Abstract
OBJECTIVE: Accurate sex estimation is a cornerstone in forensic and bioarchaeological investigations. While the pelvis and skull are traditionally used for this purpose, their absence due to taphonomic damage necessitates the use of alternative skeletal elements such as the patellar. This study evaluates the diagnostic potential of patellar morphometry for sex estimation in a Late Roman population. METHODS: The study analyzed 146 adult patellar (70 males, 76 females) recovered from the Karlığın Tepesi Necropolis 3(rd)-6(th) centuries AD in Malatya, Türkiye. Standard osteological methods were used to determine sex. Three patellar dimensions/length (PL), patellar width (PW), and patellar thickness (PT)-were measured. Intraobserver reliability was assessed via technical error of measurement (TEM), relative TEM (rTEM), and the reliability coefficient (R). Stepwise logistic regression and receiver operating characteristic analyses were conducted to identify the best predictors of sex. Area under the receiver operating characteristic (AUROC) values, cut-off thresholds, and effect sizes were reported. RESULTS: Statistically significant differences were found between males and females in PL (p=0.001), PW (p<0.001), and PT (p=0.003). The stepwise logistic regression model using PL and PT produced AUROC values of 0.906 in Step 1 and 0.920 in Step 2, with sensitivity and specificity ranging from 82.85% to 94.73%. All intraobserver reliability metrics (TEM, rTEM, R) indicated excellent measurement precision (R=1.000). CONCLUSIONS: Patellar morphometry demonstrates high diagnostic accuracy for sex estimation, particularly when multivariate models are applied. Despite the moderate discriminative power of patella thickness alone, its combination with other parameters enhances overall performance. The study provides the first population-specific discriminant model for sex estimation using the patella in an Anatolian archaeological sample. However, the skewed sex distribution and the possibility of post-depositional changes in ancient skeletal remains should be considered when interpreting results. Additionally, the population-specific nature of the archaeological sample and the lack of external validation on independent datasets limit the generalizability of the model to other contexts.