may benefit from training strategies to strengthen the ligament.

Earlier research by Romani showed that that oestrogen reduces ACL strength in rats, but that knee ligaments in both sexes contain receptors for testosterone.

“Our thought was that while oestrogen may make the female ACL weaker and more prone to injury, the male hormone testosterone may act to strengthen the ACL and protect it from injury,” he said.

Further work is needed to explain exactly which pathways and molecules testosterone and oestrogen act through to influence ligament strength, and whether the hormones have the same impact on other ligaments in the body, Johns Hopkins Medicine noted.

http://www.hopkinsmedicine.org/news/media/releases/new_evidence_may_explain_sex_difference_in_knee_injury_rates

http://www.thekneejournal.com/article/S0968-0160 (16)30105-3/abstract