Introduction and Aims: Hormonal factors are one plausible explanation for differences in musculotendinous stiffness (MTS) and knee laxity between men and women, and the resulting higher risk for ACL injury in women. This study examined MTS and ACL laxity over the course of the menstrual cycle in women and investigated the interaction of warm-up. Method: Eight female netball players aged between 16–18 years (mean = 16.3 ± 0.8 years) participated in this study. None of the participants were using oral contraceptives and all demonstrated regular menstrual cycles. Venous blood samples and MTS data were collected each week over the 28-day menstrual cycle. MTS was assessed prior to, and following a standardised warm-up consisting of light cycling and jumping. ACL laxity was determined at the beginning of each test session using the KT2000™ knee arthrometer (MEDmetric Corporation, San Diego, USA). Results: Repeated measures ANOVA results revealed significant (p < 0.05) main effects of warm-up and test session on MTS. For the effect of warm-up, MTS was found to significantly decrease by 4.2% following the warm-up intervention, indicating that relatively low levels of activity can acutely alter the viscoelastic properties of muscle. Post hoc contrasts for test session revealed that MTS was significantly lower at week three (corresponding to the ovulatory phase), in contrast to weeks one and two (7% and 4.5% decrease, respectively). For ACL laxity, repeated measures ANOVA revealed no significant (p < 0.05) differences at 30 lb anterior force across the menstrual cycle. The results did however demonstrate a trend towards increased ACL laxity during ovulation (week three) when the lower limb musculature was most compliant. Conclusion: While there were no significant differences in static ACL laxity, reduced MTS is one of the main causes of prolonged electromechanical delay (EMD) and has particular relevance for ACL injury. In conclusion, females are at greater risk of incurring an ACL injury during ovulation when oestrogen levels are highest

Anterior cruciate ligament (ACL) injuries are among the most common and debilitating knee injuries in professional athletes with an incidence in females up to eight-times higher than their male counterparts. ACL injuries can be career-threatening and are associated with increased risk of developing knee osteoarthritis in future life. The increased risk of ACL injury in females has been attributed to various anatomical, developmental, neuromuscular, and hormonal factors. Anatomical and hormonal factors have been identified and investigated as significant contributors including osseous anatomy, ligament laxity, and hamstring muscular recruitment. Postural stability and impact absorption are associated with the stabilizing effort and stress on the ACL during sport activity, increasing the risk of noncontact pivot injury. Female patients have smaller diameter hamstring autografts than males, which may predispose to increased risk of re-rupture following ACL reconstruction and to an increased risk of chondral and meniscal injuries. The addition of an extra-articular tenodesis can reduce the risk of failure; therefore, it should routinely be considered in young elite athletes. Prevention programs target key aspects of training including plyometrics, strengthening, balance, endurance and stability, and neuromuscular training, reducing the risk of ACL injuries in female athletes by up to 90%. Sex disparities in access to training facilities may also play an important role in the risk of ACL injuries between males and females. Similarly, football boots, pitches quality, and football size and weight should be considered and tailored around females’ characteristics. Finally, high levels of personal and sport-related stress have been shown to increase the risk of ACL injury which may be related to alterations in attention and coordination, together with increased muscular tension, and compromise the return to sport after ACL injury. Further investigations are still necessary to better understand and address the risk factors involved in ACL injuries in female athletes.

Cite this article: Bone Jt Open 2024;5(2):94–100.

Introduction: Today’s aging population has resulted in an increase in the number of major orthopaedic surgical interventions in the elderly. Total knee replacement (TKR) is one of the commonest operations in orthopaedic practice. The fourth annual report of the National Joint Registry showed that there were 60 986 TKR performed in England and Wales in 2006. The true figure is probably much higher. Literature showed that 20–70% of patients who had TKR needed 1–3 units of blood. Although safer than ever, allogeneic transfusion is still associated with risks for the recipient (haemolysis, infection, immunosuppression, transfusion-related acute lung injury and even death). Tranexamic acid (TA) is a synthetic antifibrinolytic agent that has been successfully used to stop bleeding after dental operation, removal of tonsils, prostate surgery, heavy menstrual bleeding, eye injuries and in patients with Haemophilia. In this study Tranexamic acid was applied topically to the exposed tissue around the knee joint prior to the wound closure and tourniquet release. It is anticipated that this method of administration is quick, easy, associated with less systemic side effect. Also, it provides a higher concentration of the Tranexamic acid at the bleeding site. Objectives: To find out whether Tranexamic acid can reduce blood loss and subsequent blood transfusion significantly after total knee replacement when applied topically without extra side effects. Design: A double blind randomised controlled trial of 150 patients who underwent unilateral primary cemented total knee replacement. This number gives a 90% power to detect a 50% reduction in blood loss and 80% power to detect a reduction in blood transfusion from current local standard 30% to 10%. Outcome Measures: Blood loss, transfusion, Length of stay, complications, Euroqol and Oxford Knee Score. Results: The two groups were comparable in age, weight, height, BMI, Tourniquet time, and type of anaesthesia. There has been significant differences in the amount of blood loss and blood transfusion in favour of tranexamic acid (p-values are 0.001 and 0.007 respectively). Fourteen patients needed blood transfusion ranged from 2–6 units. Thirteen were in the Placebo group and only one in the Tranexamic acid. There has been no significant difference among other outcomes in particular complications rates such as DVT and pulmonary embolism

Introduction: Stress fractures comprise a major problem in female police or army recruits. The incidence of stress fractures is reported ranging from 3 to 10 fold when compared to male recruits taking the same training program. This study consisted of an intervention program aiming at reducing combat gear weight and locating the gear as close as possible to the body center of gravity. Material and Methods: In a prospective study we followed up two companies of female recruits of the Israel Border Police. Both companies were followed for the four months of basic training using a basic data questionnaire inclusive of previous physical activity habits, previous acute and overuse injuries, menstrual history and previous smoking habits. An injury questionnaire was filled on commencement of the course and every two weeks thereafter. The clinical records of medic and doctor visits, as well as the personal medical file, were revised. Roentgenological and scintigraphic imaging were performed during the course, when clinical suspicion of a stress fracture arose. The first company of 71 fighters used the standard combat gear amounting to 12.5 kg. The second company of 64 fighters used combat equipment weighing 9.4 kg, held in a combat girdle close to the body center of gravity, inclusive of a shorter personal combat riffle and personal combat vest. Results: There was no difference in the number of clinic visits between the two companies. Complaints suggesting stress fractures were recorded in the first company from the 3. rd. to the 8. th. week of training and in the second from the 1. st. to 3. rd. week. The percentage of fighters sent for Scintigraphy because of clinical suspicion of stress fractures was 22.5% in the first company and 6.25% in the second. The percentage of fighters in whom stress fractures were located by Scintigraphy was 15.5% in the first company and 4.7% in the second. The number of stress fractures in average per fighter was 0.45 fractures in the first company and 0.27 fractures in the second. When calculating only “dangerous” stress fractures (long bones and navicular) there were noted 0.34 fractures per fighter in the first company and 0.20 in the second. Total average training days lost for reason of stress fractures was 2.21 per fighter in the first company and 1.08 in the second. Conclusions: Reducing the weight of the fighting gear and securing it closer to the body center of gravity may have a positive effect in reducing the incidence of stress fractures in female recruits of fighting units during the intense basic training program

Aims

Mechanical stimulation is a key factor in the development and healing of tendon-bone insertion. Treadmill training is an important rehabilitation treatment. This study aims to investigate the benefits of treadmill training initiated on postoperative day 7 for tendon-bone insertion healing.

Aims

Is it feasible to conduct a definitive multicentre trial in community settings of corticosteroid injections (CSI) and hydrodilation (HD) compared to CSI for patients with frozen shoulder? An adequately powered definitive randomized controlled trial (RCT) delivered in primary care will inform clinicians and the public whether hydrodilation is a clinically and cost-effective intervention. In this study, prior to a full RCT, we propose a feasibility trial to evaluate recruitment and retention by patient and clinician willingness of randomization; rates of withdrawal, crossover and attrition; and feasibility of outcome data collection from routine primary and secondary care data.

Objectives

Ligaments which heal spontaneously have a healing process that is similar to skin wound healing. Menopause impairs skin wound healing and may likewise impair ligament healing. Our purpose in this study was to investigate the effect of surgical menopause on ligament healing in a rabbit medial collateral ligament model.