Bone bruise of the knee Histology and cryosections in 5 cases

Rangger, C.; Kathrein, A.; Freund, Martin C.; Klestil, Thomas; Kreczy, Alfons

doi:10.3109/17453679809000933

Cited by 187 publications

(87 citation statements)

References 15 publications

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“…[1][2][3][4][5][6] A traumatic BML is an ill-defined region of high-signal intensity within the subchondral bone on fluid-sensitive magnetic resonance (MR) images that is associated with compression injury, trabecular fracture, edema, necrosis, or bleeding in the marrow. [7][8][9] The location and size of a traumatic BML may be influenced by the mechanism of injury (ie, loading during injury) or the presence of concurrent injuries (eg, compression fracture, meniscal lesion, collateral ligament sprain). 4,[10][11][12][13][14][15] Therefore, the size and location of a traumatic BML within the first few weeks of an ACL injury may provide useful information about the initial injury.…”

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confidence: 99%

Posttraumatic Bone Marrow Lesion Volume and Knee Pain Within 4 Weeks After Anterior Cruciate Ligament Injury

Driban

Lohmander

Frobell

2017

Journal of Athletic Training

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Context: After an anterior cruciate ligament (ACL) injury, a majority of patients have a traumatic bone marrow lesion (BML, or bone bruise). The clinical relevance of posttraumatic lesions remains unclear.Objective: To explore the cross-sectional associations between traumatic BML volume and self-reported knee pain and symptoms among individuals within 4 weeks of ACL injury.Design: Cross-sectional exploratory analysis of a randomized clinical trial.Setting: Orthopaedic departments at 2 hospitals in Sweden. Patients or Other Participants: As part of a randomized trial (knee anterior cruciate ligament nonoperative versus operative treatment [KANON] study), 121 young active adults (74% men, age ¼ 26 6 5 years, height ¼ 1.8 6 0.1 m, weight ¼ 76 6 13 kg) with an ACL tear were studied.Main Outcome Measure(s): The BML volume in the proximal tibia and distal femur was segmented using magnetic resonance images obtained within 4 weeks of injury. A radiologist evaluated the presence of depression fractures on the images. Pain and symptoms of the injured knee (Knee Injury and Osteoarthritis Outcome Score [KOOS] pain and symptoms subscales) were obtained the same day as imaging. We used linear regression models to assess the associations.Results: Most knees had at least 1 BML (96%), and the majority (57%) had a depression fracture. Whole-knee BML volume was not related to knee pain for the entire cohort (b ¼ À0.09, P ¼ .25). Among those without a depression fracture, larger whole-knee BML volume was associated with increased knee pain (b ¼ -0.46, P ¼ .02), whereas no association was found for those with a depression fracture (b ¼ 0.0, P ¼ .96). Larger medial (b ¼ -0.48, P ¼ .02) but not lateral (b ¼ -0.03, P ¼ .77) tibiofemoral BML volume was associated with greater pain. We found no association between BML volume and knee symptoms.Conclusions: We confirmed the absence of relationships between whole-knee BML volume and pain and symptoms within 4 weeks of ACL injury. Our findings extend previous reports in identifying weak associations between larger BML volume in the medial compartment and greater pain and between BML volume and greater pain among those without a depression fracture.Key Words: knee injuries, magnetic resonance imaging, sprains, trauma, patient-reported outcomes Key PointsWithin 4 weeks of anterior cruciate ligament injury, total-knee bone marrow lesion volume and self-reported pain and symptoms were not associated. More pain was weakly related to greater medial compartment and greater total-knee bone marrow lesion volume and to greater bone marrow lesion volume among participants without a depression fracture.

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confidence: 99%

Posttraumatic Bone Marrow Lesion Volume and Knee Pain Within 4 Weeks After Anterior Cruciate Ligament Injury

Driban

Lohmander

Frobell

2017

Journal of Athletic Training

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“…It has been suggested that bone bruises represent a spectrum of radiographically occult bone injuries, ranging from bleeding, infarction and edema to microscopic compression fractures of cancellous bone (Kier et al 1991, Zeiss et al 1995. In a recent study, histology of bones with bone bruise revealed microfractures of cancellous bone, fragments of hyaline cartilage and edema as well as bleeding in the fatty marrow, between intact lamellar bone trabecules (Rangger et al 1998). However, the clinical importance of bone bruise is not clear.…”

Section: Discussionmentioning

confidence: 99%

Diagnosis of scaphoid fracture and dedicated extremity MRI

Bretlau¹,

Christensen

Edstrom³

et al. 1999

Acta Orthopaedica Scandinavica

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“…Histopathology and cryosections of human bone bruise injuries of the knee have shown microfractures of cancellous bone and weight-bearing trabeculae, edema and bleeding of fatty marrow which correlate with the lesions detected on MRI (Rangger et al 1998). …”

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confidence: 88%

Articular cartilage degeneration after acute subchondral bone damage An experimental study in dogs with histopathological grading

Lahm

Uhl

Erggelet

et al. 2004

Acta Orthopaedica Scandinavica

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Background Subchondral fracture patterns and bone bruises have been described and some clinical studies have shown alterations in the initially healthy cartilage after such lesions.Methods and results After having performed cadaver studies, we created an animal model to produce pure subchondral damage without affecting the articular cartilage, under MRI control. We used 12 beagle dogs. For quantification of different degrees of staining, we used a grading of the sections by means of the HHGS (Histological-Histochemical Grading System) or Mankin score.Results In all cases, FLASH 3D sequences revealed intact cartilage in MRI after impact. The best detection of subchondral fractures was achieved in fat-suppressed TIRM sequences. Image analysis based on the HHGS showed changes in 10 of 12 samples, with a high degree of significance 6 months after the initial trauma. Correlation analysis showed loss of the physiological distribution of proteoglycans and glycoproteins in the different zones of articular cartilage. Subcategories "Structure", "Cells" and "Safranin-O Staining" also showed high significance, and the category "Tidemark Integrity" showed a tendency. Interpretation Our findings indicate that acute subchondral fractures are a predictor of degenerative changes within 6 months. Modifications and supplements to rehabilitation might be needed in cases with accompanying subchondral lesions, e.g. in ACL tears.

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Bone bruise of the knee Histology and cryosections in 5 cases

Cited by 187 publications

References 15 publications

Posttraumatic Bone Marrow Lesion Volume and Knee Pain Within 4 Weeks After Anterior Cruciate Ligament Injury

Posttraumatic Bone Marrow Lesion Volume and Knee Pain Within 4 Weeks After Anterior Cruciate Ligament Injury

Diagnosis of scaphoid fracture and dedicated extremity MRI

Articular cartilage degeneration after acute subchondral bone damage An experimental study in dogs with histopathological grading

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