Gender Disparity between Absolute versus Relative Size of Condylar Chondral Defects: An MRI Analysis

Abstract

Surgical repair of articular cartilage defects in the knee currently utilizes surgical algorithms based on absolute defect size. These algorithms, which have not been validated, are currently utilized not only by surgeons but also by insurance carriers for justification of reimbursement policy. However, current algorithms do not account for morphological differences between individual patients and defect size relative to condylar dimension. We hypothesized that a significant difference in relative defect size compared with condylar dimension may exist between individuals. A 3T magnetic resonance imaging from 220 skeletally mature patients, 110 males and 110 females, were analyzed. Exclusion criteria included degenerative arthritis, anatomical defects, poor image quality, and genetic abnormalities such as dwarfism. Utilizing a radiological curved measurement probe, the femoral condylar articular width was obtained for both the medial and lateral condyles. The mean condylar width from a reproducible anatomic location representing the maximal condylar dimension was measured. Statistical analysis was performed using a two-sample -test. The lateral condyle articular cartilage width (mm) for males and females was 31.62 ± 3.54 and 26.53 ± 3.70, respectively ( < 0.0001). The medical condyle articular cartilage width was 27.26 ± 4.42 and 23.05 ± 4.11 ( < 0.00001). There was a width variation up to 22.66 mm between male patients and 22.10 mm between female patients. Differences up to 28.26 mm were found between males and females. A condylar defect measuring 10 mm represents as little as 24.29% of a condyle in some males versus as much as 77.46% in smaller females. Existing surgical algorithms for condylar chondral defects apply absolute size to patients regardless of individual condylar variations. Our study suggests the relative sizes of the defect vary significantly from male to female patients as well as within the same gender. Future studies may investigate clinical outcomes utilizing surgical algorithms that take into account these differences.

Analysis of Defect Size and Ratio to Condylar Size With Respect to Outcomes After Isolated Osteochondral Allograft Transplantation

“…14,33,43,59 Additionally, morphologic differences existed among patients of various races. 38 Berman et al 5 verified these differences through an MRI study of 220 skeletally mature patients (110 males and 110 females) and demonstrated significant relative defect size differences among patients, as a chondral defect measuring 10 mm may represent as little as 24.29% of a condyle in some males as opposed to 77.46% in smaller females.…”

“…Additionally, current treatment algorithms utilize only the absolute defect size and do not account for the size and morphological differences of the affected joint among patients. Berman et al 5 recently demonstrated that there was up to a 3-cm condylar width difference and as much as a 53.17% difference in relative defect size for a 10-mm defect between sexes. When this is taken into consideration of several previous studies showing that larger chondral defect sizes result in worsening knee biomechanics, elevated adjacent rim peak forces, and even increased local chondral catabolic activity, relative defect size may be a valuable measure to determine potential treatment options.…”

Are there gender-specific differences in hip and knee cartilage composition and degeneration? A systematic literature review

“… Were the results well-described? Quality summary Kaspiris et al [ 14 ] ✔ ✔ ✔ ✔ ✔ ✔ ✗ ✔ ✔ 2 Berman et al [ 20 ] ✔ ✔ ✔ ✔ ✔ ✔ ✗ ✗ ✔ 2 Nemeth 2017 ✔ ✔ ✔ ✔ ✔ ✔ ✗ ✔ ✔ 2 Antony et al [ 21 ] ✔ ✔ ✔ ✔ ✔ ✔ ✔ ✔ ✔ 2 Kumar et al [ 16 ] ✔ ✔ ✔ ✔ ✔ ✔ ✗ ✔ ✗ 2 Pachowsky et al [ 23 ] ✔ ✔ ✔ ✔ ✔ …”

“…Moreover, Berman et al [ 20 ] discovered gender-based morphological variations in the architecture of femoral condyles, even in patients with the same height. A stratified study of patient height and medial/lateral condylar width revealed a significant difference in condylar widths for each stratum.…”

Gender Disparity between Donor Sites of the Trochlea Used for Autologous Osteoarticular Transfer: An MRI Analysis

“…In agreement with the measurement and analysis protocol previously described, the primary measurements of interest in this study were the mean width of the medial and lateral femoral trochlea in males versus females. 24 Secondary values derived from these measurements that were analyzed include the maximum difference in trochlear width between males and females, the range of trochlear widths among the entire sample, the proportion of total donor cartilage a hypothetical graft plug would represent, and the mean height and weight for male and female patients.…”