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Tibiofemoral joint congruence is lower in females with ACL injuries than males with ACL injuries

  • Knee
  • Published:
Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

Previous research has demonstrated that women have a higher risk of anterior cruciate ligament (ACL) injury than men. Tibiofemoral articular geometry may play a role in the occurrence of ACL tears. The purpose of this study was to analyze the gender-specific geometric characteristics differences in tibiofemoral morphology in ACL-deficient patients.

Methods

Medial tibial slope (MTS), lateral tibial slope (LTS), medial tibial plateau concavity, medial and lateral femoral condyle convexity, and lateral plateau convexity were analyzed in 276 patients with complete ACL injuries (138 females and 138 males). Two blinded observers measured the anatomical parameters of tibiofemoral geometry with use of multiplanar CT scans. Intra- and inter-rater reliabilities were assessed and comparisons between anatomic measures were made between male and female patients.

Results

The average ICC for all measurements was 0.90 (range 0.83–0.97) indicating good reliability. Male ACL injured patients demonstrated significantly greater LTS (10.5° ± 2.8) than female patients (9.6° ± 3.5°; p < 0.05). No gender difference in MTS was found (n.s.). Medial and lateral femoral condyle convexity and medial tibial plateau concavity were greater in males than females (all p < 0.05). Lateral tibial plateau convexity in females was higher than in males (p < 0.001). The medial and lateral compartments were found to be more incongruent in females than males (p < 0.01 and p < 0.001, respectively).

Conclusions

Female patients were noted to have more incongruent medial and lateral compartments than male patients. These gender-specific differences in joint morphology may contribute to graft tear risk and outcomes of ACL reconstruction; however, comparative clinical studies are needed to confirm this possibility.

Level of evidence

3.

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Abbreviations

ACL:

Anterior cruciate ligament

MTS:

Medial tibial slope

LTS:

Lateral tibial slope

CT:

Computerized tomography

ICC:

Intra-class correlation

MRI:

Magnetic resonance imaging

IKDC:

International knee documentation committee

PACS:

Picture archiving and communications system

FOV:

Field of view

DICOM:

Digital imaging and communications in medicine

MPR:

Multi-planar reconstruction

PTAA:

Proximal tibial anatomic axis

MPL:

Medial tibial plateau length

LPL:

Lateral tibial plateau length

MCL:

Medial femoral condyle length

LCL:

Lateral femoral condyle length

MCR:

Medial compartment ratio

LCR:

Lateral compartment ratio

MCH:

Medial femoral condyle height

LCH:

Lateral femoral condyle height

MPH:

Medial tibial plateau height

LPH:

Lateral tibial plateau height

MCC:

Medial condyle convexity

LCC:

Lateral condyle convexity

MPC:

Medial plateau concavity

LPC:

Lateral plateau convexity

MC:

Medial femorotibial congruency

LC:

Lateral femorotibial congruency

SD:

Standard deviation

mm:

Millimeters

CI:

Confidence interval

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Author information

Authors and Affiliations

  1. Department of Orthopaedic Surgery, Groupement Hospitalier Nord, Univ Lyon–University Claude Bernard Lyon 1, 103 Grande Rue de la Croix Rousse, 69004, Lyon, France

    Antoine Schneider, Sebastien Lustig, Philippe Neyret & Elvire Servien

  2. Radiology Department, Creatis Laboratory, Hospices Civils de Lyon, University Claude Bernard Lyon 1, Lyon, France

    Salim Si-Mohamed

  3. OSU Sports Medicine, 2050 Kenny Rd, Ste 3100, Columbus, OH, 43221, USA

    Robert A. Magnussen

  4. Laboratoire de Biomécanique et Mécanique des Chocs (Université Lyon 1/IFSTTAR) LBMC, UMR_T9406, Lyon, France

    Sebastien Lustig

  5. EA 7424–Inter-University Laboratory of Human Movement Science, Lyon, France

    Elvire Servien

Authors
  1. Antoine Schneider
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  2. Salim Si-Mohamed
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  3. Robert A. Magnussen
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  4. Sebastien Lustig
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  5. Philippe Neyret
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Contributions

AS participated in the design of the study, acquisition and interpretation of the data. SS helped to evaluate the inter-observer reliability. RM helped to translate the manuscript in English and revising it critically for important intellectual content. SL have given final approval of the version to be published. PN have given final approval of the version to be published. ES have made substantial contribution to conception, design of the study and have given final approval of the version to be published.

Corresponding author

Correspondence to Antoine Schneider.

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Funding

No external source of funding was used.

Conflict of interest

AS, SS, RM, SL, PN and ES: no competing interests.

Ethical approval

This study was approved by our institutional review board.

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Patients gave informed consent that data would be published.

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Schneider, A., Si-Mohamed, S., Magnussen, R.A. et al. Tibiofemoral joint congruence is lower in females with ACL injuries than males with ACL injuries. Knee Surg Sports Traumatol Arthrosc 26, 1375–1383 (2018). https://doi.org/10.1007/s00167-017-4756-7

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