MRI study finds sex differences in knee injuries

Men appear to suffer more knee injuries from trauma, while older women are more prone to injury from joint degeneration over time, according to an MRI study to be presented at RSNA 2025. 

The finding is from an analysis of 13,549 MRI reports from four outpatient radiology facilities affiliated with Johns Hopkins Hospital in Baltimore, MD, noted lead author Ali Ghasemi, MD, and co-author Jenifer Pitman, MD, in an RSNA release. 

“In recent years, we've grown more interested in the differences in knee injuries between men and women,” Pitman said. “The majority of past research has focused on men, but as we expand our focus to include women, the more we see that they have different risk profiles and are prone to different injuries.” 

In the study, the researchers extracted demographic data including age and gender and the presence or absence of the following features from the reports: medial meniscal (MM) tear, lateral meniscal (LM) tear, anterior cruciate ligament (ACL) tear, posterior cruciate ligament (PCL) tear, medial collateral ligament (MCL) tear, lateral collateral ligament complex (LCL) tear, extensor mechanism tear, and patellofemoral dislocation.

Arrows show a complete anterior cruciate ligament rupture in an 18-year-old male who had a knee injury while playing football.RSNAAccording to the analysis, there were more ACL tears alone, ACL tears with MM tears, and ACL tears with LM tears in men than in women, except in individuals over 60 years old. Meanwhile, men under 41 had more MM tears and LM tears alone than women, but women over 41 had more of these injuries, the researchers reported. 

“We saw more ACL tears in men, especially in the 20- to 40-year-old age group, which is contrary to what’s been reported in the literature,” Ghasemi said. “Prior studies focused on sports-related injuries have shown that young women athletes have increased rates of and a greater risk for ACL tears. However, our results show a significantly higher prevalence of ACL injuries in male patients across all age groups.” 

Ultimately, the findings suggest that older women are more prone to injuries that lead to joint degeneration over time, according to Pitman. She said that recognizing such injury patterns may help radiologists and clinicians tailor imaging protocols, risk assessments, and early intervention strategies to optimize patient outcomes.   

Finally, Pitman noted that of the 13,549 MRI reports analyzed in the study, knee pain was the chief complaint. 

“If you’re having knee pain, don’t just brush it off or attribute it to old age,” she said. “We’ve seen higher rates of meniscal tears, in particular, in women 40 years and older.”