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

Abstract

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.

Younger age increases the risk of sustaining multiple concomitant injuries with an ACL rupture

“…This is low in comparison to most other studies that report between 69% and 100% [4,6,8,11,29,43,46,50]. As with the overall frequency of BMLs, the frequency of BMLs in the lateral femur and tibia were lower in this study, 44% and 39%, compared to the majority of studies reporting over 60% for the lateral femur and over 70% for the lateral tibia [4,6,11,23,24,29,43,46,50]. This diference is likely driven by the inclusion of ACL-injured subjects regardless of treatment and age.…”

Gait risk factors for disease progression differ between non-traumatic and post-traumatic knee osteoarthritis

“…This could be due to the fact that initial lateral plateau tissue damage from trauma might have been the strongest factor in OA initiation/progression in participants with post-traumatic OA and KAM during gait played a less decisive role. In support, the interaction between KAM and group was only found at the lateral plateau, which is the most common site of bone marrow lesion and fractures with cortical discontinuity following ACL injury 32,33 . Loading distribution during gait, which KAM serves as a proxy, maybe more important in OA progression at the lateral plateau in patients with non-traumatic knee OA.…”

Clinical Implications of Bone Bruise Patterns Accompanying Anterior Cruciate Ligament Tears

“…Preoperative ROM deficits are associated with higher rates of arthrofibrosis 36 and lower subjective scores. 43 Driban et al 12 also found that increased bone bruise volume is associated with lower Knee injury and Osteoarthritis Outcome Score (KOOS) pain scores in the absence of a depression fracture. When depression fractures were present, this relationship was nonexistent.…”

“…Recent studies into the distribution of bone bruises within the knee found a wide range: between 48.3% and 91.7% of ACL tears had a bruise of the lateral femoral condyle (LFC) (Figure 1), 1,5,7,8,12,26,27,31,35,44,46 between 49.4% and 97.6% of the lateral tibial plateau (LTP) (Figure 1), 1,5,7,8,12,26,27,31,35,44,46 between 12.5% and 53% of the medial femoral condyle (MFC) (Figure 2), 1,7,8,12,26,27,44,46 and between 12.4% and 83.5% of the medial tibial plateau (MTP) (Figure 3). 1,7,8,12,26,27,31,44,46…”

“…Recent studies into the distribution of bone bruises within the knee found a wide range: between 48.3% and 91.7% of ACL tears had a bruise of the lateral femoral condyle (LFC) (Figure 1), 1,5,7,8,12,26,27,31,35,44,46 between 49.4% and 97.6% of the lateral tibial plateau (LTP) (Figure 1), 1,5,7,8,12,26,27,31,35,44,46 between 12.5% and 53% of the medial femoral condyle (MFC) (Figure 2), 1,7,8,12,26,27,44,46 and between 12.4% and 83.5% of the medial tibial plateau (MTP) (Figure 3). 1,7,8,12,26,27,31,44,46 Consistently, lateral contusions are more prevalent than medial contusions, and tibial contusions are more prevalent than femoral contusions. Shi et al 44 and Bordoni et al 7 identified bone bruise locations in the sagittal plane and found bone bruises primarily in the posterior compartment of the tibia and the central or anterior compartments of the femur.…”