Gender-Related Anatomic Differences of the Middle Genicular Artery: A Comparative Cadaveric Analysis Authors: JA Tuck, S Habusta, M Bradbury Affiliation: Lake Erie College of Osteopathic Medicine, Erie, PA Introduction: To study and compare the course, length and width of the major blood supply to the anterior cruciate ligament, the middle genicular artery, in male and female cadavers and to discern if such differences exist that may help explain the increased incidence of anterior cruciate ligament injury in the female population. Knowledge of this vascular anatomical difference could be used for risk stratification regarding sports participation. We speculated that the average length and width of the female middle genicular arteries will be less than that of the male arteries, while the average course of the vessel will be similar. Methods: After obtaining a waiver from our Institutional Review Board, the popliteal fossae of 19 cadavers, (10 females and 9 males), were carefully dissected. Through gross dissection, the course, length and width of the middle genicular artery was measured and compared. Each dissection was photodocumented. Cadaver height was also measured and recorded. Results were finally compared between male and female cadavers to ascertain if differences in middle genicular artery length, width or course existed. Results: Statistically significant differences were found between males and females in the widths of the right middle genicular artery, and between the lengths and widths of the left middle genicular artery. There was a positive correlation between an individual’s height and middle genicular artery size. As the height of the anatomic specimens increased, so too did vessel length and width, regardless of gender, (Graph 1). Vessel course remained constant between the genders. The middle genicular artery arose from the anterior aspect of the popliteal artery within 5 cm of the joint line in the popliteal fossa. The artery traversed inferiorly, anterior to the popliteal artery, penetrating the posteromedial aspect of the joint capsule just lateral to the medial femoral condyle. The vessel finally traversed down anteriorly between the anterior and posterior cruciate ligaments, entering the substance of the anterior cruciate ligament posteriorly. Discussion: If gender-related differences do exist in the blood supply to the anterior cruciate ligament, this could explain the disparity of injuries of this ligament between males and females. Although significant differences existed between male and female middle genicular artery length and width, these differences appeared to be more a function of height than of gender. When corrected for height, no significant gender-specific vascular differences existed in the course, length or width of the middle genicular artery. The average difference in height between males and females, (thus difference in middle genicular artery size), may play a role in the increased incidence of anterior cruciate ligament injuries among the female athlete population. Height and Left MGA Measurements 5 4.5 Llength R² = 0.2958 4 3.5 Lwidth 3 R² = 2.5 0.2333 Linear (Llength) 2 MGA (W in mm / L in cm) MGA (W in mm 1.5 Linear (Lwidth) 1 55 60 65 70 75 Height (in) Graph 1: Regardless of gender, as height (in) increased, so too did left middle genicular artery, (MGA), length (cm) and width (mm). Refs: 1. Alford JW, Bach BR, J Musculoskel Med, 2004 2. Al-Motabagani MAH, J Anat Soc India, 2002 3. Anderson AF. et al., Am J Sports Med, 2001 4. Arendt E, Dick R, Am J Sports Med, 1995 5. Arnoczky SP, Clin Orthop, 1983 6. Arnoczky SP, Orthop Clin North Am, 1985 7. Chakravarty S. et al, J Anat Soc India, 2003 8. Conley S. et al, J Am Acad Orthop Surg, 2007 9. Fayad LM. et al, J Magn Reson Imaging, 2008 10. Giugliano DN, Solomon JL, Phys Med Rehab Clin North A, 2007 11. Huston LJ. et al, Clin Orthop, 2000 12. Ireland ML, J Athl Train, 1999 13. Kohn D. et al, Arch Orthop Trauma Surg, 1995 14. Levin RI, New Eng J Med, 2005 15. Lohmander LS. et al, Arthritis Rheum, 2004 16. McDowell MA, Nat Cen for Health Stat, 2008 17. O’Connor MI, Orthop Clin North Am, 2006 18. Parker BA, J Appl Physiol, 2007 19. Petersen W, Hansen U, J Orthop Sci, 1997 20. Salaria H, Atkinson R, J Orthop Surg, 2008 21. Scapinelli R, Clin Anatomy, 1997 22. Schulz UG, Rothwell PM, Stroke, 2001 23. Shim SS, Leung G, Clin Orthop, 1986 24. Shultz SJ. et al, J Orthop Sports Phys Ther, 2008 25. Thomas J, U.S. Dept. of State, 2008 26. Toy BJ. et al, J. Athl Train, 1995 .