Oral Contraceptive Use and Improved Graft Maturation After Anterior Cruciate Ligament Reconstruction in Female Patients: An MRI-Based Study.

BACKGROUND

Female athletes have a greater risk of anterior cruciate ligament (ACL) injuries, a disparity partly attributed to hormonal influences on ligament biomechanics and collagen metabolism. Oral contraceptives (OCs) may stabilize hormonal fluctuations and have been associated with a reduced risk of ACL injury; however, their potential effect on biological healing after ACL reconstruction (ACLR) remains unclear.

PURPOSE: To investigate whether the use of OCs affects graft maturation, assessed by the signal-to-noise quotient (SNQ) of postoperative magnetic resonance imaging (MRI), in female patients who have undergone ACLR with hamstring tendon autograft and associated lateral extra-articular tenodesis (LET).

STUDY

DESIGN

Cohort study; Level of evidence, 3.

METHODS

This retrospective comparative cohort study included a series of female patients with an active menstrual cycle, aged 16 to 45 years, who underwent anatomic ACLR with hamstring tendon autograft and LET between January 2022 and December 2023. Patients were stratified based on OC use at the time of surgery and postoperatively. Thus, the study included patients who underwent ACLR+LET with and without OC treatment. The 2 groups were comparable based on all the criteria analyzed. Follow-up MRI (3.0 T) was performed at a mean of 7 months postoperatively to analyze graft maturity using circular region of interest measurements in the proximal, midsubstance, and distal ACL graft regions, by measuring the SNQ. Lower SNQ ratios indicate less water content and better graft maturity and healing.

RESULTS

A total of 55 patients with ACLR+LET were included (30 without OC use [R group] and 25 with OC use [R+OC group]). There were no significant demographic differences between the 2 groups. The median global graft SNQ was significantly lower in the R+OC group (1.8 [IQR, 0.6-3.3]) in comparison to the group in which no OC was used (3.7 [IQR, 2.0-6.0]) (P = .001). All graft regions-distal, midsubstance, and proximal-also showed significantly lower SNQ values in patients using OCs (R+OC group) compared to those not using them: distal (1.2 [IQR, 0.3-2.6] vs 3.2 [IQR, 1.5-6.0], P = .007), midsubstance (1.3 [IQR, 0.5-3.3] vs 3.7 [IQR, 2.1-7.8], P = .002), and proximal (1.3 [IQR, 0.7-3.3] vs 3.5 [IQR, 2.0-4.9], P = .006).

CONCLUSION

OC use in female patients undergoing ACLR with hamstring tendon autograft and concomitant LET is associated with lower MRI-based SNQ values.