Hormonal Stabilization of the Bone-Metabolic Environment: Implications for Anterior Cruciate Ligament Integrity and Bone-Graft Integration

The female musculoskeletal system functions as a highly dynamic metabolic environment rather than a static anatomical frame.A critical challenge in sports medicine remains the disproportional incidence of anterior cruciate ligament (ACL) injuries in female athletes, which occurs at rates reaching up to eightfold those observed in their male counterparts.While biomechanical factors are traditionally emphasized, research increasingly highlights an underlying "hormonal window" of vulnerability during the menstrual cycle.[1]Bone and soft tissue operate as interlinked endocrine organs.The surge of 17β-estradiol during the late follicular phase serves as a potent proteolytic trigger that alters the structural integrity of the ACL.Furthermore, the hormone relaxin plays a synergistic role in this metabolic flux; by binding to specific receptors on the ACL, relaxin facilitates the degradation of the collagenous extracellular matrix, significantly increasing joint laxity and subsequent injury risk.[2] In this communication, it is argued that the orthopedic community must bridge the gap between surgical technique and endocrine health by implementing targeted prevention strategies.It is being investigated exactly how oral contraceptive therapy (OCT) can serve as a "metabolic stabilizer" to mitigate these hormonal surges, thereby improving both primary injury prevention and post-surgical graft prognosis.