Date of Award
Spring 2026
Document Type
Honors Thesis
Department/Major
Kinesiology and Sport Management
First Advisor
Dr. Adam Ladwig
Second Advisor
Dr. Jessie Daw
Third Advisor
Dr. Jed Droge
Keywords
Anterior Cruciate Ligament (ACL), Non-contact ACL injury, Female athletes, Menstrual cycle, Hormonal fluctuations, ACL injury risk, Relaxin, Progesterone, Estrogen, Ligament laxity.
Subject Categories
Rehabilitation and Therapy | Sports Sciences
Abstract
Anterior cruciate ligament (ACL) injuries are among the most common and debilitating injuries in athletic populations, with female athletes experiencing significantly higher rates of non-contact ACL rupture compared to males, often while participating in the same sports. Hormonal fluctuations associated with the menstrual cycle have been proposed as a potential intrinsic risk factor influencing injury susceptibility. The purpose of this literature review was to examine current research investigating how menstrual cycle-related hormonal fluctuations may influence the risk of non-contact ACL rupture in female athletes. A comprehensive search of PubMed, SPORTDiscus, and CINAHL databases identified fourteen peer-reviewed studies that met the inclusion criteria and were published between 2015 and 2025. Findings indicate that fluctuations in estrogen, progesterone, and relaxin may influence ligament properties, as well as changes in neuromuscular control and knee joint stability. Although these physiological effects suggest a potential role for hormonal fluctuations in injury mechanisms, current evidence directly linking menstrual cycle hormone variation to ACL injury risk remains inconclusive due to variation in study design, hormone measurement methods, study outcomes, and participant characteristics. Therefore, hormonal fluctuations are best understood as one possible contributing factor within a multifactorial model of ACL injury risk, not as an independent cause. Further research would benefit from using standardized methodologies and larger sample sizes to clarify the relationship between menstrual cycle physiological and non-contact ACL rupture risk in female athletes.
Recommended Citation
Larson, Alexa K., "Menstrual Cycle Hormonal Fluctuations and Non-Contact ACL Rupture Risk in Female Athletes: A Literature Review" (2026). Honors Thesis. 420.
https://red.library.usd.edu/honors-thesis/420