scholarly journals Comparison Between Soccer and Basketball of Bone Bruise and Meniscal Injury Patterns in Anterior Cruciate Ligament Injuries

2021 ◽  
Vol 9 (4) ◽  
pp. 232596712199584
Author(s):  
Huijuan Shi ◽  
Li Ding ◽  
Yanfang Jiang ◽  
Haocheng Zhang ◽  
Shuang Ren ◽  
...  
Keyword(s):  
Cruciate Ligament ◽  
Lateral Side ◽  
Bone Bruise ◽  
Meniscal Injury ◽  
Injury Patterns ◽  
Acl Injuries ◽  
Medial Side ◽  
Bone Bruises ◽  
Injury Mechanisms ◽  
Anterior Cruciate

Background: The varying effectiveness of anterior cruciate ligament (ACL) injury prevention programs between soccer and basketball may be due to differences in sport-specific injury mechanisms. Bone bruise patterns may provide information regarding injury mechanisms. Purpose: To compare bone bruise and meniscal injury patterns for ACL injuries sustained in soccer versus basketball. Study Design: Cross-sectional study; Level of evidence, 3. Methods: Clinical notes, operative reports, and magnetic resonance imaging scans were reviewed for patients who sustained a noncontact ACL rupture while playing soccer or basketball between August 2016 and August 2018. The presence, location, and signal intensity of bone bruises on the tibia and femur were documented, and patterns were classified according to the location of the bone bruise in the lateral-medial direction. The meniscal and bone bruise injury patterns and the specific bone bruise locations were compared between the soccer and basketball groups. Results: Overall, 138 patients were included (56 with soccer-related and 82 with basketball-related ACL injury). No significant difference between the groups was observed in bone bruise patterns ( P = .743) or meniscal injury patterns ( P = .952). Bone bruise on the lateral side only of both the femur and the tibia was the most common pattern in both soccer (41.9%) and basketball (47.0%) groups; the most common meniscal injury type was an isolated lateral meniscal injury in both soccer (50.0%) and basketball (45.0%) groups. For patients with bone bruises on both the lateral and the medial sides of both the femur and the tibia (BF+BT), the bone bruise signal intensity on the lateral side of the femur ( P < .001) and tibia ( P = .009) was significantly higher than that on the medial side for both groups. The bone bruises on the lateral side of the femur ( P < .001) and tibia ( P = .002) were significantly more anterior than those on the medial side for patients with the BF+BT pattern. Conclusion: No significant differences in bone bruise location or meniscal injury type were detected when comparing ACL injuries sustained during soccer versus basketball. The study results suggest a similar biomechanical loading pattern for ACL injuries in these sports.

scholarly journals Bone Bruise Distribution Patterns After Acute Anterior Cruciate Ligament Ruptures: Implications for the Injury Mechanism

2020 ◽  
Vol 8 (4) ◽  
pp. 232596712091116 ◽  
Author(s):  
Huijuan Shi ◽  
Li Ding ◽  
Yanfang Jiang ◽  
Haocheng Zhang ◽  
Shuang Ren ◽  
...  
Keyword(s):  
Anterior Cruciate Ligament ◽  
Acl Reconstruction ◽  
Cruciate Ligament ◽  
Acl Injury ◽  
Lateral Side ◽  
Bone Bruise ◽  
Medial Side ◽  
Bone Bruises ◽  
Anterior Cruciate ◽  
Anterior Posterior

Background: Bone bruises observed on magnetic resonance imaging (MRI) after an anterior cruciate ligament (ACL) injury could provide significant information about ACL injury mechanisms. Purpose/Hypothesis: The purpose of this study was to investigate common bone bruise patterns after an ACL injury. It was hypothesized that the most common bone bruise distribution pattern would be only the lateral side of both the femur and tibia. Study Design: Cross-sectional study; Level of evidence, 3. Methods: Knee MRI scans of patients who underwent acute ACL reconstruction from August 2016 to August 2018 at our institution were selected. Imaging sequences in the sagittal and coronal planes were used for determining the bone bruise location in the lateral-medial and anterior-posterior directions, respectively. The presence, location, and intensity of bone bruises within specific compartments of the tibia and femur were documented. The relative bone bruise patterns of the tibia and femur were classified and analyzed. Results: A total of 207 patients (165 men, 42 women) met the inclusion criteria from a total of 4209 ACL reconstruction cases. The most common relative bone bruise pattern was located on only the lateral side of both the femur and the tibia (44.4%), followed by the lateral and medial sides of both the femur and tibia (29.0%). For the pattern found on the lateral and medial sides of both the femur and tibia, the bone bruises on only the lateral side of both the tibia and femur were more severe ( P < .001 and P < .001, respectively) and more anterior ( P < .001 and P < .001, respectively) than those on only the medial side. Conclusion: The most common relative bone bruise pattern observed was on only the lateral side of both the tibia and femur. Bone bruises on the lateral side were more severe than those on the medial side in patients with bone bruises on the lateral and medial sides of both the femur and tibia. Anterior translation of the tibia relative to the femur occurred during an ACL injury based on the location of bone bruises in the anterior-posterior direction.

ACL Injury Mechanism is Related to Articular Pressure Distribution: A Cadaveric and Finite Element Investigation

2012 ◽  
Author(s):  
Ata M. Kiapour ◽  
Constantine K. Demetropoulos ◽  
Ali Kiapour ◽  
Carmen E. Quatman ◽  
Jason W. Levine ◽  
...  
Keyword(s):  
Finite Element ◽  
Pressure Distribution ◽  
Tibial Plateau ◽  
Cruciate Ligament ◽  
Acl Injury ◽  
High Rate ◽  
Bone Bruise ◽  
Acl Injuries ◽  
Injury Mechanisms ◽  
Anterior Cruciate

Acute anterior cruciate ligament (ACL) injury can be devastating, and often results in clinical sequelae that include meniscal tears, chondral lesions and osteoarthritis. Various bone bruise patterns of the femur or tibia, and bone contusions of the lateral tibial plateau have been associated in more than 80% of partial or complete ACL ruptures [1]. As quantification of articular cartilage pressure distribution under high-rate loading conditions remains challenging, validated finite element (FE) models of the knee can be used to characterize the effects of different loading parameters on tibiofemoral (TF) joint pressure distribution. This study combines high-rate cadaveric experiments with FE analysis to simulate ACL injuries and associated bone bruise patterns following landing from a jump. We hypothesized that a potential relationship exists between ACL injury mechanisms and resultant tibial plateau bone bruise patterns. This relationship may enhance our understanding of ACL injury mechanisms, which may provide insight to improve current prevention strategies that aim to decrease the risk of ACL injury and damage to secondary anatomical structures. All of this may in turn minimize associated posttraumatic knee osteoarthritis.

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.

scholarly journals Clinically Relevant Injury Patterns After an Anterior Cruciate Ligament Injury Provide Insight Into Injury Mechanisms

2012 ◽  
Vol 41 (2) ◽  
pp. 385-395 ◽  
Author(s):  
Jason W. Levine ◽  
Ata M. Kiapour ◽  
Carmen E. Quatman ◽  
Samuel C. Wordeman ◽  
Vijay K. Goel ◽  
...  
Keyword(s):  
Anterior Cruciate Ligament ◽  
Anterior Cruciate Ligament Injury ◽  
Cruciate Ligament ◽  
Ligament Injury ◽  
Injury Patterns ◽  
Injury Mechanisms ◽  
Anterior Cruciate ◽  
Insight Into

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 An Anterior Cruciate Ligament In Vitro Rupture Model Based on Clinical Imaging

2021 ◽  
pp. 036354652110171
Author(s):  
Lukas Willinger ◽  
Kiron K. Athwal ◽  
Andy Williams ◽  
Andrew A. Amis
Keyword(s):  
Anterior Cruciate Ligament ◽  
Acl Reconstruction ◽  
Pivot Shift ◽  
Cruciate Ligament ◽  
Acl Injury ◽  
Bone Bruise ◽  
Acl Injuries ◽  
Anterior Cruciate ◽  
Acl Transection

Background: Biomechanical studies on anterior cruciate ligament (ACL) injuries and reconstructions are based on ACL transection instead of realistic injury trauma. Purpose: To replicate an ACL injury in vitro and compare the laxity that occurs with that after an isolated ACL transection injury before and after ACL reconstruction. Study Design: Controlled laboratory study. Methods: Nine paired knees were ACL injured or ACL transected. For ACL injury, knees were mounted in a rig that imposed tibial anterior translation at 1000 mm/min to rupture the ACL at 22.5° of flexion, 5° of internal rotation, and 710 N of joint compressive force, replicating data published on clinical bone bruise locations. In contralateral knees, the ACL was transected arthroscopically at midsubstance. Both groups had ACL reconstruction with bone–patellar tendon–bone graft. Native, ACL-deficient, and reconstructed knee laxities were measured in a kinematics rig from 0° to 100° of flexion with optical tracking: anterior tibial translation (ATT), internal rotation (IR), anterolateral (ATT + IR), and pivot shift (IR + valgus). Results: The ACL ruptured at 26 ± 5 mm of ATT and 1550 ± 620 N of force (mean ± SD) with an audible spring-back tibiofemoral impact with 5o of valgus. ACL injury and transection increased ATT ( P < .001). ACL injury caused greater ATT than ACL transection by 1.4 mm (range, 0.4-2.2 mm; P = .033). IR increased significantly in ACL-injured knees between 0° and 30° of flexion and in ACL transection knees from 0° to 20° of flexion. ATT during the ATT + IR maneuver was increased by ACL injury between 0° and 80° and after ACL transection between 0° and 60°. Residual laxity persisted after ACL reconstruction from 0° to 40° after ACL injury and from 0° to 20° in the ACL transection knees. ACL deficiency increased ATT and IR in the pivot-shift test ( P < .001). The ATT in the pivot-shift increased significantly at 0° to 20° after ACL transection and 0° to 50° after ACL injury, and this persisted across 0° to 20° and 0° to 40° after ACL reconstruction. Conclusion: This study developed an ACL injury model in vitro that replicated clinical ACL injury as evidenced by bone bruise patterns. ACL injury caused larger increases of laxity than ACL transection, likely because of damage to adjacent tissues; these differences often persisted after ACL reconstruction. Clinical Relevance: This in vitro model created more realistic ACL injuries than surgical transection, facilitating future evaluation of ACL reconstruction techniques.

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.

scholarly journals Bone bruise of the knee associated with the lesions of anterior cruciate ligament and menisci on magnetic resonance imaging

2011 ◽  
Vol 68 (9) ◽  
pp. 762-766 ◽  
Author(s):  
Djordje Jelic ◽  
Dragan Masulovic
Keyword(s):  
Anterior Cruciate Ligament ◽  
Magnetic Resonance ◽  
Cruciate Ligament ◽  
Common Finding ◽  
Bone Bruise ◽  
Bone Marrow Change ◽  
Bone Bruises ◽  
Knee Trauma ◽  
Anterior Cruciate ◽  
Acute Knee

Background/Aim. Bone bruise is a common finding in acutely injured knee examined by magnetic resonance (MR). The aim of the study was to determine the association of bone bruise frequency with postinjury lesions of anterior cruciate ligament (ACL) and menisci. Bone bruise involves posttraumatic bone marrow change with hemorrhages, edema and microtrabecular fractures without disruption of adjacent cortices or articular cartilage. MR imaging is a method of choice for detecting bone bruises which can not be seen on conventional radiographic techniques. Methods. A representative review of 120 MR examinations for the acute knee trauma was conducted. All the patients were examined within one month of trauma. All MR examinations were performed by using a 0.3T MR unit. Results. Posttraumatic bone bruise was seen in 39 (32.5%) patients out of 120. Three patients had fracture of the cortex, so-called ?occult? fracture (not seen on plain radiography). We analyzed only bone bruises without these fractures of the cortex. Bone bruise was associated with the lesion of ACL in 27 (69%) patients. In 28 (72%) patients bone bruise was in combination with the lesion of menisci. Only two patients with bone bruise had neither ACL nor menisci lesions. There were 78 patients without bone bruise but 33 (43%) of them had lesions of ACL and 49 (63%) had lesions of menisci. Conclusion. Bone bruise is best seen in STIR (Short TI Inversion Recovery) images and is very often found in acute knee trauma. Very often it is associated with posttraumatic lesions of ACL and menisci, so attention must be paid to this when bone bruise is seen. The difference in frequency of internal structures of the knee lesions in patients with bone bruise is highly statistically significant as compared to patients with no bone bruise.

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