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

BACKGROUND: Female sex is an independent risk factor for an anterior cruciate ligament (ACL) injury, as the incidence of an ACL rupture is 4- to 6-fold higher in female athletes compared with their male counterparts. The ACL attachment location as a potential risk factor for the increased ACL ruptur...

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Autores principales: Dimitriou, Dimitris, Wang, Zhongzheng, Zou, Diyang, Helmy, Naeder, Tsai, Tsung-Yuan
Formato: Online Artículo Texto
Lenguaje:English
Publicado: SAGE Publications 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7708719/
https://www.ncbi.nlm.nih.gov/pubmed/33294470
http://dx.doi.org/10.1177/2325967120964477
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author Dimitriou, Dimitris
Wang, Zhongzheng
Zou, Diyang
Helmy, Naeder
Tsai, Tsung-Yuan
author_facet Dimitriou, Dimitris
Wang, Zhongzheng
Zou, Diyang
Helmy, Naeder
Tsai, Tsung-Yuan
author_sort Dimitriou, Dimitris
collection PubMed
description BACKGROUND: Female sex is an independent risk factor for an anterior cruciate ligament (ACL) injury, as the incidence of an ACL rupture is 4- to 6-fold higher in female athletes compared with their male counterparts. The ACL attachment location as a potential risk factor for the increased ACL rupture rate in women has never been reported in the literature. PURPOSE/HYPOTHESIS: The purpose of the present study was to investigate the 3-dimensional topographic anatomy of the ACL bundle attachment in female and male patients, with and without an ACL rupture, and identify potential sex-related differences. We hypothesized that the ACL attachment location would be significantly different between men and women, in both the intact- and ruptured-ACL states. STUDY DESIGN: Cross-sectional study; Level of evidence, 3. METHODS: Magnetic resonance images of the knee from 90 patients (55 men, 35 women) with a ruptured ACL and 90 matched controls (55 men, 35 women), who suffered a noncontact knee injury without ACL rupture, were used to create 3-dimensional models of the femur and tibia. The ACL bundles’ origin and insertion were outlined on each model, and their location was measured using an anatomical coordinate system. A 2-way analysis of variance was used to compare the ACL attachment location between male and female patients, with and without an ACL rupture. RESULTS: No significant differences were found between female and male participants regarding ACL attachment location (femoral origin and tibial insertion). Patients with a ruptured ACL demonstrated a significantly different ACL origin compared with the participants with an intact ACL by an average difference of 8.9% more posterior (P < .05) and 4.0% more proximal (P < .05) in men and 13.0% more posterior (P < .05) and 5.5% more proximal (P < .05) to the flexion-extension axis of the knee in women. CONCLUSION: The ACL attachment location should not be considered a risk factor for the increased ACL rupture rates in female compared with male athletes. However, a more posterior and proximal location of the femoral ACL origin might be a predisposing factor to an ACL rupture regardless of sex.
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spelling pubmed-77087192020-12-07 Do Sex-Specific Differences Exist in ACL Attachment Location? An MRI-Based 3-Dimensional Topographic Analysis Dimitriou, Dimitris Wang, Zhongzheng Zou, Diyang Helmy, Naeder Tsai, Tsung-Yuan Orthop J Sports Med Article BACKGROUND: Female sex is an independent risk factor for an anterior cruciate ligament (ACL) injury, as the incidence of an ACL rupture is 4- to 6-fold higher in female athletes compared with their male counterparts. The ACL attachment location as a potential risk factor for the increased ACL rupture rate in women has never been reported in the literature. PURPOSE/HYPOTHESIS: The purpose of the present study was to investigate the 3-dimensional topographic anatomy of the ACL bundle attachment in female and male patients, with and without an ACL rupture, and identify potential sex-related differences. We hypothesized that the ACL attachment location would be significantly different between men and women, in both the intact- and ruptured-ACL states. STUDY DESIGN: Cross-sectional study; Level of evidence, 3. METHODS: Magnetic resonance images of the knee from 90 patients (55 men, 35 women) with a ruptured ACL and 90 matched controls (55 men, 35 women), who suffered a noncontact knee injury without ACL rupture, were used to create 3-dimensional models of the femur and tibia. The ACL bundles’ origin and insertion were outlined on each model, and their location was measured using an anatomical coordinate system. A 2-way analysis of variance was used to compare the ACL attachment location between male and female patients, with and without an ACL rupture. RESULTS: No significant differences were found between female and male participants regarding ACL attachment location (femoral origin and tibial insertion). Patients with a ruptured ACL demonstrated a significantly different ACL origin compared with the participants with an intact ACL by an average difference of 8.9% more posterior (P < .05) and 4.0% more proximal (P < .05) in men and 13.0% more posterior (P < .05) and 5.5% more proximal (P < .05) to the flexion-extension axis of the knee in women. CONCLUSION: The ACL attachment location should not be considered a risk factor for the increased ACL rupture rates in female compared with male athletes. However, a more posterior and proximal location of the femoral ACL origin might be a predisposing factor to an ACL rupture regardless of sex. SAGE Publications 2020-11-30 /pmc/articles/PMC7708719/ /pubmed/33294470 http://dx.doi.org/10.1177/2325967120964477 Text en © The Author(s) 2020 https://creativecommons.org/licenses/by-nc-nd/4.0/ This article is distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 License (https://creativecommons.org/licenses/by-nc-nd/4.0/) which permits non-commercial use, reproduction and distribution of the work as published without adaptation or alteration, without further permission provided the original work is attributed as specified on the SAGE and Open Access pages (https://us.sagepub.com/en-us/nam/open-access-at-sage).
spellingShingle Article
Dimitriou, Dimitris
Wang, Zhongzheng
Zou, Diyang
Helmy, Naeder
Tsai, Tsung-Yuan
Do Sex-Specific Differences Exist in ACL Attachment Location? An MRI-Based 3-Dimensional Topographic Analysis
title Do Sex-Specific Differences Exist in ACL Attachment Location? An MRI-Based 3-Dimensional Topographic Analysis
title_full Do Sex-Specific Differences Exist in ACL Attachment Location? An MRI-Based 3-Dimensional Topographic Analysis
title_fullStr Do Sex-Specific Differences Exist in ACL Attachment Location? An MRI-Based 3-Dimensional Topographic Analysis
title_full_unstemmed Do Sex-Specific Differences Exist in ACL Attachment Location? An MRI-Based 3-Dimensional Topographic Analysis
title_short Do Sex-Specific Differences Exist in ACL Attachment Location? An MRI-Based 3-Dimensional Topographic Analysis
title_sort do sex-specific differences exist in acl attachment location? an mri-based 3-dimensional topographic analysis
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7708719/
https://www.ncbi.nlm.nih.gov/pubmed/33294470
http://dx.doi.org/10.1177/2325967120964477
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