Sex Differences In Posterior Cruciate Ligament Injuries


  • Ruben Oganesyan, MD Center for Engineering in Medicine and Surgery, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
  • Mark A. Anderson, MD Division of Abdominal Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
  • F. Joseph Simeone, MD Division of Musculoskeletal Imaging and Intervention, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
  • Connie Y. Chang, MD Division of Musculoskeletal Imaging and Intervention, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
  • Miho J. Tanaka, MD Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA



posterior cruciate ligament, sex differences, PCL


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.


Sanders, T. L. et al. Incidence and long-term follow-up of isolated posterior cruciate ligament tears. Knee Surg Sports Traumatol Arthrosc 25, 3017–3023 (2017).

Fanelli, G. C. & Edson, C. J. Posterior cruciate ligament injuries in trauma patients: Part II. Arthroscopy 11, 526–529 (1995).

Owesen, C. et al. Epidemiology of surgically treated posterior cruciate ligament injuries in Scandinavia. Knee Surg Sports Traumatol Arthrosc 25, 2384–2391 (2017).

Longo, U. G. et al. Epidemiology of Posterior Cruciate Ligament Reconstructions in Italy: A 15-Year Study. JCM 10, 499 (2021).

Chen, G., Fu, W., Tang, X., Li, Q. & Li, J. [Clinical epidemiological analysis on posterior cruciate ligament injuries]. Zhongguo Gu Shang 28, 638–642 (2015).

Schulz, M. S., Russe, K., Weiler, A., Eichhorn, H. J. & Strobel, M. J. Epidemiology of posterior cruciate ligament injuries. Arch Orthop Trauma Surg 123, 186–191 (2003).

Huston, L. J., Greenfield, M. L. & Wojtys, E. M. Anterior cruciate ligament injuries in the female athlete. Potential risk factors. Clin Orthop Relat Res 50–63 (2000) doi:10.1097/00003086-200003000-00007.

Henry, J. C. & Kaeding, C. Neuromuscular differences between male and female athletes. Curr Womens Health Rep 1, 241–244 (2001).

Sutton, K. M. & Bullock, J. M. Anterior cruciate ligament rupture: differences between males and females. J Am Acad Orthop Surg 21, 41–50 (2013).

Fayad, L. M., Parellada, J. A., Parker, L. & Schweitzer, M. E. MR imaging of anterior cruciate ligament tears: is there a gender gap? Skeletal Radiol 32, 639–646 (2003).

Wind, W. M., Bergfeld, J. A. & Parker, R. D. Evaluation and treatment of posterior cruciate ligament injuries: revisited. Am J Sports Med 32, 1765–1775 (2004).

Fischer, S. P. et al. Accuracy of diagnoses from magnetic resonance imaging of the knee. A multi-center analysis of one thousand and fourteen patients. J Bone Joint Surg Am 73, 2–10 (1991).

Grover, J. S., Bassett, L. W., Gross, M. L., Seeger, L. L. & Finerman, G. A. Posterior cruciate ligament: MR imaging. Radiology 174, 527–530 (1990).

Gross, M. L., Grover, J. S., Bassett, L. W., Seeger, L. L. & Finerman, G. A. Magnetic resonance imaging of the posterior cruciate ligament. Clinical use to improve diagnostic accuracy. Am J Sports Med 20, 732–737 (1992).

Rodriguez, W., Vinson, E. N., Helms, C. & Toth, A. MRI appearance of posterior cruciate ligament tears. AJR. American journal of roentgenology (2008) doi:10.2214/AJR.07.2921.

Sheskin, D. Handbook of parametric and nonparametric statistical procedures. (Chapman & Hall/CRC, 2004).

Schlumberger, M. et al. Posterior cruciate ligament lesions are mainly present as combined lesions even in sports injuries. Knee Surg Sports Traumatol Arthrosc 28, 2091–2098 (2020).

Becker, E. H., Watson, J. D. & Dreese, J. C. Investigation of multiligamentous knee injury patterns with associated injuries presenting at a level I trauma center. J Orthop Trauma 27, 226–231 (2013).

Anderson, M. A., Simeone, F. J., Palmer, W. E. & Chang, C. Y. Acute posterior cruciate ligament injuries: effect of location, severity, and associated injuries on surgical management. Skeletal Radiol 47, 1523–1532 (2018).

LaPrade, C. M., Civitarese, D. M., Rasmussen, M. T. & LaPrade, R. F. Emerging Updates on the Posterior Cruciate Ligament: A Review of the Current Literature. Am J Sports Med 43, 3077–3092 (2015).

Kirkendall, D. T. & Garrett, W. E. The anterior cruciate ligament enigma. Injury mechanisms and prevention. Clin Orthop Relat Res 64–68 (2000) doi:10.1097/00003086-200003000-00008.

Majewski, M., Susanne, H. & Klaus, S. Epidemiology of athletic knee injuries: A 10-year study. Knee 13, 184–188 (2006).

Hsuan, H.-F. et al. Posterior cruciate ligament tears in Taiwan: an analysis of 140 surgically treated cases. Clinical Imaging 40, 856–860 (2016).

Ringler, M. D., Shotts, E. E., Collins, M. S. & Howe, B. M. Intra-articular pathology associated with isolated posterior cruciate ligament injury on MRI. Skeletal Radiol 45, 1695–1703 (2016).

Hamada, M. et al. Chondral injury associated with acute isolated posterior cruciate ligament injury. Arthroscopy 16, 59–63 (2000).

Sonin, A. H., Fitzgerald, S. W., Hoff, F. L., Friedman, H. & Bresler, M. E. MR imaging of the posterior cruciate ligament: normal, abnormal, and associated injury patterns. Radiographics 15, 551–561 (1995).






Original Research

How to Cite

Sex Differences In Posterior Cruciate Ligament Injuries. (2022). Journal of Women’s Sports Medicine, 2(1), 19-26.

Similar Articles

1-10 of 19

You may also start an advanced similarity search for this article.

Most read articles by the same author(s)