Classification of Bone Bruises in Pediatric Patients With Anterior Cruciate Ligament Injuries

Abstract

Background: Bone bruises are frequently found on magnetic resonance imaging (MRI) after an anterior cruciate ligament (ACL) tear in pediatric patients. Purpose: To establish a classification system for different bone bruise patterns to estimate the severity of a knee injury in pediatric patients with ACL tears. Study Design: Cross-sectional study; Level of evidence, 3. Methods: A medical database was retrospectively reviewed to identify all cases of primary ACL tears in patients who were aged ≤17 years at the time of the injury and underwent MRI at our institution within 4 weeks of the injury between January 2011 and December 2020. A total of 188 patients were identified (67 male, 121 female; mean age, 15.1 ± 1.4 years). Bone bruises were classified according to their depth and location on MRI in the sagittal and coronal planes. Results: The new classification system identified 3 grades of depth: grade I, the bone bruise was located within the epiphysis but did not reach the epiphyseal plate (n = 54 [35.3%]); grade II, the bone bruise was within the epiphysis that reached the epiphyseal plate (n = 55 [35.9%]); and grade III, the bone bruise was in both the epiphysis and metaphysis (n = 44 [28.8%]). The bone bruise location was classified into 4 types: type a, the deepest bone bruise area was in the lateral tibial plateau (n = 66 [43.1%]); type b, the deepest bone bruise area was in the lateral femoral condyle, commonly occurring in the lateral one-third to two-thirds of the lateral femoral condyle (n = 22 [14.4%]); type c, the bone bruise area had a similar depth in both the lateral femoral condyle and lateral tibial plateau (n = 54 [35.3%]); and type d, the bone bruise area was in the lateral tibial plateau and lateral femoral condyle and extended to the fibular head (n = 11 [7.2%]). The prevalence of collateral ligament injuries increased from grade I to III. All patients with grade III type c bone bruises had meniscal lesions. Conclusion: This new classification system provides a basis for estimating associated lesions of the knee before surgery.

A Systematic Review of Bone Bruise Patterns following Acute Anterior Cruciate Ligament Tears: Insights into the Mechanism of Injury

“…It is believed that more appropriate results can be obtained if results prior to 2010 are included [21,27]. Finally, no classification was made regarding gender (men and women) [44], age (pediatrics and adults) [32,33], or injury type (contact or non-contact injury) [19]. Although these factors can have a significant impact on the pattern of bone bruising, they could not be distinguished clearly using the data included in this study, so they were expressed in an integrated manner.…”

Bone Bruises and Concomitant Meniscus and Cartilage Damage in Anterior Cruciate Ligament Injuries: A Systematic Review and Meta-Analysis

“…Various studies have been conducted on bone bruises in ACL injury [8,[24][25][26]29,30,33,43,[68][69][70]. In addition to research on bone bruises and associated injury in ACL injury [69,70], there were also studies on the ACL injury mechanism according to the bone bruise pattern [68].…”

“…However, most studies focused on the relationship between ACL bone bruises and ligament injuries [71], and there were no systematic reviews or meta-analyses that synthesized the findings from several studies on the relationship between ACL bone bruises and meniscus or cartilage injuries. Previously, there were individual studies that reviewed only the bone bruise patterns and resultant injuries [8,[24][25][26]29,30,33,43,[68][69][70], but this research compiled numerous studies on the relationships among bone bruises, meniscal injuries, and cartilage damages. By investigating the relationships between bone bruises, as well as meniscal and cartilage damages in ACL injuries, our findings provide additional explanations to patients about the associated injuries in clinical settings, thus enhancing clinical relevance.…”