Sex Differences In Posterior Cruciate Ligament Injuries

Abstract

BACKGROUND: Acute tears of the posterior cruciate ligament (PCL) have been more commonly reported in males than females, with males constituting between 60 and 84% of isolated and combined PCL injuries. However, there is a paucity of studies comparing the injury patterns between males and females. This study aimed to evaluate the differences in patterns of isolated PCL tears and associated injuries between males and females on magnetic resonance imaging (MRI). METHODS: Patients with PCL tears were identified through an institutional database. Two musculoskeletal imaging radiologists independently reviewed each case to describe injury patterns as well as the presence and severity of concurrent injuries. After applying exclusion criteria, male and female cohorts were compared for differences in injury patterns and the presence of concurrent injuries. Linear regression analysis was performed to assess for differences in injury patterns related to age. RESULTS: A search yielded 322 consecutive patients with PCL injury. After reviewing MRI exams and applying exclusion criteria, the cohorts included 79 patients (21 female and 58 male). Overall, females with PCL tears were more likely to sustain concurrent injuries to the posteromedial corner (71.4% vs. 25.9%, p < 0.001), anterior cruciate ligament (14.3% vs. 0%, p = 0.003), partial injury to the medial collateral ligament (23.8% vs. 6.9%, p = 0.037), and lateral meniscus (38.1% vs. 3.5%, p < 0.001). Comparison of patients with Grade 3 PCL injuries showed that this type of injury occurred at a greater age in females when compared to males (46.0±22.1 vs. 32.3±13.5, p=0.019). Regression analysis between age and injury pattern in patients with Grade 3 PCL tears revealed significant findings only in female patients, with a positive correlation between age and distal location of the PCL tear (R2 = 0.5937, p = 0.003). We also observed significant negative correlations between age and associated injuries of the ACL (R2 = 0.3623, p = 0.038), and lateral retinaculum (R2 = 0.3325, p = 0.049). CONCLUSION: We observed significant sex differences in the number and type of accompanying injuries with acute PCL injuries. Complete PCL injuries were found to occur at a greater age in females, with an age-dependent distribution of PCL injury location and number of accompanying injuries. Further studies are needed to understand the role of these findings in the treatment and outcomes after PCL injury.