Gender differences in passive knee biomechanical properties in tibial rotation

Abstract

The anterior cruciate ligament (ACL) is the most commonly injured knee ligament with the highest incidence of injury in female athletes who participate in pivoting sports. Noncontact ACL injuries commonly occur with both internal and external tibial rotation. ACL impingement against the lateral wall of the intercondylar notch during tibial external rotation and abduction has been proposed as an injury mechanism, but few studies have evaluated in vivo gender-specific differences in laxity and stiffness in external and internal tibial rotations. The purpose of this study was to evaluate these differences. The knees of 10 male and 10 female healthy subjects were rotated between internal and external tibial rotation with the knee at 608 of flexion. Joint laxity, stiffness, and energy loss were compared between male and female subjects. Women had higher laxity (p ¼ 0.01), lower stiffness (p ¼ 0.038), and higher energy loss (p ¼ 0.008) in external tibial rotation than did men. The results suggest that women may be at greater risk of ACL injury resulting from impingement against the lateral wall of the intercondylar notch, which has been shown to be associated with external tibial rotation and abduction. ß

Objective measurements of static anterior and rotational knee laxity

“…As for rotational knee laxity, it has been shown that women have up to 40 % higher knee rotation compared to men [32]. This difference has been confirmed by several investigations [18,32,36,55].…”

“…The average side-to-side difference (SSD) between normal knees was 3.5° [31]. -Device by Park et al [32]: Park et al [32] presented the first motorized device to measure knee rotational laxity. The patient sits in a modified chair with the hips flexed at 85°and knees at 60°.…”

Does Severity or Specific Joint Laxity Influence Clinical Outcomes of Anterior Cruciate Ligament Reconstruction?

“…There is a paucity of published information concerning the relationship between knee hyperextension and stress concentration on the reconstructed ACL. However, it is possible, in patients with knee hyperextension, a reconstructed ACL may undergo more consistent severe stress than in those with normal knee laxity because of the absence of sufficiently taut ligaments and tendons that surround the lower extremity, stabilize the knee, and absorb ground reaction force [18,21]. Actually, hyperextension of the knee and physiologic joint laxity have been considered intrinsic factors contributing to traumatic ACL injuries [23,25].…”

Anterior Cruciate Ligament Injuries Identifiable for Pre-participation Imagiological Analysis: Risk Factors

“…Another study (Park et al 2008) compared ten healthy men and ten healthy women with the knee at 60 of flexion and established that women had increased external rotation laxity. Branch et al (2010a) also reported gender-related outcomes with implications on detection of risk factors for ACL injury.…”

“…Robotic systems have promised to overcome bias inherent to manual force application by means of comprising mechanical methods to apply load or torque in a controlled mode (magnitude, direction, rate) (Lob et al 2006;Park et al 2008;Tsai et al 2008;Robert et al 2009;Woo and Fisher 2009;Branch et al 2010a;Musahl et al 2010;Citak et al 2011;Mayr et al 2011). …”