Comparison Between Sexes of Bone Contusions and Meniscal Tear Patterns in Noncontact Anterior Cruciate Ligament Injuries

Wittstein, Jocelyn; Vinson, Emily N.; Garrett, William E.

doi:10.1177/0363546514527415

Cited by 39 publications

(84 citation statements)

References 40 publications

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“…However, in a study reporting bone bruise frequency in non-contact and contact ACL injuries, bone bruises on the medial femoral condyle and medial tibial plateau were present in 38% and 60%, respectively, of subjects with a non-contact injury mechanism 57 . Similarly, a recent study analyzing 73 subjects with non-contact ACL injury reported that 84% of males and 89% of females had MR evidence of bone bruises in both medial and lateral compartments with no differences observed between the sexes 60 . These studies 57, 60 suggest that the present study focused on a relatively common pattern of bone bruising.…”

Section: Discussionmentioning

confidence: 86%

“…Similarly, a recent study analyzing 73 subjects with non-contact ACL injury reported that 84% of males and 89% of females had MR evidence of bone bruises in both medial and lateral compartments with no differences observed between the sexes 60 . These studies 57, 60 suggest that the present study focused on a relatively common pattern of bone bruising. Future studies may investigate knee positions associated with other patterns of bone bruising.…”

Section: Discussionmentioning

confidence: 86%

“…Due to the high incidence of bone bruising in the lateral compartment in individuals with ACL injury 53, 57, 62 , some studies have emphasized the importance of valgus rotation 48, 50 . Medial compartment bruising in non-contact injuries has been attributed to anterior tibial translation and internal tibial rotation rather than valgus stress due to the location of femoral condyle bruising relative to tibial plateau bruising 57, 60 . These different conclusions in the literature may be due in part to difficulties associated with inferring the position and orientation of the knee at the time of injury by observation of the location of bone bruising on MR images alone.…”

Section: Discussionmentioning

confidence: 99%

“…While previous studies have largely focused on lateral compartment bruises, recent studies have reported a relatively high incidence of medial compartment bone bruises 57, 60 . Perhaps one reason that medial compartment bruises are reported less frequently is that the intensity and depth of lateral compartment bruising may be significantly greater than medial compartment bruising on both the femoral condyles and the tibial plateau 57 .…”

Section: Discussionmentioning

confidence: 99%

“…This particular bone bruise pattern was selected because it allows for a unique solution for the numerical optimization. Furthermore, recent studies have suggested that more than 80% of patients with non-contact ACL injury have evidence of bone bruises in both medial and lateral compartments 60 .…”

Section: Methodsmentioning

confidence: 99%

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Knee Kinematics During Noncontact Anterior Cruciate Ligament Injury as Determined From Bone Bruise Location

et al. 2015

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Background The motions causing non-contact ACL injury remain unclear. Tibiofemoral bone bruises are believed to be the result of joint impact near the time of ACL rupture. The locations and frequencies of these bone bruises have been reported, but there is limited data quantifying knee position and orientation near the time of injury based on these contusions. Hypothesis Knee position and orientation near the time of non-contact ACL injury include extension and anterior tibial translation. Study Design Descriptive Laboratory Study Methods Magnetic resonance (MR) images of eight subjects with non-contact ACL injuries were acquired within one month of injury and subsequently analyzed. All subjects exhibited bruises on both the femur and tibia in both medial and lateral compartments. The outer margins of bone and the bone bruise surfaces were outlined on each image to create a 3D model of each subject’s knee in its position during MR imaging (MRI position). Numerical optimization was used to maximize overlap of the bone bruises on the femur and tibia and predict the position of injury. Flexion angle, valgus orientation, internal tibial rotation, and anterior tibial translation were measured in both the MRI position and the predicted position of injury. Differences in kinematics between the MRI position, which served as an unloaded reference, and the predicted position of injury were compared using paired t-tests. Results Flexion angle was near full extension in both the MRI position and the predicted position of injury (8° versus 12°, p=0.2). Statistically significant increases in valgus orientation (5°, p=0.003), internal tibial rotation (15°, p=0.003), and anterior tibial translation (22mm, p<0.001) were observed in the predicted position of injury relative to the MRI position. Conclusions These results suggest that for the bone bruise pattern studied, landing on an extended knee is high risk for ACL injury. Extension was accompanied by increased anterior tibial translation (22mm), internal tibial rotation (15°), and valgus rotation (5°) in the predicted position of injury relative to the MRI position. Clinical Relevance This study provides novel data characterizing the motions associated with ACL injury, information critical to improving strategies aimed at injury prevention.

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