AJSM - 2026-05-11 - Journal Article
Oral Contraceptive Use and Improved Graft Maturation After Anterior Cruciate Ligament Reconstruction in Female Patients: An MRI-Based Study.
Masferrer-Pino A, Martínez-Peñas J, Ormazabal I, Pizza N, Perelli S, Monllau JC
Topics
Key Takeaway
Female patients using oral contraceptives at the time of ACLR+LET demonstrated significantly lower global graft SNQ on 7-month MRI (1.8 vs 3.7, P=.001), indicating superior graft maturation compared to non-OC users.
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Summary
This retrospective comparative cohort investigated whether oral contraceptive use affects hamstring autograft maturation after ACLR+LET in females aged 16–45, using 3.0T MRI SNQ as the primary outcome. OC users demonstrated significantly lower SNQ across all three graft regions—distal (1.2 vs 3.2), midsubstance (1.3 vs 3.7), and proximal (1.3 vs 3.5)—all with P<.01. Lower SNQ reflects reduced graft water content and is interpreted as more advanced ligamentization at 7 months.
Key Limitation
The sample size of 55 patients is underpowered to control for confounders such as OC formulation type, estrogen dose, duration of use, and compliance, all of which independently influence collagen metabolism and could account for the observed SNQ difference.
Original Abstract
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.