2025 ISAKOS Congress in Munich, Germany

2025 ISAKOS Biennial Congress Paper


Systemic Hormonal Contraceptives Increase the Risk of Soft Tissue Pathology in the Knee: An Epidemiological Analysis of 1,294,435 Patients

Aakash Shah, BA, New York, NY UNITED STATES
Robert Burkhart, MD, Cleveland, OH UNITED STATES
Isha Shah, BA, New York UNITED STATES
Bhargavi Maheshwer, MD, Cleveland UNITED STATES
Amanda Weiss-Kelly, MD, Cleveland UNITED STATES
Michael J. Salata, MD
James E. Voos, MD
Jacob Giovanni Calcei, MD, Shaker Heights, OH UNITED STATES

University Hospitals Case Medical Center, Cleveland, Ohio, UNITED STATES

FDA Status Not Applicable

Summary

Female patients who had been prescribed any therapy class of hormonal contraceptives had higher odds of suffering from a knee-related orthopaedic soft tissue complication compared to matched control patients.

Abstract

Purpose

Soft tissue injuries are more prevalent among female athletes compared to their male counterparts, with higher incidences of ACL tears, patellofemoral pain, stress fractures, and ligamentous laxity. Emerging evidence suggests that hormones such as estrogen and progesterone significantly influence this disparity. Estrogen has been shown to increase ACL laxity, while progesterone contributes to collateral ligament laxity. Despite the widespread use of hormonal contraceptives (HCs), there is limited research on the impact of different HC formulations on knee injuries. This study aims to determine whether various HC formulations affect the 5-year risk of soft tissue injuries in females.

Methods

A retrospective cohort study was conducted using a national database to identify female patients between the ages of 13 and 50 who were prescribed HCs from 2005 to 2019. One-to-one propensity score matching was conducted to compare estrogen-only HCs, progestin-only HCs, and combined HCs to a control cohort. Soft tissue complications occurring within a minimum of 5 years after starting HCs were assessed.

Result: A total of 1,294,435 patients were included in the final analysis. Females using any hormonal contraceptive (HC) formulation showed an increased risk of knee soft tissue injuries. The estrogen-only cohort was more likely to have a meniscal tear (p = <0.001) or any ligamentous pathology (p = 0.036). The progestin-only cohort had higher odds of having a meniscal tear, collateral ligament tear, and any ligamentous pathology (OR: p = <0.001) The mixed HC cohort was more likely to have an ACL tear (p = 0.024), meniscal tear, a collateral ligament tear, and any ligamentous pathology (p = <0.001).

Conclusion

To our knowledge, this is the first study utilizing a large database to identify the association between different HC types and the long-term risk of soft tissue complications. The results of this analysis encourage further research into the advantages and costs associated with HC concerning soft tissue injuries. Given that a significant portion of female patients use some form of HCs, it is crucial to educate them about the potential increased risk of soft tissue injuries.