Sex-based differences in the anthropometric characteristics of the anterior cruciate ligament and its relation to intercondylar notch geometry - A cadaveric study

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 degrees 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.