A magazine for friends of the Warren Alpert Medical School of Brown University.

A Dose of Prevention


Female athletes on the Pill are less likely to need surgery after tearing their ACLs.

Oral contraceptives may help protect against serious knee injuries, according to new research.

Steven DeFroda, MD, a resident in the orthopedic surgery program at Brown who studies athletic injuries of the knee, analyzed 10 years’ of data for more than 165,000 patients who had torn an anterior cruciate ligament (ACL).

He and his fellow researchers reported that the birth control pill appeared to offer the most protection for teenagers, who, when compared with other young women who hadn’t taken contraceptives, were 63 percent less likely to need reconstructive surgery after injuring their ACLs.

Nearly 1 in 2 athletes with ACL tears can’t play competitively again, according to the researchers. ACL injuries are extremely common, especially among young athletes, and are significantly more common in women than men; there’s evidence that women’s elevated risk may be due to estrogen levels.

As for why the Pill could protect against ACL tears, DeFroda says, “It’s likely that oral contraceptives help maintain lower and more consistent levels of estrogen and progesterone,” another female sex hormone commonly used in birth control pills.

The observational study, which was published in the journal The Physician and Sportsmedicine, analyzed prescription and insurance information for patients ages 15 to 49 between the years 2007 and 2017. The researchers compared rates of ACL reconstruction in women taking the Pill during the year prior to injury and undergoing surgery to a control group of patients of similar age and injury who weren’t taking contraceptives.

They found that women taking birth control pills were 18 percent less likely to require reconstructive surgery compared to the control group.

The authors wrote that despite the potential risks of taking the Pill, its benefits could outweigh those risks, especially for young athletes. They also noted that they couldn’t draw firm conclusions about cause and effect because they were analyzing data after the fact. A carefully controlled study that tracks athletes over time would more definitively determine whether those who take oral contraceptives actually have fewer ACL injuries, they wrote.

“Young athletes use oral contraceptives for a variety of reasons, including regulating their menstrual cycle and/or preventing pregnancy,” DeFroda says. “With careful assessment of the risks, injury risk reduction could be another way in which female athletes may benefit from their use.”


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