Bone Bruise Patterns in Skeletally Immature Patients With Anterior Cruciate Ligament Injury: Shock-Absorbing Function of the Physis

2018 ◽  
Vol 46 (9) ◽  
pp. 2128-2132 ◽  
Author(s):  
João V. Novaretti ◽  
Jason J. Shin ◽  
Marcio Albers ◽  
Monique C. Chambers ◽  
Moises Cohen ◽  
...  
Keyword(s):  
Anterior Cruciate Ligament ◽  
Distribution Pattern ◽  
Cruciate Ligament ◽  
Ligament Injury ◽  
Bone Bruise ◽  
Skeletally Immature ◽  
Level Of Evidence ◽  
Bone Bruises ◽  
Open Physis ◽  
Anterior Cruciate

Background: Bone bruises are frequently found on magnetic resonance imaging (MRI) after anterior cruciate ligament (ACL) injury and have been related to the force associated with the trauma. Yet, little is known about the bone bruise distribution pattern of skeletally immature (SI) patients, as the presence of an open physis may play a role in energy dissipation given its unique structure. Purpose: To describe and compare the location and distribution of tibial and femoral bone bruises, observed on MRI, between 2 groups of ACL-injured knees: the first group with an open physis and the second with a closed physis. Additionally, based on the bone bruise distribution pattern, the secondary aim of the study was to propose a new classification of bone bruise in SI patients. Study Design: Cross-sectional study; Level of evidence, 3. Methods: A retrospective review was conducted to identify all cases of primary ACL tears in patients ≤16 years old, with MRI within 6 weeks of injury between January 2012 and December 2016. Overall, 106 patients were identified: 53 with open physis (skeletally immature [SI] group) and 53 with closed physis as control (skeletally mature [SM] group). MRI scans were reviewed to assess for the presence and location of bone bruises. Longitudinal bone bruise distribution was described as epiphyseal and metaphyseal in both femur and tibia. The proposed classification for tibia and femur has 2 parts: the location of the bone bruise in the (I) lateral, (II) medial, or (III) medial and lateral parts of the bone; and if the bone bruise (a) does not or (b) does cross the physis. For the tibia, if the bone bruise is also present in the central portion, a letter C is added. Results: The SI group had significantly fewer bone bruises cross the physis and extend into the metaphysis than did the SM group for both the tibia (25% vs 85%, respectively; P < .0001) and the femur (4% vs 42%; P < .0001). The most common patterns observed in the SI group were type IIICa in the tibia (medial/lateral and central, not extending into the metaphysis: 42%) and type Ia in the femur (lateral, not extending into the metaphysis: 59%). Conclusion: The data from this study shows that patients with an open physis at the occurrence of an acute ACL rupture have unique bone bruise patterns as compared with those with a closed physis. In the SI patients, the bone bruise pattern is significantly less frequently observed in the tibial and femoral metaphysis.

Clinical Implications of Bone Bruise Patterns Accompanying Anterior Cruciate Ligament Tears

2021 ◽  
pp. 194173812110295
Author(s):  
Patrick Ward ◽  
Peter Chang ◽  
Logan Radtke ◽  
Robert H. Brophy
Keyword(s):  
Magnetic Resonance Imaging ◽  
Anterior Cruciate Ligament ◽  
Magnetic Resonance ◽  
Functional Outcomes ◽  
Cruciate Ligament ◽  
Acl Injury ◽  
Bone Bruise ◽  
Resonance Imaging ◽  
Bone Bruises ◽  
Anterior Cruciate

Background: Anterior cruciate ligament (ACL) tears are common injuries; they are often associated with concomitant injuries to other structures in the knee, including bone bruises. While there is limited evidence that bone bruises are associated with slightly worse clinical outcomes, the implications of bone bruises for the articular cartilage and the risk of developing osteoarthritis (OA) in the knee are less clear. Recent studies suggest that the bone bruise pattern may be helpful in predicting the presence of meniscal ramp lesions. Evidence Acquisition: A literature review was performed in EMBASE using the keyword search phrase (acl OR (anterior AND cruciate AND ligament)) AND ((bone AND bruise) OR (bone AND contusion) OR (bone AND marrow AND edema) OR (bone AND marrow AND lesion) OR (subchondral AND edema)). Study Design: Clinical review. Level of Evidence: Level 4. Results: The literature search returned 93 articles of which 25 were ultimately included in this review. Most studies identified a high prevalence of bone bruises in the setting of acute ACL injury. Individual studies have found relationships between bone bruise volume and functional outcomes; however, these results were not supported by systematic review. Similarly, the literature has contradictory findings on the relationship between bone bruises and the progression of OA after ACL reconstruction. Investigations into concomitant injury found anterolateral ligament and meniscal ramp lesions to be associated with bone bruise presence on magnetic resonance imaging. Conclusion: Despite the ample literature identifying the prevalence of bone bruises in association with ACL injury, there is little evidence to correlate bone bruises to functional outcomes or progression of OA. Bone bruises may best be used as a marker for concomitant injury such as medial meniscal ramp lesions that are not always well visualized on magnetic resonance imaging. Further research is required to establish the longitudinal effects of bone bruises on ACL tear recovery. Strength of Recommendation Taxonomy: 2.

Bone Bruise and Anterior Cruciate Ligament Tears: Presence, Distribution Pattern, and Associated Lesions in the Pediatric Population

2019 ◽  
Vol 47 (13) ◽  
pp. 3181-3186
Author(s):  
Vittorio Bordoni ◽  
Giorgio di Laura Frattura ◽  
Davide Previtali ◽  
Simone Tamborini ◽  
Christian Candrian ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Anterior Cruciate Ligament ◽  
Pediatric Patients ◽  
Pediatric Population ◽  
Cruciate Ligament ◽  
Bone Bruise ◽  
Resonance Imaging ◽  
Meniscal Lesions ◽  
Bone Bruises ◽  
Anterior Cruciate

Background: Bone bruise characteristics after anterior cruciate ligament (ACL) injury have been correlated with the level of joint derangement in adults. However, the literature lacks information about younger patients, whose higher ligamentous laxity may lead to different lesion patterns. Purpose: To investigate the prevalence, size, location, and role of bone bruise associated with ACL rupture in the pediatric population. Study Design: Cross-sectional study; Level of evidence, 3. Methods: Knee magnetic resonance imaging scans (MRIs) of patients aged 8 to 16 years with ACL tears from 2010 to 2018 were selected from the institution database. Inclusion criteria were open or partially open physes, less than 90 days between trauma and MRI, and no history of injury or surgery. Presence, localization, and size of bone bruise were analyzed by 2 blinded researchers and scored with the Whole-Organ Magnetic Resonance Imaging Score (WORMS) bone bruise subscale. Ligamentous, cartilaginous, meniscal, and other lesions were documented. Results: Of the 78 pediatric patients selected from the database, 54 (69%) had bone bruise. The mean area of bone bruise was larger in males than in females (femur, 3.8 ± 2.8 vs 2.2 ± 1.4 cm2, respectively, P = .006; tibia, 2.6 ± 1.6 vs 1.5 ± 0.8 cm2, respectively, P = .007). The subregions most affected by bone bruise were the lateral posterior tibia and the lateral central femur (in 83% and 80% of the knees affected, respectively). A low correlation was found between age and bone bruise area (biggest areas r = 0.30, P = .03, and sum of areas r = 0.27, P = .04), but no correlation was found between age and WORMS (femur, r = −0.03, P = .85; tibia, r = −0.04, P = .76). The injuries most associated with bone bruise were 23 meniscal lesions (43%), 10 lesions of other ligaments (19.0%), 2 cartilage lesions (3.7%), and 2 patellar fractures (3.7%). Conclusion: The prevalence of bone bruises in pediatric patients with ACL tears is high, although it seems slightly lower than the prevalence documented in adults but with similar localization. The area and the distribution pattern of bone bruises are similar among different ages. The pediatric patients had a lower presence of cartilage and meniscal lesions compared with that reported in adults, which suggests a different effect of this trauma on the knee of pediatric patients.

Articular Cartilage Changes Seen With Magnetic Resonance Imaging-Detected Bone Bruises Associated With Acute Anterior Cruciate Ligament Rupture

1998 ◽  
Vol 26 (3) ◽  
pp. 409-414 ◽  
Author(s):  
Darren L. Johnson ◽  
William P. Urban ◽  
David N. M. Caborn ◽  
William J. Vanarthos ◽  
Cathy S. Carlson
Keyword(s):  
Magnetic Resonance Imaging ◽  
Anterior Cruciate Ligament ◽  
Articular Cartilage ◽  
Magnetic Resonance ◽  
Subchondral Bone ◽  
Cruciate Ligament ◽  
Bone Bruise ◽  
Resonance Imaging ◽  
Bone Bruises ◽  
Anterior Cruciate

Occult osteochondral lesions (bone bruises) have been documented on magnetic resonance images in more than 80% of patients sustaining acute anterior cruciate ligament ruptures. Despite the high prevalence of these lesions, little is known about the histologic changes in the adjacent articular cartilage. Ten patients with acute anterior cruciate ligament ruptures who had a preoperatively documented (by magnetic resonance imaging) geographic bone bruise at the sulcus terminalis on the lateral femoral condyle underwent a 3-mm diameter trephine biopsy of the articular cartilage and subchondral bone overlying the bone bruise at the time of anterior cruciate ligament reconstruction. Biopsy samples of the articular cartilage and subchondral bone were stained with hematoxylin and eosin and toluidine blue. All patients had significant arthroscopic and histologic articular cartilage irregularity in the area overlying the bone bruise. Arthroscopic findings of the articular cartilage included softening (dimpling), fissuring, or overt chondral fracture. Histologic examination revealed degeneration of the chondrocytes and loss of toluidine blue staining in the articular cartilage (loss of proteoglycan). There was necrosis of osteocytes in the subchondral bone, and empty lacuna were visible. This study defines the exact histologic changes of the articular cartilage overlying a geographic bone bruise secondary to an acute anterior cruciate ligament tear. Our findings suggest that a geographic bone bruise found on magnetic resonance imaging indicates substantial damage to normal articular cartilage homeostasis.

scholarly journals EPIDEMIOLOGY OF ANTERIOR CRUCIATE LIGAMENT INJURY IN SOCCER PLAYERS IN THE BRAZILIAN CHAMPIONSHIP

2021 ◽  
Vol 29 (1) ◽  
pp. 45-48
Author(s):  
CONRADO TAZIMA NITTA ◽  
ARTHUR RODRIGUES BALDAN ◽  
LUCAS PLENS DE BRITTO COSTA ◽  
MOISES COHEN ◽  
JORGE ROBERTO PAGURA ◽  
...  
Keyword(s):  
Anterior Cruciate Ligament ◽  
Cruciate Ligament ◽  
Epidemiological Data ◽  
Soccer Players ◽  
Ligament Injury ◽  
Online Data ◽  
Level Of Evidence ◽  
Professional Soccer ◽  
Significant Difference ◽  
Anterior Cruciate

ABSTRACT Objective: To evaluate and collect epidemiological data on injuries of the anterior cruciate ligament of the knee in professional soccer players of the Brazilian Championship. Methods: Transversal study, with information extracted from the online data platform www.transfermrkt.com.br (Transfermarkt GmbH & Co. KG), with 5 seasons (2015 - 2019) of the Brazilian championship series A and B being analyzed and revised by 3 researchers. Results: 52 injuries of the anterior cruciate ligament were detected, with a mean age of 26,3 years, time off due to injury of 244.5 ±31.6 days, regardless of the division. Forwarders and defenders had the highest incidences of injury without statistically significant difference, but they had greater chances than goalkeepers, left/right backs and midfielders. Conclusion: The incidence of injury to the anterior cruciate ligament of the knee in professional football players in the first and second divisions of the Brazilian soccer championship between 2015 and 2019 is 0.414 per 1,000 hours of play, a value similar to described in the literature. The incidence of the injury varies according to the player’s field position, being the forwarders and defenders the most injured players. Level of Evidence II, Retrospective study.

scholarly journals "Bone bruise" Detected with MR Imaging Associated with Anterior Cruciate Ligament Injury.

1994 ◽  
Vol 43 (4) ◽  
pp. 1419-1422
Author(s):  
Yutaka Otsuka ◽  
Kenji Kubota ◽  
Hiroshi Mizuta ◽  
Eiichi Nakamura ◽  
Noriyoshi Nagamoto ◽  
...  
Keyword(s):  
Anterior Cruciate Ligament ◽  
Mr Imaging ◽  
Anterior Cruciate Ligament Injury ◽  
Cruciate Ligament ◽  
Ligament Injury ◽  
Bone Bruise ◽  
Anterior Cruciate

scholarly journals Association of Compartmental Bone Bruise Distribution With Concomitant Intra-articular and Extra-articular Injuries in Acute Anterior Cruciate Ligament Tears After Noncontact Sports Trauma

2018 ◽  
Vol 6 (4) ◽  
pp. 232596711876762 ◽  
Author(s):  
Palaniswamy Aravindh ◽  
Tianyi Wu ◽  
Chloe Xiaoyun Chan ◽  
Keng Lin Wong ◽  
Lingaraj Krishna
Keyword(s):  
Anterior Cruciate Ligament ◽  
Tibial Plateau ◽  
Femoral Condyle ◽  
Cruciate Ligament ◽  
Lateral Compartment ◽  
Bone Bruise ◽  
Collateral Ligament ◽  
Sports Trauma ◽  
Bone Bruises ◽  
Anterior Cruciate

Background: Anterior cruciate ligament (ACL) injuries are frequently associated with bone bruises, and their presence may be associated with concomitant intra- and extra-articular injuries. Purpose: To investigate the prevalence and pattern of distribution of bone bruises in patients with acute ACL tears from noncontact sports trauma and their association with specific intra- and extra-articular injuries. Study Design: Cross-sectional study; Level of evidence, 3. Methods: A total of 168 patients underwent magnetic resonance imaging (MRI) within 6 weeks of sustaining an ACL tear. Information regarding their demographics as well as MRI evidence of bone bruise patterns and associated injuries was carefully documented. Univariate and multivariate logistic regression analyses were performed to determine the association between bone bruises and concomitant intra- and extra-articular injuries seen on MRI. Results: Bone bruises were observed in 155 (92.3%) of 168 patients. The prevalence of bone bruises was 83.9%, 78.6%, 56.5%, and 29.8% on the lateral tibial plateau, lateral femoral condyle, medial tibial plateau, and medial femoral condyle, respectively. A total of 110 (65.5%) patients had bone bruises in both the medial and lateral compartments of the knee, 41 (24.4%) had isolated lateral compartment bone bruises, 4 (2.4%) had isolated medial compartment bone bruises, and 13 (7.7%) did not have any bone bruises. None of the demographic factors were significantly associated with the presence or absence of bone bruises. The presence of bone bruises was significantly associated with lateral meniscal injuries ( P = .05). Lateral compartment bone bruises were significantly associated with lateral meniscal injuries ( P = .034), while bone bruises affecting both the lateral and medial compartments were significantly associated with medial collateral ligament (MCL) injuries ( P = .044) and lateral collateral ligament (LCL) injuries ( P = .038) in addition to lateral meniscal injuries ( P = .022). Conclusion: Bone bruises are common in patients with acute ACL tears after noncontact sports injuries. The compartmental distribution of bone bruises is associated with concomitant intra- and extra-articular injuries. Bone bruises involving the lateral compartment of the knee are associated with lateral meniscal injuries, while bone bruises involving both the lateral and medial compartments of the knee are associated with MCL and LCL injuries in addition to lateral meniscal injuries.

scholarly journals Are Bone Bruise Characteristics and Articular Cartilage Pathology Associated with Inferior Outcomes 2 and 6 Years After Anterior Cruciate Ligament Reconstruction?

Cartilage ◽  
2016 ◽  
Vol 8 (2) ◽  
pp. 139-145 ◽  
Author(s):  
Christian Lattermann ◽  
Cale A. Jacobs ◽  
Emily K. Reinke ◽  
Erica A. Scaramuzza ◽  
Laura J. Huston ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Anterior Cruciate Ligament ◽  
Articular Cartilage ◽  
Ligament Reconstruction ◽  
Cruciate Ligament ◽  
Bone Bruise ◽  
Resonance Imaging ◽  
Cruciate Ligament Reconstruction ◽  
Bone Bruises ◽  
Anterior Cruciate

Objective To determine (1) if bone bruise characteristics seen on magnetic resonance imaging are associated with patient-reported outcomes prior to and following anterior cruciate ligament reconstruction and (2) if the combined presence of bone bruises with articular cartilage pathology results in inferior 2- or 6-year outcomes. Design Bone bruise volume and severity were measured on 81 patients’ preoperative magnetic resonance imaging in the medial and lateral femoral condyle (MFC, LFC) and medial and lateral tibial plateau (MTP, LTP) using the Costa-Paz classification and a modified version of Roemer and Bohndorf’s technique. The relationships between bone bruise volume and severity with Knee Injury and Osteoarthritis Outcome Score (KOOS) and International Knee Documentation Committee (IKDC) scores were assessed, and pre- and postoperative KOOS and IKDC scores were compared between those with bone bruises either with or without combined local articular cartilage pathology. Results All 81 patients had a bone bruise in at least 1 region and 70 (86%) had bone bruises in ≥2 regions. LTP bruises were the most common (76/81, 94%), followed by the LFC (66, 81%), MTP (46, 57%), and MFC (20, 25%). Neither bone bruise volume nor severity was associated with inferior postoperative outcomes. The subset of 17 patients with bone bruises and combined articular cartilage pathology were 3.4 times more likely to be symptomatic at 6-year follow-up than those without articular cartilage pathology ( P = 0.04). Conclusions The volume and severity of preoperative bone bruises alone were not associated with 2- or 6-year outcomes; however, bone bruises combined with local articular cartilage pathology appear to be more symptomatic after ACL reconstruction.

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