Department of Orthopaedic Surgery, Hanyang University Seoul Hospital, Seongdong-gu, Seoul, Korea.
Department of Orthopaedic Surgery, Hanyang University Guri Hospital, Guri, Gyeonggi-do, Korea.
PLoS One. 2019 Aug 1;14(8):e0219586. doi: 10.1371/journal.pone.0219586. eCollection 2019.
Non-contact anterior cruciate ligament (ACL) rupture is mostly caused by a pivot shift mechanism including valgus collapse and internal tibial rotation. In female athletes, the incidence of ACL rupture has been reported to be significantly higher than in their male counterparts. However, to date, there have been limited reports and controversy regarding sex differences underlying injury mechanisms of ACL and severity of injury. In this study, we hypothesized that 1) in patients with non-contact ACL rupture, the incidence and severity of pivot shift injury, which are determined by injury pattern on MRI, would be significantly higher in females, and 2) anatomical factors associated with pivot shift injury would be significantly associated with female sex. A total of 148 primary ACL ruptures (145 patients) caused by non-contact injury mechanisms were included in this study. Among them, 41 knees (41 patients) were female and 107 knees (104 patients) were male. The status of the osseous lesions, lateral and medial tibial slope, depth of the medial tibial plateau, collateral ligaments, and menisci were assessed by MRI and compared between sexes. The severity of osseous lesions at the lateral tibial plateau, lateral femoral condyle, medial tibial plateau, and medial femoral condyle were comparable between sexes. There were no significant differences between sexes in the location of tibial contusions (p = 0.21), femoral contusions (p = 0.23), or meniscus tears (p = 0.189). Lateral tibial slope was found to be significantly larger in females (8.95° vs. 6.82°; p<0.0001; odds ratio = 1.464), and medial tibial depth was significantly shallower in females (1.80mm vs. 2.41mm; p<0.0001; odds ratio = 0.145). In conclusion, females showed greater lateral tibial slope and shallower medial tibial depth compared to males, however it did not affect the sex differences in injury pattern.
非接触性前交叉韧带（ACL）断裂主要由包括外旋塌陷和胫骨内旋的枢轴转移机制引起。在女性运动员中，ACL 断裂的发生率明显高于男性。然而，迄今为止，关于 ACL 损伤机制和损伤严重程度的性别差异的报道有限，存在争议。在这项研究中，我们假设：1）在非接触性 ACL 断裂患者中，通过 MRI 确定的损伤模式，枢轴转移损伤的发生率和严重程度在女性中会显著更高，2）与枢轴转移损伤相关的解剖因素与女性性别显著相关。本研究共纳入 145 名患者的 148 例非接触性 ACL 断裂（145 名患者）。其中，41 例（41 名患者）为女性，107 例（104 名患者）为男性。通过 MRI 评估了骨病变、胫骨外侧和内侧倾斜度、胫骨内侧平台深度、侧副韧带和半月板的状态，并比较了性别间的差异。外侧胫骨平台、外侧股骨髁、胫骨内侧平台和内侧股骨髁的骨病变严重程度在性别间无显著差异。胫骨挫伤部位（p=0.21）、股骨挫伤部位（p=0.23）或半月板撕裂（p=0.189）在性别间无显著差异。女性的外侧胫骨倾斜度明显大于男性（8.95°vs.6.82°；p<0.0001；优势比=1.464），女性的胫骨内侧深度明显较浅（1.80mm vs.2.41mm；p<0.0001；优势比=0.145）。总之，与男性相比，女性的外侧胫骨倾斜度更大，胫骨内侧深度更浅，但这并未影响损伤模式的性别差异。
