The gender blind spot in personalized knee joint modeling: rethinking biomechanical models

Sexual dimorphism in knee anatomy, tissue properties, and biomechanics is well documented, but most musculoskeletal and finite element knee models remain sex-neutral. This review shows that few models account for sex-specific differences in geometry, material properties, or functional parameters, which may bias predictions of joint loading, stability, and tissue stress. Such limitations reduce reliability in surgical planning and injury-risk assessment. Feasible strategies include sex-aware scaling of muscle force, ligament properties, bone density-modulus relationships, and soft-tissue representation. Incorporating sex-specific factors can improve physiological realism and support more individualized clinical and biomechanical applications.