Gender Differences in the Impact of Anatomical Factors on Non- contact Anterior Cruciate Ligament Injuries: A Magnetic Resonance Study

Purpose: To identify MRI-detected anatomical risk factors for non-contact ACL injuries across genders. Methods We retrospectively analyzed 141 ACL-reconstructed patients (35 females, 106 males) and 142 controls (37 females, 105 males) from January 2020 to April 2022. Inclusion criteria were primary non-contact ACL injuries. We measured the tibial plateau slope, lateral femoral condyle index, Insall-Salvati index, and patellar tendon angle, using binary logistic regression for gender-specific risk evaluation. Results Increased lateral tibial plateau slope, reduced intercondylar notch width index, lateral femoral condyle index, and patellar tendon angle correlated with ACL injuries in both genders (P < 0.05). The Insall-Salvati index was a significant risk factor in females (P = 0.001) but not in males (P = 0.601). Conclusion Anatomical variations like the lateral tibial plateau slope and the Insall-Salvati index in females are significant ACL injury risk factors. These findings suggest the need for gender-specific prevention strategies.