Sex Comparisons of In Vivo Anterior Cruciate Ligament Morphometry

Overview

Journal J Athl Train

Specialty Orthopedics

Date 2019 May 7

PMID 31058539

Citations 7

Authors

Hsin-Min Wang

Sandra J Shultz

Scott E Ross

Robert A Henson

David H Perrin

Robert A Kraft

Randy J Schmitz

Affiliations

Soon will be listed here.

Abstract

Context: Females have consistently higher anterior cruciate ligament (ACL) injury rates than males. The reasons for this disparity are not fully understood. Whereas ACL morphometric characteristics are associated with injury risk and females have a smaller absolute ACL size, comprehensive sex comparisons that adequately account for sex differences in body mass index (BMI) have been limited.

Objective: To investigate sex differences among in vivo ACL morphometric measures before and after controlling for femoral notch width and BMI.

Design: Cross-sectional study.

Setting: Laboratory.

Patients Or Other Participants: Twenty recreationally active men (age = 23.2 ± 2.9 years, height = 180.4 ± 6.7 cm, mass = 84.0 ± 10.9 kg) and 20 recreationally active women (age = 21.3 ± 2.3 years, height = 166.9 ± 7.7 cm, mass = 61.9 ± 7.2 kg) participated.

Main Outcome Measure(s): Structural magnetic resonance imaging sequences were performed on the left knee. Anterior cruciate ligament volume, width, and cross-sectional area measures were obtained from T2-weighted images and normalized to femoral notch width and BMI. Femoral notch width was measured from T1-weighted images. We used independent-samples tests to examine sex differences in absolute and normalized measures.

Results: Men had greater absolute ACL volume (1712.2 ± 356.3 versus 1200.1 ± 337.8 mm; = -4.67, < .001) and ACL width (8.5 ± 2.3 versus 7.0 ± 1.2 mm; = -2.53, = .02) than women. The ACL volume remained greater in men than in women after controlling for femoral notch width (89.31 ± 15.63 versus 72.42 ± 16.82 mm/mm; = -3.29, = .002) and BMI (67.13 ± 15.40 versus 54.69 ± 16.39 mm/kg/m; = -2.47, = .02).

Conclusions: Whereas men had greater ACL volume and width than women, only ACL volume remained different when we accounted for femoral notch width and BMI. This suggests that ACL volume may be an appropriate measure of ACL anatomy in investigations of ACL morphometry and ACL injury risk that include sex comparisons.

Citing Articles

The association between anterior cruciate ligament degeneration and incident knee osteoarthritis: Data from the osteoarthritis initiative.

Luo P, Wang Q, Cao P, Chen T, Li S, Wang X J Orthop Translat. 2024; 44:1-8.

PMID: 38174315 PMC: 10762318. DOI: 10.1016/j.jot.2023.09.005.

Sex-Specific Changes in Physical Risk Factors for Anterior Cruciate Ligament Injury by Chronological Age and Stages of Growth and Maturation From 8 to 18 Years of Age.

Shultz S, Cruz M, Casey E, Dompier T, Ford K, Pietrosimone B J Athl Train. 2023; 57(9-10):830-876.

PMID: 36638346 PMC: 9842121. DOI: 10.4085/1062-6050-0038.22.

Narrow Notch Width and Low Anterior Cruciate Ligament Volume Are Risk Factors for Anterior Cruciate Ligament Injury: A Magnetic Resonance Imaging-Based Study.

Gupta R, Jhatiwal S, Kapoor A, Kaur R, Soni A, Singhal A HSS J. 2022; 18(3):376-384.

PMID: 35846265 PMC: 9247593. DOI: 10.1177/15563316211041090.

Three-dimensional magnetic resonance imaging analysis shows sex-specific patterns in changes in anterior cruciate ligament cross-sectional area along its length.

Menghini D, Kaushal S, Flannery S, Ecklund K, Murray M, Fleming B J Orthop Res. 2022; 41(4):771-778.

PMID: 35803594 PMC: 9825677. DOI: 10.1002/jor.25413.

Current trends in the anterior cruciate ligament part 1: biology and biomechanics.

Musahl V, Nazzal E, Lucidi G, Serrano R, Hughes J, Margheritini F Knee Surg Sports Traumatol Arthrosc. 2021; 30(1):20-33.

PMID: 34927221 DOI: 10.1007/s00167-021-06826-y.

References

Davis T, Shelbourne K, Klootwyk T . Correlation of the intercondylar notch width of the femur to the width of the anterior and posterior cruciate ligaments. Knee Surg Sports Traumatol Arthrosc. 1999; 7(4):209-14. DOI: 10.1007/s001670050150. View

Anderson A, Dome D, Gautam S, Awh M, Rennirt G . 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 Med. 2001; 29(1):58-66. DOI: 10.1177/03635465010290011501. View

Marx R, Stump T, Jones E, Wickiewicz T, Warren R . Development and evaluation of an activity rating scale for disorders of the knee. Am J Sports Med. 2001; 29(2):213-8. DOI: 10.1177/03635465010290021601. View

Ireland M, Ballantyne B, Little K, McClay I . A radiographic analysis of the relationship between the size and shape of the intercondylar notch and anterior cruciate ligament injury. Knee Surg Sports Traumatol Arthrosc. 2001; 9(4):200-5. DOI: 10.1007/s001670100197. View

Charlton W, St John T, Ciccotti M, Harrison N, Schweitzer M . Differences in femoral notch anatomy between men and women: a magnetic resonance imaging study. Am J Sports Med. 2002; 30(3):329-33. DOI: 10.1177/03635465020300030501. View

Fung D, Zhang L . Modeling of ACL impingement against the intercondylar notch. Clin Biomech (Bristol). 2003; 18(10):933-41. DOI: 10.1016/s0268-0033(03)00174-8. View

Uhorchak J, Scoville C, Williams G, Arciero R, St Pierre P, Taylor D . Risk factors associated with noncontact injury of the anterior cruciate ligament: a prospective four-year evaluation of 859 West Point cadets. Am J Sports Med. 2003; 31(6):831-42. DOI: 10.1177/03635465030310061801. View

Chandrashekar N, Slauterbeck J, Hashemi J . Sex-based differences in the anthropometric characteristics of the anterior cruciate ligament and its relation to intercondylar notch geometry: a cadaveric study. Am J Sports Med. 2005; 33(10):1492-8. DOI: 10.1177/0363546504274149. View

Yushkevich P, Piven J, Hazlett H, Smith R, Ho S, Gee J . User-guided 3D active contour segmentation of anatomical structures: significantly improved efficiency and reliability. Neuroimage. 2006; 31(3):1116-28. DOI: 10.1016/j.neuroimage.2006.01.015. View

10.

Arendt E, Agel J, Dick R . Anterior cruciate ligament injury patterns among collegiate men and women. J Athl Train. 2006; 34(2):86-92. PMC: 1322895. View

11.

Dienst M, Schneider G, Altmeyer K, Voelkering K, Georg T, Kramann B . Correlation of intercondylar notch cross sections to the ACL size: a high resolution MR tomographic in vivo analysis. Arch Orthop Trauma Surg. 2006; 127(4):253-60. DOI: 10.1007/s00402-006-0177-7. View

12.

Fayad L, Rosenthal E, Morrison W, Carrino J . Anterior cruciate ligament volume: analysis of gender differences. J Magn Reson Imaging. 2007; 27(1):218-23. DOI: 10.1002/jmri.21239. View

13.

Prodromos C, Han Y, Rogowski J, Joyce B, Shi K . A meta-analysis of the incidence of anterior cruciate ligament tears as a function of gender, sport, and a knee injury-reduction regimen. Arthroscopy. 2007; 23(12):1320-1325.e6. DOI: 10.1016/j.arthro.2007.07.003. View

14.

Chaudhari A, Zelman E, Flanigan D, Kaeding C, Nagaraja H . Anterior cruciate ligament-injured subjects have smaller anterior cruciate ligaments than matched controls: a magnetic resonance imaging study. Am J Sports Med. 2009; 37(7):1282-7. PMC: 3641641. DOI: 10.1177/0363546509332256. View

15.

Stein V, Li L, Guermazi A, Zhang Y, Kwoh C, Eaton C . The relation of femoral notch stenosis to ACL tears in persons with knee osteoarthritis. Osteoarthritis Cartilage. 2009; 18(2):192-9. PMC: 4174406. DOI: 10.1016/j.joca.2009.09.006. View

16.

Jamison S, Flanigan D, Nagaraja H, Chaudhari A . Side-to-side differences in anterior cruciate ligament volume in healthy control subjects. J Biomech. 2009; 43(3):576-8. PMC: 2813385. DOI: 10.1016/j.jbiomech.2009.10.006. View

17.

Simon R, Everhart J, Nagaraja H, Chaudhari A . A case-control study of anterior cruciate ligament volume, tibial plateau slopes and intercondylar notch dimensions in ACL-injured knees. J Biomech. 2010; 43(9):1702-7. PMC: 2882557. DOI: 10.1016/j.jbiomech.2010.02.033. View

18.

Fleming B, Vajapeyam S, Connolly S, Magarian E, Murray M . The use of magnetic resonance imaging to predict ACL graft structural properties. J Biomech. 2011; 44(16):2843-6. PMC: 3208804. DOI: 10.1016/j.jbiomech.2011.09.004. View

19.

Grzelak P, Podgorski M, Stefanczyk L, Krochmalski M, Domzalski M . Hypertrophied cruciate ligament in high performance weightlifters observed in magnetic resonance imaging. Int Orthop. 2012; 36(8):1715-9. PMC: 3535026. DOI: 10.1007/s00264-012-1528-3. View

20.

Westermann R, Wolf B, Elkins J . Effect of ACL reconstruction graft size on simulated Lachman testing: a finite element analysis. Iowa Orthop J. 2013; 33:70-7. PMC: 3748896. View