Mechanisms of non-contact anterior cruciate ligament injury as determined by bone contusion location and severity

Qiu, Lanyu; Sheng, Bo; Li, Jia; Xiao, Zhibo; Yuan, Man; Yang, Haitao; Lv, Fajin

doi:10.21037/qims-20-1212

Cited by 8 publications

(13 citation statements)

References 28 publications

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“…In line with previous reports [ 22 , 23 , 25 , 27 ], our results show that combined central lateral femoral condyle and posterior lateral tibial plateau BB pattern to be the result of indirect ACL injury mechanism in 100% of cases, and was the primary or typical BB pattern accounting for 58% of the included footballers. Identifying this initial pattern in patients undergoing ACL reconstruction surgery may have a potential role in guiding footballers' rehabilitation, focusing on valgus knee collapse prevention exercises and improving cutting task biomechanics, and recognizing individuals at higher risk of reinjury.…”

Section: Discussionsupporting

confidence: 92%

“…Kim-Wang et al, in a cross-sectional study comprising 136 patients undergoing ACL reconstruction, found medial compartment BB in 72% of patients in his series and the presence of 3 or 4 contusions in 65% of them, with a prevalence of 35% involving all compartments [ 16 ]. Similarly, Qiu et al, in a retrospective analysis of 93 patients with an ACL injury, reported medial tibial plateau involvement in 69.8% and medial femoral condyle BB in 49.4% of patients [ 23 ]. Although medial compartment-only patterns represented only 5.3% of patients, four contusion patterns were the most common, accounting for 36.5% of patients.…”

Section: Discussionmentioning

confidence: 99%

“…Another aspect which is gaining the attention of the panorama of ACL research is the pattern of bone bruises which are usually present in MRI of ACL-injured patients [ 1 , 11 , 17 , 22 , 23 , 27 ]. Specifically, bone bruises are defined as areas of increased signal on short-tau inversion recovery (STIR) or T2-weighted MRI images, representing areas of increased water content due to trabecular microfractures.…”

Section: Introductionmentioning

confidence: 99%

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The injury mechanism correlation between MRI and video-analysis in professional football players with an acute ACL knee injury reveals consistent bone bruise patterns

D’Hooghe

Grassi

Villa³

et al. 2022

Knee Surg Sports Traumatol Arthrosc

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Purpose To analyze the MRI features, in particular bone bruises pattern, of Anterior Cruciate Ligament (ACL) injured footballers, and to correlate them with the characteristics of injury mechanism and situation obtained from direct video footage. Methods Nineteen professional football (soccer) players that sustained ACL injury while playing during an official match of First League Championship were included in the study. The video of injury was obtained from the Television broadcast. Knee Magnetic Resonance (MRI) was obtained within 7 days from the injury. BB and meniscal lesions were analyzed on MRI, while a video-analysis of mechanisms of ACL injury and injury dynamic were assessed from the videos. Results The most commonly involved Bone Bruise areas in the knee were the Posterior Lateral Tibial Plateau (LTp) in 16 cases (84%) and the Central Lateral Femoral Condyle (LFc) in 11 cases (58%). Three patients (16%) had bone bruise in the Posterior Medial Tibial Plateau (MTp) while none (0%) had bone bruise in the Medial Femoral Condyle. Based on the bone bruise pattern, 11 (58%) had simultaneous LFc and LTp and were defined “Typical” while 8 (42%) had other locations or no bone bruise and were defined “Atypical”. 9 out of 11 injuries (82%) of athletes with “Typical” pattern occurred with a “Pivoting” action”, in contrast to only 1 case (12%) in those with “Atypical” bone bruise pattern (p = 0.0055). The most common situational mechanism pattern on video analysis was “pressing” (n = 7) accounting for the 47% of the “indirect” ACL injuries. In terms of movement pattern, ten injuries (52%) occurred during a “Pivoting” movement (7 pressing, 1 dribbling, 1 tackled, 1 goalkeeping), whereas the remaining were classified as “Planting” in four cases, “Direct Blow” in four cases and “Landing”. Conclusion A well-defined and consistent bone bruise pattern involving the posterior tibial plateau and central femoral condyle of lateral compartment is present in footballers that sustained non-contact and indirect ACL injuries during pivoting with sudden change of direction/deceleration, while heterogeneous patterns were present in those with direct contact or injury mechanisms involving high horizontal velocity. Level of evidence Level IV.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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The injury mechanism correlation between MRI and video-analysis in professional football players with an acute ACL knee injury reveals consistent bone bruise patterns

D’Hooghe

Grassi

Villa³

et al. 2022

Knee Surg Sports Traumatol Arthrosc

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“…They have long been suspected as a risk predictor for worse outcomes following ACL injury [ 30 ], although to our knowledge, no data on this association has been published. Qiu et al [ 31 ] performed a retrospective study by analyzing 93 MRI images of patients who had suffered an acute non-contact ACL injury to identify bony contusions of the knee by MRI scans for each anatomic femoral and tibial joint site. They found a prevalence of bone contusions of 78.49% at the lateral femoral condyle, 88.17% at the lateral tibial plateau, 49.46% at the medial femoral condyle, and 69.89% at the medial tibial plateau; determining that the location patterns and severity of bone contusions in patients indicated that tibial internal rotation, valgus, and anterior and lateral tibial translation were the main mechanisms of non-contact ACL injury.…”

Section: Discussionmentioning

confidence: 99%

Identifying Clinical and MRI Characteristics Associated with Quality of Life in Patients with Anterior Cruciate Ligament Injury: Prognostic Factors for Long-Term

Romero

Lim

Pérez

et al. 2021

IJERPH

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Background: Associated lesions in the diagnostic MRI may be related to worse long-term subjective outcomes. There is a lack of conclusive information about the long-term outcomes of associated injuries in anterior cruciate ligament (ACL) tears. The purpose of this study is to assess the long-term effects of associated injuries in ACL tears measured by means of a quality of life (QOL) assessment. Methods: A retrospective cohort study of 225 consecutive patients admitted for physical therapy with ACL injury (42 ± 12 years, 28.2% female) were conducted. All demographic and clinical variables were used to measure a QOL. Univariate and multivariable analyses were completed. Results: The mean follow-up period was 8.4 ± 2.6 years. In univariate analysis, male gender, and sports as the cause of the ACL lesion were factors significantly associated with improved International Knee Documentation Committee (IKDC) scores at the end of follow-up (all p < 0.002). In multivariable analysis, the occurrence of bone contusion was positively associated with injury (OR = 2.12) and negatively associated with sports injury (OR = 0.44) and medial collateral ligament (MCL) injury (OR = 0.48). Conclusions: After ACL injury, male gender and sports injury were associated with better clinical outcomes.

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“…18,19 In contrast, more than 70% of ACL injuries occur in a noncontact manner, during which rapid movement that confers supraphysiological stresses, such as changing directions, landing, deceleration, or pivoting, can lead to rupture of the ACL. 10,12 While the mechanisms of ACL injury have been thoroughly investigated, the underlying kinematic forces at the time of injury remain debated.…”

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confidence: 99%

Examining the Distribution of Bone Bruise Patterns in Contact and Noncontact Acute Anterior Cruciate Ligament Injuries

et al. 2023

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Background: Bone bruises are commonly seen on magnetic resonance imaging (MRI) in acute anterior cruciate ligament (ACL) injuries and can provide insight into the underlying mechanism of injury. There are limited reports that have compared the bone bruise patterns between contact and noncontact mechanisms of ACL injury. Purpose: To examine and compare the number and location of bone bruises in contact and noncontact ACL injuries. Study Design: Cross-sectional study; Level of evidence, 3. Methods: Three hundred twenty patients who underwent ACL reconstruction surgery between 2015 and 2021 were identified. Inclusion criteria were clear documentation of the mechanism of injury and MRI within 30 days of the injury on a 3-T scanner. Patients with concomitant fractures, injuries to the posterolateral corner or posterior cruciate ligament, and/or previous ipsilateral knee injury were excluded. Patients were stratified into 2 cohorts based on a contact or noncontact mechanism. Preoperative MRI scans were retrospectively reviewed by 2 musculoskeletal radiologists for bone bruises. The number and location of the bone bruises were recorded in the coronal and sagittal planes using fat-suppressed T2-weighted images and a standardized mapping technique. Lateral and medial meniscal tears were recorded from the operative notes, while medial collateral ligament (MCL) injuries were graded on MRI. Results: A total of 220 patients were included, with 142 (64.5%) noncontact injuries and 78 (35.5%) contact injuries. There was a significantly higher frequency of men in the contact cohort compared with the noncontact cohort (69.2% vs 54.2%, P = .030), while age and body mass index were comparable between the 2 cohorts. The bivariate analysis demonstrated a significantly higher rate of combined lateral tibiofemoral (lateral femoral condyle [LFC] + lateral tibial plateau [LTP]) bone bruises (82.1% vs 48.6%, P < .001) and a lower rate of combined medial tibiofemoral (medial femoral condyle [MFC] + medial tibial plateau [MTP]) bone bruises (39.7% vs 66.2%, P < .001) in knees with contact injuries. Similarly, noncontact injuries had a significantly higher rate of centrally located MFC bone bruises (80.3% vs 61.5%, P = .003) and posteriorly located MTP bruises (66.2% vs 52.6%, P = .047). When controlling for age and sex, the multivariate logistical regression model demonstrated that knees with contact injuries were more likely to have LTP bone bruises (OR, 4.721 [95% CI, 1.147-19.433], P = .032) and less likely to have combined medial tibiofemoral (MFC + MTP) bone bruises (OR, 0.331 [95% CI, 0.144-0.762], P = .009) compared with those with noncontact injuries. Conclusion: Significantly different bone bruise patterns were observed on MRI based on ACL injury mechanism, with contact and noncontact injuries demonstrating characteristic findings in the lateral tibiofemoral and medial tibiofemoral compartments, respectively.

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Mechanisms of non-contact anterior cruciate ligament injury as determined by bone contusion location and severity

Cited by 8 publications

References 28 publications

The injury mechanism correlation between MRI and video-analysis in professional football players with an acute ACL knee injury reveals consistent bone bruise patterns

The injury mechanism correlation between MRI and video-analysis in professional football players with an acute ACL knee injury reveals consistent bone bruise patterns

Identifying Clinical and MRI Characteristics Associated with Quality of Life in Patients with Anterior Cruciate Ligament Injury: Prognostic Factors for Long-Term

Examining the Distribution of Bone Bruise Patterns in Contact and Noncontact Acute Anterior Cruciate Ligament Injuries

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