Prevalence and Location of Bone Bruises Associated with Anterior Cruciate Ligament Injury and Implications for Mechanism of Injury: A Systematic Review

Patel, Sonika; Hageman, Jason; Quatman, Carmen E.; Wordeman, S. C.; Hewett, Timothy E.

doi:10.1007/s40279-013-0116-z

Cited by 116 publications

(140 citation statements)

References 46 publications

Supporting

Mentioning

132

Contrasting

Order By: Relevance

“…Some studies have suggested that the high incidence of bruising near the terminal sulcus and the posterolateral tibial plateau may be due to a pivot shift event in which anterior subluxation occurs concurrently with an ACL tear 17, 23, 53 . Due to the high incidence of bone bruising in the lateral compartment in individuals with ACL injury 53, 57, 62 , some studies have emphasized the importance of valgus rotation 48, 50 . Medial compartment bruising in non-contact injuries has been attributed to anterior tibial translation and internal tibial rotation rather than valgus stress due to the location of femoral condyle bruising relative to tibial plateau bruising 57, 60 .…”

Section: Discussionmentioning

confidence: 99%

“…Although previous studies have reported on the location, volume, intensity, depth, and frequency at which bone bruising occurs with ACL injury 36, 43, 48, 53, 57 , little data is available quantifying the position and orientation of the knee at the time of injury. Thus, in order to assess the repeatability of our measurements, three independent trials of bone bruise outlining were performed on a single knee using the same procedure as described above.…”

Section: Methodsmentioning

confidence: 99%

“…These bruises are visible as increased signal intensity on short Tau inversion recovery (STIR) or T2 weighted images, a result of increased water content due to trabecular microfracture 36, 43, 53 . These contusions are thought to be the result of impact between the femur and tibia near the time of ACL injury 29, 48, 57, 62 . Although previous studies have utilized MR images of individuals with non-contact ACL injuries to characterize the locations and frequencies of these bone bruises 23, 29, 53, 57, 62 , it may be difficult to determine the position and orientation of the knee at the time of injury from the examination of MR images alone.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Knee Kinematics During Noncontact Anterior Cruciate Ligament Injury as Determined From Bone Bruise Location

et al. 2015

View full text Add to dashboard Cite

Background The motions causing non-contact ACL injury remain unclear. Tibiofemoral bone bruises are believed to be the result of joint impact near the time of ACL rupture. The locations and frequencies of these bone bruises have been reported, but there is limited data quantifying knee position and orientation near the time of injury based on these contusions. Hypothesis Knee position and orientation near the time of non-contact ACL injury include extension and anterior tibial translation. Study Design Descriptive Laboratory Study Methods Magnetic resonance (MR) images of eight subjects with non-contact ACL injuries were acquired within one month of injury and subsequently analyzed. All subjects exhibited bruises on both the femur and tibia in both medial and lateral compartments. The outer margins of bone and the bone bruise surfaces were outlined on each image to create a 3D model of each subject’s knee in its position during MR imaging (MRI position). Numerical optimization was used to maximize overlap of the bone bruises on the femur and tibia and predict the position of injury. Flexion angle, valgus orientation, internal tibial rotation, and anterior tibial translation were measured in both the MRI position and the predicted position of injury. Differences in kinematics between the MRI position, which served as an unloaded reference, and the predicted position of injury were compared using paired t-tests. Results Flexion angle was near full extension in both the MRI position and the predicted position of injury (8° versus 12°, p=0.2). Statistically significant increases in valgus orientation (5°, p=0.003), internal tibial rotation (15°, p=0.003), and anterior tibial translation (22mm, p<0.001) were observed in the predicted position of injury relative to the MRI position. Conclusions These results suggest that for the bone bruise pattern studied, landing on an extended knee is high risk for ACL injury. Extension was accompanied by increased anterior tibial translation (22mm), internal tibial rotation (15°), and valgus rotation (5°) in the predicted position of injury relative to the MRI position. Clinical Relevance This study provides novel data characterizing the motions associated with ACL injury, information critical to improving strategies aimed at injury prevention.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Knee Kinematics During Noncontact Anterior Cruciate Ligament Injury as Determined From Bone Bruise Location

et al. 2015

View full text Add to dashboard Cite

show abstract

“…[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. Furthermore, the size of a traumatic BML may relate to knee pain or symptoms either because it is a proxy for the severity of the initial injury or because the lesion causes knee pain.…”

mentioning

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

View full text Add to dashboard Cite

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.

show abstract

“…3 Several studies have confirmed the higher incidence and greater degree of impaction in the lateral compartment commonly attributed to a pivot shift valgus-loading injury mechanism. 6 The most common pattern observed at MR imaging is a noncontiguous bone contusions on the midportion of lateral femoral condyle and the posterior margin of the lateral aspect of the tibial plateau. Although the presence of bone contusions in the medial compartment of the knee has been previously recognized, its mechanism and clinical relevance remain poorly understood.…”

Section: Discussionmentioning

confidence: 99%

The Anteromedial Tibial Rim Sign

Wissman

England²,

Mehta³

et al. 2015

Journal of Computer Assisted Tomography

View full text Add to dashboard Cite

show abstract

Prevalence and Location of Bone Bruises Associated with Anterior Cruciate Ligament Injury and Implications for Mechanism of Injury: A Systematic Review

Cited by 116 publications

References 46 publications

Knee Kinematics During Noncontact Anterior Cruciate Ligament Injury as Determined From Bone Bruise Location

Knee Kinematics During Noncontact Anterior Cruciate Ligament Injury as Determined From Bone Bruise Location

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

The Anteromedial Tibial Rim Sign

Contact Info

Product

Resources

About