{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,12]],"date-time":"2026-05-12T16:23:06Z","timestamp":1778602986946,"version":"3.51.4"},"reference-count":60,"publisher":"National Athletic Trainers' Association","issue":"4","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2008,7]]},"abstract":"<jats:title>Abstract<\/jats:title>\n        <jats:sec>\n          <jats:title>Context:<\/jats:title>\n          <jats:p>Sex hormone fluctuations have been implicated as a contributing factor to the high rates of noncontact injury to the anterior cruciate ligament in females.<\/jats:p>\n        <\/jats:sec>\n        <jats:sec>\n          <jats:title>Objective:<\/jats:title>\n          <jats:p>To determine the strength of the relationships among variables of sex hormone concentrations, motoneuron excitability, and anterior tibial displacement (ATD) in women and men and to determine if these relationships differ between the sexes.<\/jats:p>\n        <\/jats:sec>\n        <jats:sec>\n          <jats:title>Design:<\/jats:title>\n          <jats:p>Cohort study.<\/jats:p>\n        <\/jats:sec>\n        <jats:sec>\n          <jats:title>Setting:<\/jats:title>\n          <jats:p>Sports medicine laboratory.<\/jats:p>\n        <\/jats:sec>\n        <jats:sec>\n          <jats:title>Patients or Other Participants:<\/jats:title>\n          <jats:p>Twenty-eight regularly menstruating women (age \u200a=\u200a 22.4 \u00b1 3.4 years) and 15 men (age \u200a=\u200a 22.3 \u00b1 3.7 years) participated in the study.<\/jats:p>\n        <\/jats:sec>\n        <jats:sec>\n          <jats:title>Intervention(s):<\/jats:title>\n          <jats:p>Fluctuations in sex hormones were determined for the participants. Female participants were tested every other day of their menstrual cycles, whereas male participants were tested every fourth day during the 28-day period.<\/jats:p>\n        <\/jats:sec>\n        <jats:sec>\n          <jats:title>Main Outcome Measure(s):<\/jats:title>\n          <jats:p>We measured Hoffmann reflexes (maximum Hoffmann reflex [H<jats:sub>max<\/jats:sub>] to maximum M-wave [M<jats:sub>max<\/jats:sub>] ratio in the soleus), ATD under a 134-N load, and saliva concentrations of estrogen and progesterone. The independent variable was sex. Pearson product moment correlation coefficients were calculated for each participant by pairing measurements made on the same day. Two-tailed independent-samples <jats:italic>t<\/jats:italic> tests were used to determine the difference between the male and female correlations for each variable.<\/jats:p>\n        <\/jats:sec>\n        <jats:sec>\n          <jats:title>Results:<\/jats:title>\n          <jats:p>Over the course of the study, the relationships between H<jats:sub>max<\/jats:sub>\u2236M<jats:sub>max<\/jats:sub> and estrogen, H<jats:sub>max<\/jats:sub>\u2236M<jats:sub>max<\/jats:sub> and progesterone, ATD and estrogen, and ATD and progesterone were not different between the sexes. However, the relationship between ATD and progesterone was different between the sexes (<jats:italic>P<\/jats:italic> \u200a=\u200a .036).<\/jats:p>\n        <\/jats:sec>\n        <jats:sec>\n          <jats:title>Conclusions:<\/jats:title>\n          <jats:p>The observed correlations did not support our hypothesis that the relationships between sex hormone levels and reflex activity or between sex hormone levels and ATD would be different for women compared with men. If sex hormone concentrations significantly contribute to anterior cruciate ligament ruptures because of changes in laxity or in motoneuron excitability, their mechanism of action is likely multifactorial and complex.<\/jats:p>\n        <\/jats:sec>","DOI":"10.4085\/1062-6050-43.4.364","type":"journal-article","created":{"date-parts":[[2009,12,30]],"date-time":"2009-12-30T15:37:25Z","timestamp":1262187445000},"page":"364-372","source":"Crossref","is-referenced-by-count":35,"title":["The Interrelationships Among Sex Hormone Concentrations, Motoneuron Excitability, and Anterior Tibial Displacement in Women and Men"],"prefix":"10.4085","volume":"43","author":[{"given":"Mark","family":"Hoffman","sequence":"first","affiliation":[{"name":"Oregon State University, Corvallis, OR"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rod A.","family":"Harter","sequence":"additional","affiliation":[{"name":"Oregon State University, Corvallis, OR"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bradley T.","family":"Hayes","sequence":"additional","affiliation":[{"name":"University of Utah, Salt Lake City, UT"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Edward M.","family":"Wojtys","sequence":"additional","affiliation":[{"name":"University of Michigan, Ann Arbor, MI"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Paul","family":"Murtaugh","sequence":"additional","affiliation":[{"name":"Oregon State University, Corvallis, OR"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"2557","reference":[{"issue":"2","key":"i1062-6050-43-4-364-Davis1","series-title":"J Orthop Sports Phys Ther","first-page":"A2","article-title":"ACL injuries: the gender bias.","volume":"37","author":"Davis, I.","year":"2007","unstructured":"Davis, I., M. L.Ireland, and S.Hanaki. ACL injuries: the gender bias.J Orthop Sports Phys Ther2007. 372:A2\u2013A7."},{"issue":"1","key":"i1062-6050-43-4-364-Anderson1","series-title":"Am J Sports Med","first-page":"58","article-title":"Correlation of anthropometric measurements, strength, anterior cruciate ligament size, and intercondylar notch characteristics to sex differences in anterior cruciate ligament tear rates.","volume":"29","author":"Anderson, A. F.","year":"2001","unstructured":"Anderson, A. F., D. C.Dome, S.Gautam, M. H.Awh, and G. W.Rennirt. Correlation of anthropometric measurements, strength, anterior cruciate ligament size, and intercondylar notch characteristics to sex differences in anterior cruciate ligament tear rates.Am J Sports Med2001. 291:58\u201366."},{"issue":"2","key":"i1062-6050-43-4-364-Harmon1","series-title":"Clin Sports Med","first-page":"287","article-title":"Gender differences in noncontact anterior cruciate ligament injuries.","volume":"19","author":"Harmon, K. 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Relaxin receptors in the human female anterior cruciate ligament.Am J Sports Med2003. 314:577\u2013584."},{"issue":"2","key":"i1062-6050-43-4-364-Heitz1","series-title":"J Athl Train","first-page":"144","article-title":"Hormonal changes throughout the menstrual cycle and increased anterior cruciate ligament laxity in females.","volume":"34","author":"Heitz, N. A.","year":"1999","unstructured":"Heitz, N. A., P. A.Eisenman, C. L.Beck, and J. A.Walker. Hormonal changes throughout the menstrual cycle and increased anterior cruciate ligament laxity in females.J Athl Train1999. 342:144\u2013149."},{"key":"i1062-6050-43-4-364-Huston2","series-title":"Clin Orthop Relat Res","first-page":"50","article-title":"Anterior cruciate ligament injuries in the female athlete: potential risk factors.","volume":"372","author":"Huston, L. J.","year":"2000","unstructured":"Huston, L. J., M. L.Greenfield, and E. M.Wojtys. Anterior cruciate ligament injuries in the female athlete: potential risk factors.Clin Orthop Relat Res2000. 372:50\u201363."},{"issue":"3","key":"i1062-6050-43-4-364-Karageanes1","series-title":"Clin J Sport Med","first-page":"162","article-title":"The association of the menstrual cycle with the laxity of the anterior cruciate ligament in adolescent female athletes.","volume":"10","author":"Karageanes, S. J.","year":"2000","unstructured":"Karageanes, S. J., K.Blackburn, and Z. A.Vangelos. The association of the menstrual cycle with the laxity of the anterior cruciate ligament in adolescent female athletes.Clin J Sport Med2000. 103:162\u2013168."},{"issue":"4","key":"i1062-6050-43-4-364-Liu1","series-title":"J Orthop Res","first-page":"526","article-title":"Primary immunolocalization of estrogen and progesterone target cells in the human anterior cruciate ligament.","volume":"14","author":"Liu, S. H.","year":"1996","unstructured":"Liu, S. H., R.al-Shaikh, V.Panossian, et al. Primary immunolocalization of estrogen and progesterone target cells in the human anterior cruciate ligament.J Orthop Res1996. 144:526\u2013533."},{"issue":"5","key":"i1062-6050-43-4-364-Sciore1","series-title":"J Orthop Res","first-page":"604","article-title":"Identification of sex hormone receptors in human and rabbit ligaments of the knee by reverse transcription-polymerase chain reaction: evidence that receptors are present in tissue from both male and female subjects.","volume":"16","author":"Sciore, P.","year":"1998","unstructured":"Sciore, P., C. B.Frank, and D. A.Hart. 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E.Hewett. Gender differences in the kinematics of unanticipated cutting in young athletes.Med Sci Sports Exerc2005. 371:124\u2013129."},{"issue":"10","key":"i1062-6050-43-4-364-Carcia1","series-title":"Clin Biomech (Bristol, Avon)","first-page":"1048","article-title":"Knee ligament behavior following a controlled loading protocol does not differ by menstrual cycle day.","volume":"19","author":"Carcia, C. R.","year":"2004","unstructured":"Carcia, C. R., S. J.Shultz, K. P.Granata, B. M.Gansneder, and D. H.Perrin. 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Muscle strength and endurance do not significantly vary across 3 phases of the menstrual cycle in moderately active premenopausal women.Clin J Sport Med2003. 134:238\u2013241."},{"issue":"6","key":"i1062-6050-43-4-364-Fridn2","series-title":"Gynecol Endocrinol","first-page":"433","article-title":"The influence of premenstrual symptoms on postural balance and kinesthesia during the menstrual cycle.","volume":"17","author":"Frid\u00e9n, C.","year":"2003","unstructured":"Frid\u00e9n, C., A. L.Hirschberg, T.Saartok, T.B\u00e4ckstr\u00f6m, J.Leanderson, and P.Renstr\u00f6m. 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Combined effects of estrogen and progesterone on the anterior cruciate ligament.Clin Orthop Relat Res2001. 383:268\u2013281."},{"issue":"9","key":"i1062-6050-43-4-364-Beynnon1","series-title":"Am J Sports Med","first-page":"1298","article-title":"The effect of estradiol and progesterone on knee and ankle joint laxity.","volume":"33","author":"Beynnon, B. D.","year":"2005","unstructured":"Beynnon, B. D., I. M.Bernstein, A.Belisle, et al. The effect of estradiol and progesterone on knee and ankle joint laxity.Am J Sports Med2005. 339:1298\u20131304."},{"issue":"7","key":"i1062-6050-43-4-364-Shultz2","series-title":"Med Sci Sports Exerc","first-page":"1165","article-title":"Relationship between sex hormones and anterior knee laxity across the menstrual cycle.","volume":"36","author":"Shultz, S. J.","year":"2004","unstructured":"Shultz, S. J., S. E.Kirk, M. L.Johnson, T. C.Sander, and D. H.Perrin. Relationship between sex hormones and anterior knee laxity across the menstrual cycle.Med Sci Sports Exerc2004. 367:1165\u20131174."},{"issue":"2","key":"i1062-6050-43-4-364-Arendt1","series-title":"J Gend Specif Med","first-page":"19","article-title":"Periodicity of noncontact anterior cruciate ligament injuries during the menstrual cycle.","volume":"5","author":"Arendt, E. A.","year":"2002","unstructured":"Arendt, E. A., B.Bershadsky, and J.Agel. Periodicity of noncontact anterior cruciate ligament injuries during the menstrual cycle.J Gend Specif Med2002. 52:19\u201326."},{"issue":"5","key":"i1062-6050-43-4-364-Beynnon2","series-title":"Am J Sports Med","first-page":"757","article-title":"The relationship between menstrual cycle phase and anterior cruciate ligament injury: a case-control study of recreational alpine skiers.","volume":"34","author":"Beynnon, B. D.","year":"2006","unstructured":"Beynnon, B. D., R. J.Johnson, S.Braun, et al. 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N.Lindenfeld, T. E.Hewett, and M. L.Greenfield. Association between the menstrual cycle and anterior cruciate ligament injuries in female athletes.Am J Sports Med1998. 265:614\u2013619."},{"issue":"6","key":"i1062-6050-43-4-364-McLean2","series-title":"Med Sci Sports Exerc","first-page":"1008","article-title":"Effect of gender and defensive opponent on the biomechanics of sidestep cutting.","volume":"36","author":"McLean, S. G.","year":"2004","unstructured":"McLean, S. G., S. W.Lipfert, and A. J.van den Bogert. Effect of gender and defensive opponent on the biomechanics of sidestep cutting.Med Sci Sports Exerc2004. 366:1008\u20131016."},{"issue":"2","key":"i1062-6050-43-4-364-Myer1","series-title":"J Electromyogr Kinesiol","first-page":"181","article-title":"The effects of gender on quadriceps muscle activation strategies during a maneuver that mimics a high ACL injury risk position.","volume":"15","author":"Myer, G. D.","year":"2005","unstructured":"Myer, G. D., K. R.Ford, and T. E.Hewett. The effects of gender on quadriceps muscle activation strategies during a maneuver that mimics a high ACL injury risk position.J Electromyogr Kinesiol2005. 152:181\u2013189."},{"issue":"1","key":"i1062-6050-43-4-364-Ford2","series-title":"Med Sci Sports Exerc","first-page":"124","article-title":"Gender differences in the kinematics of unanticipated cutting in young athletes.","volume":"37","author":"Ford, K. R.","year":"2005","unstructured":"Ford, K. R., G. D.Myer, H. E.Toms, and T. E.Hewett. Gender differences in the kinematics of unanticipated cutting in young athletes.Med Sci Sports Exerc2005. 371:124\u2013129."},{"issue":"1","key":"i1062-6050-43-4-364-Mortimer1","series-title":"Expert Rev Neurother","first-page":"45","article-title":"Relationship between estrogen and schizophrenia.","volume":"7","author":"Mortimer, A. M.","year":"2007","unstructured":"Mortimer, A. M.\n          \n          Relationship between estrogen and schizophrenia.\n          Expert Rev Neurother\n          2007. 71:45\u201355."},{"issue":"5","key":"i1062-6050-43-4-364-Stewart1","series-title":"Psychosomatics","first-page":"445","article-title":"Depression, estrogen, and the Women's Health Initiative.","volume":"45","author":"Stewart, D. E.","year":"2004","unstructured":"Stewart, D. E., D. E.Rolfe, and E.Robertson. Depression, estrogen, and the Women's Health Initiative.Psychosomatics2004. 455:445\u2013447."},{"issue":"2","key":"i1062-6050-43-4-364-Tsen1","series-title":"J Clin Anesth","first-page":"118","article-title":"Can estrogen influence the response to noxious stimuli?","volume":"13","author":"Tsen, L. C.","year":"2001","unstructured":"Tsen, L. C., M.Natale, S.Datta, and S.Eappen. Can estrogen influence the response to noxious stimuli?J Clin Anesth2001. 132:118\u2013121."},{"issue":"3","key":"i1062-6050-43-4-364-Palmieri1","series-title":"J Athl Train","first-page":"268","article-title":"The Hoffmann reflex: methodologic considerations and applications for use in sports medicine and athletic training research.","volume":"39","author":"Palmieri, R. M.","year":"2004","unstructured":"Palmieri, R. M., C. D.Ingersoll, and M. A.Hoffman. The Hoffmann reflex: methodologic considerations and applications for use in sports medicine and athletic training research.J Athl Train2004. 393:268\u2013277."},{"issue":"7","key":"i1062-6050-43-4-364-Palmieri2","series-title":"Int J Neurosci","first-page":"841","article-title":"Intersession reliability for H-reflex measurements arising from the soleus, peroneal, and tibialis anterior musculature.","volume":"112","author":"Palmieri, R. M.","year":"2002","unstructured":"Palmieri, R. M., M. A.Hoffman, and C. D.Ingersoll. 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