Gender difference exists in sagittal curvature of the distal femoral condyle morphology for osteoarthritic population

  • Yong-Gon Koh
  • Ji-Hoon Nam
  • Hyun-Seok Chung
  • Hyo-Jeong Kim
  • Changhyun Baek
  • Kyoung-Tak KangEmail author



The aim of this study was to investigate gender-related differences in the sagittal curvature of the distal femoral condyle in the Korean osteoarthritic population


The sagittal curvatures of the distal femoral condyle of 1979 Korean patients (1680 female and 299 male) were evaluated using magnetic resonance imaging (MRI). MRI scans were obtained before total knee arthroplasty (TKA) in consecutive patients with end-stage osteoarthritis. The sagittal curvature of the distal medial and lateral femoral condyles was characterized with respect to the anterior, distal, and posterior circles. The diameter of each circle was measured. This study included 1873 varus and 106 valgus knees.


The anterior, distal, and posterior diameters were significantly greater in the male patients than in the female patients (P < 0.05). In the male patients, the lateral diameter was significantly greater than the medial diameter in the anterior and posterior circles (P < 0.05). However, in the female patients, the lateral diameter was significantly greater only in the anterior circle. In both genders, the medial diameter was significantly greater than the lateral diameter of the distal circle (P < 0.05). For both the varus and valgus knees, the lateral diameter was greater than the medial diameter in the anterior circle.


It has been concluded that the sagittal curvature of the femoral condyles in females is significantly different to their male counterparts. This study provides a reliable evaluation of the sagittal curvature of the femoral condyle in the Korean population. These gender-related differences in the sagittal curvature of the femoral condyle may require further investigation to determine surgical implications such as in TKA, and the existence of gender-related dimorphism in specific knee injuries and pathologies, such as ligament injuries and tibiofemoral problems.

Level of evidence



Korean patients Morphometry Femur condyle Sagittal curvature Total knee arthroplasty 


Compliance with ethical standards

Conflict of interest

The authors declare that they have no competing interests.


No funding has been received for this study.

Ethical approval

Ethical approval was obtained by the institutional review board at the Yonsei Sarang Hostpital.


  1. 1.
    Asseln M, Hanisch C, Schick F, Radermacher K (2018) Gender differences in knee morphology and the prospects for implant design in total knee replacement. Knee 25:545–558CrossRefGoogle Scholar
  2. 2.
    Biščević M, Hebibović M, Smrke D (2005) Variations of femoral condyle shape. Coll Antropol 29:409–414PubMedGoogle Scholar
  3. 3.
    Blaha JD, Mancinelli CA, Simons WH (2002) Using the transepicondylar axis to define the sagittal morphology of the distal part of the femur. J Bone Joint Surg Am 84-A Suppl 2:48–55.CrossRefGoogle Scholar
  4. 4.
    Conley S, Rosenberg A, Crowninshield R (2007) The female knee: anatomic variations. JAAOS 15:S31–S36PubMedGoogle Scholar
  5. 5.
    Freeman MA, Pinskerova V (2005) The movement of the normal tibio-femoral joint. J Biomech 38:197–208CrossRefGoogle Scholar
  6. 6.
    Greene KA (2007) Gender-specific design in total knee arthroplasty. J Arthroplasty 22:27–31CrossRefGoogle Scholar
  7. 7.
    Hoshino Y, Kuroda R, Nishizawa Y, Nakano N, Nagai K, Araki D et al (2018) Stress distribution is deviated around the aperture of the femoral tunnel in the anatomic anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 26:1145–1151PubMedGoogle Scholar
  8. 8.
    Howell SM, Howell SJ, Hull ML (2010) Assessment of the radii of the medial and lateral femoral condyles in varus and valgus knees with osteoarthritis. J Bone Joint Surg Am 92:98–104CrossRefGoogle Scholar
  9. 9.
    Kessler O, Durselen L, Banks S, Mannel H, Marin F (2007) Sagittal curvature of total knee replacements predicts in vivo kinematics. Clin Biomech (Bristol, Avon) 22:52–58CrossRefGoogle Scholar
  10. 10.
    Kettelkamp DB, Jacobs AW (1972) Tibiofemoral contact area–determination and implications. J Bone Joint Surg Am 54:349–356CrossRefGoogle Scholar
  11. 11.
    Koh YG, Nam JH, Chung HS, Kim HJ, Chun HJ, Kang KT (2018) Gender differences in morphology exist in posterior condylar offsets of the knee in Korean population. Knee Surg Sports Traumatol Arthrosc 27:1628–1634CrossRefGoogle Scholar
  12. 12.
    Koh YG, Nam JH, Chung HS, Lee HY, Kim HJ, Kim HJ et al (2019) Gender-related morphological differences in sulcus angle and condylar height for the femoral trochlea using magnetic resonance imaging. Knee Surg Sports Traumatol Arthrosc. CrossRefPubMedGoogle Scholar
  13. 13.
    Krych AJ, Johnson NR, Mohan R, Dahm DL, Levy BA, Stuart MJ (2018) Partial meniscectomy provides no benefit for symptomatic degenerative medial meniscus posterior root tears. Knee Surg Sports Traumatol Arthrosc 26:1117–1122PubMedGoogle Scholar
  14. 14.
    Lonner JH, Jasko JG, Thomas BS (2008) Anthropomorphic differences between the distal femora of men and women. Clin Orthop Relat Res 466:2724–2729CrossRefGoogle Scholar
  15. 15.
    Mahfouz MR, Merkl BC, Fatah EE, Booth R Jr, Argenson JN (2007) Automatic methods for characterization of sexual dimorphism of adult femora: distal femur. Comput Methods Biomech Biomed Engin 10:447–456CrossRefGoogle Scholar
  16. 16.
    Malek IA, Moorehead JD, Abiddin Z, Montgomery SC (2009) The correlation between femoral condyle radii and subject height. Clin Anat 22:517–522CrossRefGoogle Scholar
  17. 17.
    Matsuda S, Miura H, Nagamine R, Mawatari T, Tokunaga M, Nabeyama R et al (2004) Anatomical analysis of the femoral condyle in normal and osteoarthritic knees. J Orthop Res 22:104–109CrossRefGoogle Scholar
  18. 18.
    Merchant AC, Arendt EA, Dye SF, Fredericson M, Grelsamer RP, Leadbetter WB et al (2008) The female knee: anatomic variations and the female-specific total knee design. Clin Orthop Relat Res 466:3059–3065CrossRefGoogle Scholar
  19. 19.
    Minami T, Muneta T, Sekiya I, Watanabe T, Mochizuki T, Horie M et al (2018) Lateral meniscus posterior root tear contributes to anterolateral rotational instability and meniscus extrusion in anterior cruciate ligament-injured patients. Knee Surg Sports Traumatol Arthrosc 26:1174–1181PubMedGoogle Scholar
  20. 20.
    Monk AP, Choji K, O'Connor JJ, Goodfellow JW, Murray DW (2014) The shape of the distal femur: a geometrical study using MRI. Bone Joint J 96-b:1623–1630CrossRefGoogle Scholar
  21. 21.
    Nunley RM, Ellison BS, Zhu J, Ruh EL, Howell SM, Barrack RL (2012) Do patient-specific guides improve coronal alignment in total knee arthroplasty? Clin Orthop Relat Res 470:895–902CrossRefGoogle Scholar
  22. 22.
    Nuño N, Ahmed A (2003) Three-dimensional morphometry of the femoral condyles. Clin Biomech 18:924–932CrossRefGoogle Scholar
  23. 23.
    Rostlund T, Carlsson L, Albrektsson B, Albrektsson T (1989) Morphometrical studies of human femoral condyles. J Biomed Eng 11:442–448CrossRefGoogle Scholar
  24. 24.
    Siebold R, Axe J, Irrgang JJ, Li K, Tashman S, Fu FH (2010) A computerized analysis of femoral condyle radii in ACL intact and contralateral ACL reconstructed knees using 3D CT. Knee Surg Sports Traumatol Arthrosc 18:26–31CrossRefGoogle Scholar
  25. 25.
    Siston RA, Patel JJ, Goodman SB, Delp SL, Giori NJ (2005) The variability of femoral rotational alignment in total knee arthroplasty. J Bone Joint Surg Am 87:2276–2280PubMedGoogle Scholar
  26. 26.
    Siu D, Rudan J, Wevers HW, Griffiths P (1996) Femoral articular shape and geometry. A three-dimensional computerized analysis of the knee. J Arthroplasty 11:166–173CrossRefGoogle Scholar
  27. 27.
    Wang J, Yue B, Wang Y, Yan M, Zeng Y (2012) The 3D analysis of the sagittal curvature of the femoral trochlea in the Chinese population. Knee Surg Sports Traumatol Arthrosc 20:957–963CrossRefGoogle Scholar
  28. 28.
    Yue B, Varadarajan KM, Ai S, Tang T, Rubash HE, Li G (2011) Gender differences in the knees of Chinese population. Knee Surg Sports Traumatol Arthrosc 19:80–88CrossRefGoogle Scholar

Copyright information

© European Society of Sports Traumatology, Knee Surgery, Arthroscopy (ESSKA) 2019

Authors and Affiliations

  1. 1.Joint Reconstruction Center, Department of Orthopaedic SurgeryYonsei Sarang HospitalSeoulRepublic of Korea
  2. 2.Department of Mechanical EngineeringYonsei UniversitySeoulRepublic of Korea
  3. 3.Department of Sport and Healthy AgingKorea National Sport UniversitySeoulRepublic of Korea
  4. 4.Department of Mechanical and Control EngineeringThe Cyber University of KoreaSeoulRepublic of Korea

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