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Am J Sports Med. 2018 Jun;46(7):1559-1565. doi: 10.1177/0363546518764681. Epub 2018 Apr 18.

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.

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Department of Orthopaedic Surgery, Duke University, Durham, North Carolina, USA.
Department of Biomedical Engineering, Duke University, Durham, North Carolina, USA.
Department of Radiology, Duke University, Durham, North Carolina, USA.
Department of Mechanical Engineering and Materials Science, Duke University, Durham, North Carolina, USA.



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.


Controlled laboratory study.


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.


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).


These findings suggest that a similar mechanism results in an ACL rupture in both male and female athletes with this pattern of bone bruising.


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.


MRI; anterior cruciate ligament; bone contusion; imaging; injury mechanism; kinematics; rupture

[Available on 2019-06-01]

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