Do Sex-Specific Differences Exist in ACL Attachment Location? An MRI-Based 3-Dimensional Topographic Analysis.

Area of Science:

• Orthopedic surgery
• Sports medicine
• Anatomy

Background:

• Female athletes exhibit a 4- to 6-fold higher incidence of anterior cruciate ligament (ACL) rupture compared to male athletes.
• The potential role of ACL attachment location in sex-related differences in ACL injury rates remains unexplored.

Purpose of the Study:

• To investigate 3-dimensional topographic anatomy of the ACL bundle attachment in female and male patients.
• To identify potential sex-related differences in ACL attachment location.
• To compare ACL attachment location in patients with and without ACL rupture.

Main Methods:

• Cross-sectional study utilizing magnetic resonance imaging (MRI) data from 90 patients with ACL rupture and 90 matched controls.
• Creation of 3-dimensional knee models to outline and measure ACL bundle origin and insertion points.
• Statistical analysis (2-way ANOVA) to compare ACL attachment locations between sexes and injury groups.

Main Results:

• No significant differences in ACL attachment location (femoral origin and tibial insertion) were observed between female and male participants.
• Patients with ACL rupture showed significantly different femoral ACL origins compared to intact ACL individuals.
• A more posterior and proximal femoral ACL origin was noted in both sexes with ACL rupture.

Conclusions:

• ACL attachment location is not a contributing factor to the higher ACL rupture rates observed in female athletes.
• A posterior and proximal femoral ACL origin may predispose individuals to ACL rupture, irrespective of sex.
• Further research is warranted to elucidate other potential sex-specific risk factors for ACL injuries.