Type of Oral Contraceptive Pills in Patients with Complete ACL Tears: A Retrospective Study





ACL tears, estrogen, oral contraceptives


Purpose: Differences in sex hormones are one of the proposed mechanisms for the increased risk of anterior cruciate ligament (ACL) injury in female athletes. Oral contraceptive pills (OCPs) may reduce the risk of ACL injuries in females, but the effects of different types of OCPs have not been examined. This study aimed to investigate the type of OCPs used in women diagnosed with ACL tears. We hypothesized that a greater proportion of women with ACL tears will be exposed to OCPs containing high estrogen and less androgenic progestins than other types of OCPs. Methods: Medical records from Hospital for Special Surgery (New York, NY) for women ages 16-55 with diagnosis of an ACL tear while concurrently taking OCPs were reviewed from January 2016 to June 2018 for demographic data, documentation of ACL injury, type of OCP at time of injury, ethinyl estrogen dose, and progestin dose. OCP androgenicity was determined by multiplying the dose of progestin by the progestin’s androgenicity. Results: A total of 223 patients sustained an ACL tear while taking OCPs. The most commonly used OCP was a high estrogen/low androgenicity progestin pill (107/223=48%).When each hormone was considered individually, the majority of women were exposed to OCPs with high estrogen (58.7% vs 41.3%, p<0.0001) and low androgenicity progestin (84.8% vs 15.3%, p<0.0001). Conclusion: A large portion of women who sustained ACL tears were taking a high estrogen/low androgenicity progestin OCP at the time of injury and this is different than population data where the majority of women are exposed to moderately high androgenicity progestins. Future studies should be conducted to determine if OCPs with high estrogen and low androgenicity progestin correlate with increased risk of ACL injury.