Differences in Knee Morphology According to Age and Gender: An Evaluation Based on MRI

Abstract

Objective: The knee joint is an articulation exposed to excessive load during daily activities at all ages. There are ongoing discussions about the suitability of the currently used standard implants for this joint in terms of age and gender. In our study, we aimed to determine the possible morphometric differences of the bone structures involved in this joint according to age groups and gender. Materials and Methods: The magnetic resonance (MR) images of the knee joints of 212 individuals (106 males, 106 females) aged between 18 and 69 years were retrospectively analyzed, and morphometric data were obtained from these images. Patients were separated according to age groups and gender, and the obtained data were analyzed. Results: In the study, the measurement values related to the morphology of the femur, tibia, patella, and patellar ligament were generally higher in males than in females (p<0.05). When evaluated separately by sex, statistically significant differences were observed in certain morphometric parameters among the age groups (p<0.05). Conclusions: Our study has shown that human knee anatomy varies significantly according to age and gender. These differences should be considered in the design of individualized and gender-specific knee joint prostheses.

Keywords

• Gender
• knee
• knee joint
• morphometry
• MRI

Yaş ve Cinsiyete Göre Diz Morfolojisindeki Farklılıklar: MRG Üzerinden Yapılan Bir Değerlendirme

Öz

Amaç: Diz eklemi günlük aktiviteler sırasında her yaşta aşırı yüke maruz kalan bir eklemdir. Günümüzde bu ekleme uygulanan mevcut standart implantların yaşa ve cinsiyete uygunluğu ile ilgili tartışmalar devam etmektedir. Biz de çalışmamızda bu ekleme katılan kemik yapıların yaş gruplarına ve cinsiyete göre olası morfometrik farklılıklarının belirlenmesini amaçladık. Materyal ve Metot: 18-69 yaş aralığındaki 212 kişiye (106 erkek, 106 kadın) ait diz manyetik rezonans (MR) görüntüleri retrospektif olarak incelenerek bu görüntüler üzerinden morfometrik veriler elde edildi. Hastalar yaş gruplarına ve cinsiyete göre ayrılarak elde edilen veriler analiz edildi. Bulgular: Çalışmada, femur, tibia, patella ve patellar ligamentin morfolojisi ile ilgili ölçüm değerleri genel olarak erkeklerde kadınlardan daha yüksek bulundu (p<0,05). Cinsiyetler ayrı olarak değerlendirildiğinde, yaş grupları arasında bazı morfometrik parametrelerde istatistiksel olarak anlamlı farklılıklar tespit edildi (p<0,05). Sonuç: Çalışmamızda insan diz anatomisinin yaşa ve cinsiyete göre önemli farklılıklar içerdiği gösterilmiştir. Bu farklılıklar bireysel ve cinsiyete özgü diz eklemi protezi tasarımı çalışmalarında dikkate alınmalıdır.

Anahtar Kelimeler

• Cinsiyet
• diz
• diz eklemi
• morfometri
• MRG

Kaynakça

1. Şahin B. Temel İnsan Anatomisi Hareket Sistemi. 1. Cilt. Ankara: Ankara Nobel Tıp Kitabevi; 2025.
2. Chien A, Weaver JS, Kinne E, Omar I. Magnetic resonance imaging of the knee. Pol J Radiol. 2020;85:509-531. doi:10.5114/pjr.2020.99415
3. White DT, Folkens PA. The human bone manual. U. S. A.: Elsevier Academic Press; 2005. Sharma S, Gupta R, Jain SK, Rastogi R. Gender-wise Description of Morphometric Measures of Knee Joint
4. Based on Magnetic Resonance Imaging Scan: A Descriptive Cross-sectional Study. J Anat Soc India. 2024;73(3):237-248. doi:10.4103/jasi.jasi_69_24
5. Kim DI, Kwak DS, Han SH. Sex determination using discriminant analysis of the medial and lateral condyles of the femur in Koreans. Forensic Sci Int. 2013;233(1-3):121-125. doi:10.1016/j.forsciint.2013.08.028
6. Yue B, Varadarajan KM, Ai S, Tang T, Rubash HE, Li G. Differences of knee anthropometry between Chinese and white men and women. J Arthroplasty. 2011;26(1):124-130. doi:10.1016/j.arth.2009.11.020
7. Nahir M, Şahin B. Can graphic tablets facilitate expedited and more accurate volume measurements? J. Exp. Clin. Med. 2024;41(2):233-238.
8. Prithishkumar IJ, Paul H, Punekar, Abdul S, Lakshmanan J, Albelooshi A. A Comparative Study of Morphometric Parameters of Knee Using Magnetic Resonance Imaging in Different Population Groups. National Journal of Clinical Anatomy. 2024;13(1):4-11. doi:10.4103/NJCA.NJCA_4_24

9. Kwak DS, Surendran S, Pengatteeri YH, et al. Morphometry of the proximal tibia to design the tibial component of total knee arthroplasty for the Korean population. Knee. 2007;14(4):295-300. doi:10.1016/j.knee.2007.05.004
10. Chang TW, Huang CH, McClean CJ, Lai YS, Lu YC, Cheng CK. Morphometrical measurement of resected surface of medial and lateral proximal tibia for Chinese population. Knee Surg Sports Traumatol Arthrosc. 2012;20(9):1730-1735. doi:10.1007/s00167-011-1749-9
11. Günaydın E, Duran D. Femoral Trochlea Morphology: A Gender and Bilateral Comparative Study Using MRI. Balıkesir Medical Journal. 2019:3(3):147-156. doi:10.33716/bmedj.612782
12. Hsu CP, Lee PY, Wei HW, et al. Gender differences in femoral trochlea morphology. Knee Surg Sports Traumatol Arthrosc. 2021;29(2):563-572. doi:10.1007/s00167-020-05944-3
13. Hasler RM, Gal I, Biedert RM. Landmarks of the normal adult human trochlea based on axial MRI measurements: a cross-sectional study. Knee Surg Sports Traumatol Arthrosc. 2014;22(10):2372-2376. doi:10.1007/s00167-014-3152-9
14. Yanagisawa K, Watanabe T, Koga H, Sekiya I, Muneta T, Jinno T. Do the distal femur and the proximal tibia have narrower aspect ratios in smaller knees? A morphological analysis of osteoarthritic knees in the Japanese population using computed tomography. Knee. 2021;33:84-92. doi:10.1016/j.knee.2021.08.023
15. Kodama Y, Furumatsu T, Tamura M, et al. Steep posterior slope of the medial tibial plateau and anterior cruciate ligament degeneration contribute to medial meniscus posterior root tears in young patients. Knee Surg Sports Traumatol Arthrosc. 2023;31(1):279-285. Doi:10.1007/s00167-022-07095-z
16. Weinberg DS, Williamson DF, Gebhart JJ, Knapik DM, Voos JE. Differences in Medial and Lateral Posterior Tibial Slope: An Osteological Review of 1090 Tibiae Comparing Age, Sex, and Race. Am J Sports Med. 2017;45(1):106-113. doi:10.1177/0363546516662449
17. Nguyen TT, Le HDT, Hoang NT, Le TB, Ha TH. Morphologic Evaluation of the Patella: The Impact of Gender and Age. Orthop Res Rev. 2024;16:59-66. doi:10.2147/ORR.S444533
18. Meier MP, Hochrein Y, Seitz MT, et al. MRI analysis of the physiological patellofemoral joint morphology of adult knees. Skeletal Radiol. 2025;54:1001–1009. doi:10.1007/s00256-024-04794-1
19. Le Hoang Di T, Hoang Ngoc T, Ngo DHA, et al. Evaluation of the Insall-Salvati Ratio Among the Vietnamese Population: Application for Diagnosis of Patellar Malalignment. Orthop Res Rev. 2021;13:57-61. doi:10.2147/orr.s306316
20. Hong HT, Koh YG, Nam JH, Kim PS, Kwak YH, Kang KT. Gender differences in patellar positions among the Korean population. Applied Sciences. 2020;10(24):8842. doi:10.3390/app10248842
21. Pontoh LA, Dilogo IH, Rahyussalim AJ, Widodo W, Pandapotan Hutapea RE, Fiolin J. Evaluation of patellar dimension and Bristol Index in Asian population: An MRI study. Ann Med Surg (Lond). 2021;72:103072. doi:10.1016/j.amsu.2021.103072
22. Jain R, Kalia RB, Das L. Anthropometric measurements of patella and its clinical implications. Eur J Orthop Surg Traumatol. 2019;29(8):1765-1769. doi:10.1007/s00590-019-02490-8