Determination of the position of the knee at the time of an anterior cruciate ligament rupture for male versus female patients by an analysis of bone bruises
Open accessAbstract
Background: The incidence of anterior cruciate ligament (ACL) ruptures is 2 to 4 times higher in female athletes as compared with their male counterparts. As a result, a number of recent studies have addressed the hypothesis that female and male patients sustain ACL injuries via different mechanisms. The efficacy of prevention programs may be improved by a better understanding of whether there are differences in the injury mechanism between sexes. Hypothesis/Purpose: To compare knee positions at the time of a noncontact ACL injury between sexes. It was hypothesized that there would be no differences in the position of injury. Study Design: Controlled laboratory study. Methods: Clinical T2-weighted magnetic resonance imaging (MRI) scans from 30 participants (15 male and 15 female) with a noncontact ACL rupture were reviewed retrospectively. MRI scans were obtained within 1 month of injury. Participants had contusions associated with an ACL injury on both the medial and lateral articular surfaces of the femur and tibia. Three-dimensional models of the femur, tibia, and associated bone bruises were created via segmentation on MRI. The femur was positioned relative to the tibia to maximize bone bruise overlap, thereby predicting the bone positions near the time of the injury. Flexion, valgus, internal tibial rotation, and anterior tibial translation were measured in the predicted position of injury. Results: No statistically significant differences between male and female patients were detected in the position of injury with regard to knee flexion ( P = .66), valgus ( P = .87), internal tibial rotation ( P = .26), or anterior tibial translation ( P = .18). Conclusion: These findings suggest that a similar mechanism results in an ACL rupture in both male and female athletes with this pattern of bone bruising. Clinical Relevance: This study provides a novel comparison of male and female knee positions at the time of an ACL injury that may offer information to improve injury prevention strategies.
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No strong evidence exists that the biomechanics at the moment of ACL injury is different between sexes.
“but no strong evidence exists that the biomechanics at the moment of ACL injury is different between sexes.34 35”
From Anterior cruciate ligament injury: towards a gendered environmental approach (2021) · cites this paper as [35]
The Discussion reports no statistically significant sex differences in four predicted knee-position measures at non-contact ACL injury. But the finding is limited to participants with bone bruises on both medial and lateral surfaces of the femur and tibia; it does not establish that no strong evidence of any biomechanical difference exists more generally. The Introduction also notes video evidence supporting a role for valgus collapse, particularly in females. (LLM, conf=0.84)
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References 68 · Cited by 73
Research works printed but not linked: 1
- [35]Lamontagne M Benoit D Ramsey D Caraffa A Cerulli G What can we learn from in vivo biomechanical investigations of lower extremity? Paper presented at: ISBS-Conference Proceedings Archive 2008
- Authors
- Owusu-Akyaw, K. A., Kim, S. Y., Spritzer, C. E., Collins, A. T., Englander, Z. A., Utturkar, G. M., Garrett, W. E., & DeFrate, L. E.
- Affiliations
- Department of Orthopaedic Surgery, Duke University, Durham, North Carolina, USA
- Duke University (US)
- Corresponding author
- DeFrate, Louis E.
- Venue
- The American Journal of Sports Medicine
- Publisher
- SAGE Publications
- Published
- 2018-04-18
- Volume
- 46
- Issue
- 7
- Pages
- 1559-1565
- ISSN
- 0363-5465 (ISSN-L)
- 1552-3365
- PMC
- PMC5976536
- OpenAlex
- W2802726266
- Cited by
- 73
- References
- 68
- Citations by year
- 2026: 3 · 2025: 5 · 2024: 10 · 2023: 10 · 2022: 10 · 2021: 10 · 2020: 9 · 2019: 14 · 2018: 2
- FWCI
- 9.10
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- The American Journal of Sports Medicine (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institute of Arthritis and Musculoskeletal and Skin Diseases (F32AR066477, R01AR065527)
- Topics
- Health Sciences › Medicine › Surgery › Knee injuries and reconstruction techniques
- Physical Sciences › Engineering › Biomedical Engineering › Lower Extremity Biomechanics and Pathologies
- Health Sciences › Medicine › Orthopedics and Sports Medicine › Sports injuries and prevention
- Keywords
- anterior cruciate ligament rupture, non-contact ACL injury, sex differences, injury mechanisms, bone bruise, knee flexion, genu valgum, tibial rotation, tibial translation, 3D bone models, injury prevention
- MeSH terms
- Anterior Cruciate Ligament Injuries, Adolescent, Adult, Athletic Injuries, Contusions, Female, Femur, Hematoma, Humans, Knee Injuries, Knee Joint, Magnetic Resonance Imaging, Male, Models, Anatomic, Retrospective Studies, Rotation, Sex Factors, Tibia, Range of Motion, Articular, Anterior Cruciate Ligament, Young Adult, Athletes
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