Context: Sex-specific responses to steroid sex hormones have been suggested as a potential cause for the disparate anterior cruciate ligament (ACL) injury rates between male and female athletes. Type 1 collagen (T1C) and type 3 collagen (T3C) are crucial structural components that define the ligament's ability to withstand tensile loads. Messenger RNA (mRNA) is an important mediator of downstream collagen synthesis and remodeling, but the sex-specific mechanisms of collagen mRNA expression and ACL strength are unknown.Objective: To examine the influence of sex on T1C and T3C mRNA expression and mass-normalized stiffness and peak failure load in the ACLs of skeletally mature rats.Design: Observational study. Setting: Basic sciences and biomechanical testing laboratories.Patients or Other Participants: Nineteen 12-week-old male (n 5 9) and female (n 5 10) Sprague Dawley rats.Main Outcome Measure(s): We used real-time polymerase chain reaction to determine T1C and T3C mRNA expression and a hydraulic materials testing device to measure ACL stiffness and failure load. Nonparametric Wilcoxon rank sum tests were used to compare the groups.Results: Female rats had lower amounts of T3C mRNA expression and higher normalized ACL tangent stiffness and failure load than male rats.Conclusions: These findings suggest that sex-specific differences in T1C and T3C mRNA expression may play an important role in the downstream mechanical properties of the ACL.Key Words: knee injuries, women's health, real-time polymerase chain reaction Key Points N Compared with male rats, female rats demonstrated less type 3 collagen messenger RNA (mRNA) expression and greater normalized anterior cruciate ligament stiffness and load to failure.N Sex-specific differences in type 1 and type 3 collagen mRNA expression may influence the mechanical properties of the anterior cruciate ligament.T he anterior cruciate ligament (ACL) provides as much as 86% of the passive anterior restraint of the tibia on the femur. 1 As a result, ACL injuries often require surgical reconstruction and extensive rehabilitation to restore knee stability and ensure a full functional recovery. The long-term consequences of ACL injuries include accelerated knee joint degeneration; laxity; osteophyte formation; and type 2 collagen degradation, which may lead to early onset of osteoarthritis. [2][3][4][5] Most ACL injuries result from high tensile loads applied to the ligament during sudden changes of direction and jumping. 6 Whereas sex differences in landing and running biomechanics may place the ACL at risk, 7,8 the structure's ability to withstand those tensile loads likely depends upon several factors, including ligament size, rate of collagen remodeling, and collagen isoform. 9-11 Type 1 collagen (T1C) accounts for up to 87% 9,12 of the ligament's collagen content 9,12-14 and, along with type 3 collagen (T3C), acts to resist the loads applied to the ACL. 9,12 Type 3 collagen is also believed to play an important role in healing. [13][14][15] The extracellular matrix (ECM), ...