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

Novaretti, João Victor; Shin, Jason J.; Albers, Márcio; Chambers, Monique C.; Cohen, Moisés; Musahl, Volker; Fu, Freddie H.

doi:10.1177/0363546518777247

Cited by 20 publications

(32 citation statements)

References 30 publications

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“…An important finding of this study was that pediatric and adult patients display similar bone bruise localization, 22 which is in contrast with previous evidence showing that patients with open physes at the occurrence of an acute ACL rupture have unique bone bruise patterns compared with those with closed physes. 29 As reported in the Results section, the lateral central femur and the lateral posterior tibia were the areas most commonly affected by bone bruises in the pediatric patients included in this study; as reported by Filardo et al, 6 these are also the areas most commonly affected by bone bruises in adults. This finding indicates that the mechanisms that lead to ACL tears are the same regardless of age.…”

Section: Discussionsupporting

confidence: 72%

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

et al. 2019

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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.

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Section: Discussionsupporting

confidence: 72%

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

et al. 2019

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“…Although a 6week threshold has commonly been used in the literature, the 4-week threshold was selected to further minimize timing errors 12 and preserve the signal characteristics of bone bruises. Given that skeletally immature patients demonstrate unique bone bruise patterns, 23 and bone mineral density decreases gradually in patients aged >40 years, 13 which could affect the signal characteristics of a bone bruise, only those aged 18 to 40 years were selected. The exclusion criteria included (1) previous trauma to the affected knee, (2) posterior cruciate ligament injuries, (3) medial or lateral collateral ligament injuries, and (4) absent or poor-quality MRI scans ( Figure 1).…”

Section: Patient Selectionmentioning

confidence: 99%

“…Femoral and tibial bone bruises are thought to represent a footprint of impact at the time of the injury, offering insight into the mechanisms of an ACL injury. 29,32,33 Previous studies have reported that the most common patterns observed in an ACL injury were bone bruises in the lateral compartment, 23,29 which indicated that the valgus load was the primary mechanism of an ACL injury. 20 Other studies reported that anterior tibial translation with a small knee flexion angle may be the primary mechanism of an ACL injury based on the observed bone bruises on the posterior tibia and anterior femur.…”

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confidence: 99%

“…Additionally, most studies have focused on the lateral-medial direction of bone bruise locations, with little attention to the anterior-posterior direction. 1,2,10,19,23,28,31 Further, 2 recent systematic reviews concluded that further studies on bone bruise distribution patterns should be conducted to improve the accuracy of the bone bruise pattern. 25,38 Therefore, the purpose of this study was to investigate the common bone bruise patterns after an ACL injury.…”

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confidence: 99%

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

Shi

Jiang

Zhang

et al. 2020

Orthopaedic Journal of Sports Medicine

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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.

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“…Much of the recent literature regarding posterolateral tibial plateau injury in the setting of an ACL tear has focused on bone bruises, sometimes described as occult or nondisplaced impaction fractures. 1,3,8,9,15,16 Bone bruising in the setting of ACL tear has a reported incidence of approximately 80%. 1,13 When bone bruising is present, it suggests a higher energy pivoting injury, as full or high-grade partial ACL tears are more frequently associated with bone bruising compared with low-grade partial tears.…”

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confidence: 99%

Morphologic Variants of Posterolateral Tibial Plateau Impaction Fractures in the Setting of Primary Anterior Cruciate Ligament Tear

et al. 2020

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Background: Impaction fractures of the posterolateral tibial plateau commonly occur in the setting of anterior cruciate ligament (ACL) tears, with considerable variability found in fracture size and morphologic features. Purpose: The primary objective was to characterize different morphologic variants of posterolateral tibial plateau impaction fractures. The secondary objective was to investigate the association between these impaction fracture variants and concomitant meniscal and ligamentous injuries. Study Design: Cross-sectional study; Level of evidence 3. Methods: Patients treated for primary ACL tears and having magnetic resonance imaging available were included in this study, and magnetic resonance images were reviewed with denotation of displaced posterolateral tibial impaction fractures. A classification system was created based on morphologic variants of impaction fractures; associations were evaluated through use of independent chi-square testing. Results: There were 825 knees meeting the inclusion criteria, with displaced posterolateral tibial plateau impaction fractures present in 407 knees (49.3%). We observed 3 distinct morphologic variants of lateral tibial plateau impaction fractures: (I) posterior cortical buckle not involving the articular surface; (II) posterior impaction fracture involving the articular surface, with subtypes based on (A) tibial plateau depth bone loss <10% and (B) bone loss >10%; and (III) displaced osteochondral fragment, with subtypes for (A) shear or (B) depressed fragment. Type IIIA impaction fractures were associated with an increased incidence of lateral meniscus posterior root tears (33.3% vs 12.4%; P = .009) and an increased incidence of lateral meniscal tears (83.3% vs 56.7%; P = .024) compared with all knees without type IIIA impaction fracture. An increased incidence of medial collateral ligament (MCL) tears was noted in patients with type IIIA impaction fractures compared with those who had no fracture or had another fracture type (61.1% vs 20.1%; P < .001). Type IIIB impaction fractures were associated with an increased incidence of lateral meniscal tears (80.0% vs 56.2%; P = .005). Conclusion: A high prevalence of displaced posterolateral tibial plateau impaction fractures occur in the setting of ACL tears, and they can be classified into distinct morphologic subtypes. Posterolateral tibial plateau impaction fractures with displaced depressed or shear fragments were both associated with an increased incidence of lateral meniscal tears, whereas impaction fractures with a shear fragment were associated with an increased incidence of lateral meniscus posterior root tears and MCL tears.

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

Cited by 20 publications

References 30 publications

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

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

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

Morphologic Variants of Posterolateral Tibial Plateau Impaction Fractures in the Setting of Primary Anterior Cruciate Ligament Tear

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