Prospective study of osseous, articular, and meniscal lesions in recent anterior cruciate ligament tears by magnetic resonance imaging and arthroscopy

Abstract

Fifty-four patients with anterior cruciate ligament tears that were arthroscopically reconstructed within 3 months of initial injury were prospectively evaluated. Patients with grade 3 medial collateral ligament, lateral collateral ligament, or posterior cruciate ligament tears were excluded. Eighty percent of our patients had a bone bruise present on the magnetic resonance image, with 68% in the lateral femoral condyle. Two of the latter findings--an abnormal articular cartilage signal (P = 0.02) and a thin and impacted subchondral bone (P = 0.03)--had a significant relationship with injury to the overlying articular cartilage. Meniscal tears were found in 56% of the lateral menisci and 37% of the medial menisci. A significant association was present between bone bruising on the lateral femoral condyle and the lateral tibial plateau (P = 0.02). Results of our study support the concept that the common mechanism of injury to the anterior cruciate ligament involves severe anterior subluxation with impaction of the posterior tibia on the anterior femur. Determination of the significance of bone bruising, articular cartilage injury, or meniscal tears will require a long-term followup that includes evaluation for arthritis, stability, and function. These 54 patients represent the first cohort evaluated in this ongoing prospective clinical study.

The Mechanism of Non-contact Anterior Cruciate Ligament Injury in Female Athletes: Is the Injury Mechanism Different between the Genders?

“…Similar lesions have been found on the posterolateral aspect of the tibia and the anterolateral aspect of the femur in approximately 80% of patients with an acute ACL injury [176,[188][189][190]. These are most likely caused by a valgus force when the tibia is in anterolateral subluxation after the ACL is torn [190].…”

Acute repair of chondrocytes in the rabbit tibiofemoral joint following blunt impact using P188 surfactant and a preliminary investigation of its long-term efficacy

“…7 Clinically, in over 80% of patients suffering anterior cruciate ligament (ACL) tears, a characteristic osteochondral lesion occurs in the posterolateral aspect of the tibia and/or anterolateral aspect of the lateral femoral condyle. [8][9][10][11] These injuries are also associated with visible damage to chondrocytes 12 and an overt loss of cartilage within 6 months, 13 overlying ''geographic'' bone bruises in particular. These types of bone lesions have been associated with occult microcracks of subchondral and/or trabecular bone.…”

Clinical Outcome at a Minimum of Five Years After Reconstruction of the Anterior Cruciate Ligament

“…To our knowledge, we are the first to use a series of validated outcome questionnaires to evaluate a group of patients at a minimum of five years following reconstruction of the anterior cruciate ligament. Our hypothesis 19 was that patient demographics, injury variables, and intra-articular injuries and their treatment are significantly associated with function (outcomes) at a minimum of five years following reconstructions of the anterior cruciate ligament.…”

“…The recorded demographic and injury variables are shown in Table I. The intraoperative factors included noninstrumented laxity measurements made with the patient under anesthesia and intra-articular injuries and their treatment as recorded on a scaled diagram and converted to a numeric classification as previously described 19 . Each of the six articular cartilage surfaces (medial tibial plateau, medial femoral condyle, lateral tibial plateau, lateral femoral condyle, patella, and trochlear groove) were analyzed separately to record the size of the area of chondromalacia on each surface and to grade the chondromalacia on each surface with use of a modified Outerbridge scale 20 (Grade I = softening, Grade II = superficial changes, Grade III = deep changes, and Grade IV = exposed bone).…”