Document Title: Chandrashekar-AJSM-Oct05.shtml
Article Title: Sex-Based Differences in the Anthropometric Characteristics of the Anterior Cruciate Ligament and Its Relation to Intercondylar Notch Geometry A Cadaveric Study
Authors: Naveen Chandrashekar, MS, James Slauterbeck, MD and Javad Hashemi, PhD.
Publication: American Journal of Sports Medicine, Baltimore, Maryland
Date: October 2005
Volume 33, pages 1492-1498
Keywords: ACL anatomy, physiology, function, biomechanics, relationship to intercondylar-notch width, size, geometry, gender/sex-based differences, injury proclivity.

(Reference-denoting numbers appear in the same font and point size as the document text. As with all Knee Library documents, this article is provided in full-text form, complete with all figures and tables.)

Comments: In this razor-sharp study, the authors found that gender makes a substantial difference in terms of the ACL's form and structural characteristics. Most notably, the female ACL has a markedly smaller cross-section than that of its male counterpart. They note that ACL mass increases with height in men, but not in women, and also that ACL size increases proportionally to intercondylar-notch width in men, but not in women. The authors astutely note that more research is needed in order to determine gender-based differences in ACL anatomy and physiology. (Note: Another superb article by Chandrashekar was published in December 2006, and can be found at Chandrashekar-JB-Dec06.shtml. It found that the material properties of the female ACL are such that it is weaker, less elastic, and more prone to tearing than its male counterpart.)

ABSTRACT

Background: A significantly higher rate of anterior cruciate ligament injuries occurs in women involved in sports activities compared to the corresponding male population. Reasons for this disparity are not well understood; however, sex-based differences in the geometry of the anterior cruciate ligament, its morphologic characteristics, and the intercondylar notch size have been cited as possible factors.

Hypotheses: (1) The anterior cruciate ligament in women has a shorter length, and smaller cross-sectional area and volume than that in men. (2) The female anterior cruciate ligament has a lower mass density. (3) Ligament size is proportional to notch width in both male and female populations.

Study Design: Descriptive laboratory study.

Methods: Using a 3-dimensional imaging system, the authors measured the geometric parameters, including length, area, and volume, of the anterior cruciate ligaments of 10 male and 10 female donors (all Caucasian). A digital image of the frontal plane of the knee flexed at 90° was used to measure notch size. After the ligament’s removal from its attachment sites, its mass was measured using a digital balance. Geometric parameters, mass density, and notch size were compared based on sex. Correlation analyses between ligament size and body anthropometric characteristics, and between notch size and ligament size were performed.

Results: The anterior cruciate ligament in women was smaller in length, cross-sectional area, volume, and mass when compared to that in men. No significant difference in ligament mass density was found between the sexes. Also, no differences were found in notch geometry between male and female populations. A correlation between notch size and ligament size was found for men but not for women.

Conclusions: Because the densities of female and male anterior cruciate ligaments appear to be similar, the smaller ligament size in women may contribute to their having a higher rate of ligament injuries. Anterior cruciate ligament size increases in proportion to notch width in men but not in women.

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