Bone bruise in anterior cruciate ligament rupture entails a more severe joint damage affecting joint degenerative progression

Abstract

Purpose During anterior cruciate ligament (ACL) injury, the large external forces responsible for ligament rupture cause a violent impact between tibial and femoral articular cartilage, which is transferred to bone resulting in bone bruise detectable at MRI. Several aspects remain controversial and await evidence on how this MRI finding should be managed while addressing the ligament lesion. Thus, the aim of the present review was to document the evidence of all available literature on the role of bone bruise associated with ACL lesions. Methods A systematic review of the literature was performed on bone bruise associated with ACL injury. The search was conducted in September 2017 on three medical electronic databases: PubMed, Web of Science, and the Cochrane Collaboration. Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines were used. Relevant articles were studied to investigate three main aspects: prevalence and progression of bone bruise associated with ACL lesions, its impact on the knee in terms of lesion severity and joint degeneration progression over time and, finally, the influence of bone bruise on patient prognosis in terms of clinical outcome. Results The search identified 415 records and, after an initial screening according to the inclusion/exclusion criteria, 83 papers were used for analysis, involving a total of 10,047 patients. Bone bruise has a high prevalence (78% in the most recent papers), with distinct patterns related to the mechanism of injury. This MRI finding is detectable only in a minority of cases the first few months after trauma, but its presence and persistence have been correlated to a more severe joint damage that may affect the degenerative progression of the entire joint, with recent evidence suggesting possible effects on long-term clinical outcome. Conclusion This systematic review of the literature documented a growing interest on bone bruise associated with ACL injury, highlighting aspects which could provide to orthopaedic surgeons evidence-based suggestions in terms of clinical relevance when dealing with patients affected by bone bruise following ACL injury. However, prospective long-term studies are needed to better understand the natural history of bone bruise, identifying prognostic factors and targets of specific treatments that should be developed in light of the overall joint derangements accompanying ACL lesions. Levels of evidence IV, Systematic review of level I-IV studies.

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

“…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.…”

“…In the pediatric patients analyzed in this study, the prevalence of bone bruises (69%) seemed to be slightly lower than in adults. 6,29 In fact, although high prevalence values have been reported in the overall literature, the most recent findings (excluding older studies with poor imaging techniques) documented a 78% prevalence. 6 It is possible that the higher ligamentous laxity of younger patients, along with differences in their tissue composition, reduces the trauma that follows an ACL lesion, thus leading to a lower incidence of bone bruise than in adults.…”

“…Bone bruises have been thoroughly investigated in adults with ACL tears, 6 but little is known about how bone bruises affect pediatric patients. This study of bone bruise documented presence, distribution pattern, and association with other joint lesions in the pediatric population.…”

“…The main finding of this study is that bone bruise is frequent in pediatric patients with ACL tears, affecting 69% of patients; the lateral posterior tibia and lateral central femur are involved most frequently, often being associated with lesions of the meniscus and other ligaments but rarely implying damage of the overlying cartilage layer. Bone bruises have been thoroughly investigated in adults with ACL tears, 6 but little is known about how bone bruises affect pediatric patients. This study of bone bruise documented presence, distribution pattern, and association with other joint lesions in the pediatric population.…”

“…7 Although controversial findings on the importance of bone bruise have been reported in the literature, 13,30,38 the presence of bone bruise has been suggested to correlate with the level of derangement of the joint, and bone bruise has been proposed as an indicator of how much the trauma has affected joint homeostasis and patient prognosis. 6,24 Although much research has been done on the implications of bone bruising in adults with ACL tears, little is known regarding how bone bruises affect pediatric patients, whose higher ligamentous laxity may lead to different lesion patterns than in adults. 18,25 The only study to date that addressed bone bruises in pediatric patients with ACL tears used bone bruise as a surrogate measure of joint trauma, 21 thus providing a limited picture of the issue.…”