Results could shape future risk assessments and preventive strategies
One of the largest MRI-based studies comparing knee injuries between men and women reveals surprising differences in injury patterns based on gender and age, according to a study presented at RSNA 2025.
“In recent years, we've grown more interested in the differences in knee injuries between men and women,” said study co-author Jenifer Pitman, MD, assistant professor of radiology at Johns Hopkins Medical Institute in Baltimore, Maryland. “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.”
The study included 13,549 consecutive routine knee MRI exams performed between 2019 and 2024 at four outpatient radiology facilities affiliated with Johns Hopkins Hospital. The patients reported knee pain as their chief complaint. The researchers extracted the following features from radiology reports: tears in or injuries to the medial and lateral menisci, anterior cruciate ligament (ACL), posterior cruciate ligament, medial collateral ligament (MCL), lateral collateral ligament complex, and extensor mechanism or patellofemoral dislocation.
Analysis of the MRI reports revealed that specific injuries were observed more often in men compared to women, including ACL tears alone, ACL tear with medial meniscal tear or ACL tear with lateral meniscal tear.
“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,” said first author Ali Ghasemi, MD, postdoctoral research fellow at Johns Hopkins. “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.”
Dr. Pitman theorized the discrepancy between their research and previous studies may be due to broadening their focus beyond sports-related knee injuries. The Johns Hopkins researchers studied all patients with knee pain, regardless of age or cause of injury.
Men had a greater number of injuries overall.
The researchers also found that meniscal and MCL tears occurred more frequently in men under 40 and among older women.
“In younger patients, meniscal and MCL tears were more commonly seen in men, while in older patients, women had more of these types of tears than men, which was unexpected,” Dr. Ghasemi said.
The findings suggest that older women are more prone to injuries that lead to joint degeneration over time.
“Both men and women should take precautions to avoid high-impact injuries, especially during sports or physical activity and women, especially over 40, should pay attention to joint health and consider incorporating dedicated strength training to help protect their knees as they age,” Dr. Pitman said.
Recognizing the injury patterns may help radiologists and clinicians tailor imaging protocols, risk assessments and early intervention strategies to optimize patient outcomes.
“The pre-established notion that ACL tears are more common in younger women may not be the case 100% of the time,” Dr. Pitman said. “Radiologists can also expect to see more frequent meniscal pathology and arthritis in older women.”
The researchers are continuing their investigation into knee injury patterns by gender, analyzing demographic information and patient history to better understand trends in injury patterns.
Dr. Pitman said that athletes should consider working with a health professional to build balanced strength around the knee. She advises individuals—especially older patients—with knee pain to see their physician.
“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.”
Access the presentation, “Injury Patterns in Knee MRI: Is There a Gender Gap?” (R5A-SPMK-4) on demand at RSNA.org/MeetingCentral.
© 2025 RSNA.
The RSNA 2025 Daily Bulletin is the official publication of the 110th Scientific Assembly and Annual Meeting of the Radiological Society of North America. Published online Sunday, November 30 — Thursday, December 4.
The RSNA 2025 Daily Bulletin is owned and published by the Radiological Society of North America, Inc., 820 Jorie Blvd., Suite 200, Oak Brook, IL 60523.
