Dimitriou Dimitris, Wang Zhongzheng, Zou Diyang, Helmy Naeder, Tsai Tsung-Yuan
Department of Orthopedics, Bürgerspital Solothurn, Solothurn, Switzerland.
Orthop J Sports Med. 2020 Nov 30;8(11):2325967120964477. doi: 10.1177/2325967120964477. eCollection 2020 Nov.
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.
Cross-sectional study; Level of evidence, 3.
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.
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 ( < .05) and 4.0% more proximal ( < .05) in men and 13.0% more posterior ( < .05) and 5.5% more proximal ( < .05) to the flexion-extension axis of the knee in women.
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.
女性是前交叉韧带（ACL）损伤的独立危险因素，因为女性运动员ACL断裂的发生率比男性运动员高4至6倍。ACL附着位置作为女性ACL断裂率增加的潜在危险因素，在文献中从未有过报道。
目的/假设：本研究的目的是调查有或没有ACL断裂的女性和男性患者中ACL束附着的三维局部解剖结构，并确定潜在的性别相关差异。我们假设，在ACL完整和断裂状态下，男性和女性之间的ACL附着位置会有显著差异。
横断面研究；证据等级，3级。
使用90例ACL断裂患者（55例男性，35例女性）和90例匹配对照（55例男性，35例女性）的膝关节磁共振图像，这些对照为非接触性膝关节损伤但没有ACL断裂，用于创建股骨和胫骨的三维模型。在每个模型上勾勒出ACL束的起点和止点，并使用解剖坐标系测量其位置。采用双向方差分析比较有或没有ACL断裂的男性和女性患者之间的ACL附着位置。
在ACL附着位置（股骨起点和胫骨止点）方面，女性和男性参与者之间未发现显著差异。与ACL完整的参与者相比，ACL断裂的患者表现出显著不同的ACL起点，男性平均向后多8.9%（P<0.05）、向上多4.0%（P<0.05），女性平均向后多13.0%（P<0.05）、向上多5.5%（P<0.05），相对于膝关节屈伸轴。
与男性运动员相比，不应将ACL附着位置视为女性ACL断裂率增加的危险因素。然而，无论性别如何，股骨ACL起点更靠后和更靠上的位置可能是ACL断裂的一个诱发因素。
