Bone signal abnormalities in the posterolateral tibia and lateral femoral condyle in complete tears of the anterior cruciate ligament: a specific sign?

Abstract

Thirty-two patients with acute, complete tears of the anterior cruciate ligament (ACL) proved at surgery underwent examination with magnetic resonance (MR) imaging. Bone impaction sites were present in the posterolateral tibial plateau in 30 patients (94%) and in the lateral femoral condyle (LFC) in 29 patients (91%). The bone abnormalities had low signal intensity on T1-weighted images and high signal intensity on T2-weighted images when compared with the signal intensity of normal marrow. It is assumed that the bone changes occur during injury when the LFC impacts into the posterior tibia, either during the initial rotary subluxation or as the LFC recoils to return to anatomic alignment. Only one of six partial ACL tears had a bone signal change. In patients with acute knee injury, bone impaction sites in the posterolateral tibia and the LFC suggest that a complete ACL tear is present.

Bone bruise of the knee Histology and cryosections in 5 cases

“…Vellet et al (1991) found that rotation of the tibia and femur relative to each other, as well as deceleration, and valgus force had occurred in two thirds of 83 patients with bone bruise injuries. Others think that the lesion is caused by traumas and forces similar to those which cause an anterior cruciate ligament rupture (Murphy et al 1992, Stallenberg et al 1993, Stein et al 1995, Zeiss et al 1995. During anterior translation, the posterior aspect of the lateral tibial plateau impinges on the lateral femoral condyle or else a violent reduction of a pivot-shift event might occur.…”

“…During anterior translation, the posterior aspect of the lateral tibial plateau impinges on the lateral femoral condyle or else a violent reduction of a pivot-shift event might occur. It has been suggested that, with the knee less flexed, the osseous contusion appears more anteriorly on the lateral femoral condyle, and moves posteriorly with increased flexion (Murphy et al 1992, Stein et al 1995. In our study, we could not determine the mechanism of injury.…”

“…The articular cartilage was normal. Since then, bone bruise injuries have been reported frequently in the knee (Mink and Deutsch 1989, Vellet et al 1991, Murphy et al 1992, Stallenberg et al 1993, Stein et al 1995, Zeiss et al 1995, Rangger et al 1996 and also in the wrist, the calcaneus, the foot and ankle, and in the hip (Kier et al 1991, Laorr et al 1995, Shih et al 1995, Soudry and Mannting 1995.…”

Bone marrow edema-like lesions (BMELs) are associated with higher T1ρ and T2 values of cartilage in anterior cruciate ligament (ACL)-reconstructed knees: a longitudinal study

“…Bone marrow edema-like lesions (BMELs), which appear as patchy high signal abnormalities on fat-suppressed T 2 weighted MR images, are observed in on average 70% of patients with acute ACL injuries (7). During ACL rupture, the anterior lateral femur impacts on the posterior lateral tibia which leaves a "footprint" on the femur and tibia, also known as "kissing lesions" (8). The presence of BMELs was reported to correlate with meniscal tears, collateral ligament tears and large volumes of BMEL were associated with cortical fractures (7,9,10), suggesting BMEL as a potential indicator of injury severity.…”

Knee Frontal-Plane Biomechanics in Adults With or Without Bone Marrow Edema-Like Lesions After Anterior Cruciate Ligament Injury

“…1 These BBs are most common in the lateral tibiofemoral compartment. 2 Whereas the clinical importance of these BBs remains unclear, they have been shown to increase symptoms 3 and disability [3][4][5] after injury. Specifically, Johnson et al 3 demonstrated that, compared with individuals with an isolated ACL injury, patients with lateral BBs had larger and longer-lasting knee-joint effusions, increased pain, prolonged restoration of normal knee range of motion, and delayed return of nonantalgic gait without the use of assistive devices.…”