Examining the Distribution of Bone Bruise Patterns in Contact and Noncontact Acute Anterior Cruciate Ligament Injuries

Abstract

Background: Bone bruises are commonly seen on magnetic resonance imaging (MRI) in acute anterior cruciate ligament (ACL) injuries and can provide insight into the underlying mechanism of injury. There are limited reports that have compared the bone bruise patterns between contact and noncontact mechanisms of ACL injury. Purpose: To examine and compare the number and location of bone bruises in contact and noncontact ACL injuries. Study Design: Cross-sectional study; Level of evidence, 3. Methods: Three hundred twenty patients who underwent ACL reconstruction surgery between 2015 and 2021 were identified. Inclusion criteria were clear documentation of the mechanism of injury and MRI within 30 days of the injury on a 3-T scanner. Patients with concomitant fractures, injuries to the posterolateral corner or posterior cruciate ligament, and/or previous ipsilateral knee injury were excluded. Patients were stratified into 2 cohorts based on a contact or noncontact mechanism. Preoperative MRI scans were retrospectively reviewed by 2 musculoskeletal radiologists for bone bruises. The number and location of the bone bruises were recorded in the coronal and sagittal planes using fat-suppressed T2-weighted images and a standardized mapping technique. Lateral and medial meniscal tears were recorded from the operative notes, while medial collateral ligament (MCL) injuries were graded on MRI. Results: A total of 220 patients were included, with 142 (64.5%) noncontact injuries and 78 (35.5%) contact injuries. There was a significantly higher frequency of men in the contact cohort compared with the noncontact cohort (69.2% vs 54.2%, P = .030), while age and body mass index were comparable between the 2 cohorts. The bivariate analysis demonstrated a significantly higher rate of combined lateral tibiofemoral (lateral femoral condyle [LFC] + lateral tibial plateau [LTP]) bone bruises (82.1% vs 48.6%, P < .001) and a lower rate of combined medial tibiofemoral (medial femoral condyle [MFC] + medial tibial plateau [MTP]) bone bruises (39.7% vs 66.2%, P < .001) in knees with contact injuries. Similarly, noncontact injuries had a significantly higher rate of centrally located MFC bone bruises (80.3% vs 61.5%, P = .003) and posteriorly located MTP bruises (66.2% vs 52.6%, P = .047). When controlling for age and sex, the multivariate logistical regression model demonstrated that knees with contact injuries were more likely to have LTP bone bruises (OR, 4.721 [95% CI, 1.147-19.433], P = .032) and less likely to have combined medial tibiofemoral (MFC + MTP) bone bruises (OR, 0.331 [95% CI, 0.144-0.762], P = .009) compared with those with noncontact injuries. Conclusion: Significantly different bone bruise patterns were observed on MRI based on ACL injury mechanism, with contact and noncontact injuries demonstrating characteristic findings in the lateral tibiofemoral and medial tibiofemoral compartments, respectively.

Comparison of Bone Bruise Patterns Epidemiology between ACL Rupture and Patellar Dislocation Patients-Implications of Injury Mechanism

“…Our study not only recorded the bone bruise but also calculate the specific location of bone bruises of ACL rupture and patellar dislocation (Fig 6). For non-contact sports knee injury, bone bruise is not only an intensity signal, but also a footprint of damaging process, which could be as implications of injury mechanism, or the product of the mechanism since different mechanisms of injury have different bone bruise patterns 25 . Numerical optimization was used to maximize overlap of the bone bruises on the femur and tibia and to predict the position of injury by Kim Sophia Y, at al who choose the most commonly 3-and 4-bone bruise of ACL rupture as Infrastructure to create 3-dimensional surface models, and found landing on an extended knee is a high risk for ACL injury 15,17 while others found that knee valgus is the critical component of the injury mechanism 12,19,26 .…”

“…Previous studies have also shown that bone bruises of the knee on MRI could provide implications for the mechanism of ACL and patellar dislocation injury 20,35,37 . In addition, the bone bruise patterns of femur and tibia in ACL injury differed with the femur and patella bone bruises in patellar dislocation 25,41 , and there are actually limited reports that have compared the bone bruise patterns between different knee injury.…”

The influence of distribution, severity and volume of posttraumatic bone bruise on functional outcome after ACL reconstruction for isolated ACL injuries

“…Several authors identified an association between BB distribution and injury mechanism, e.g., non-contact valgus injuries represented by BB predominantly in the LTP and LFC [ 3 , 9 , 34 , 45 – 47 ]. Other authors found medial BB representative of extension and anterior tibial translation mechanisms [ 37 , 48 ].…”

The “Bankart knee”: high‐grade impression fractures of the posterolateral tibial plateau lead to increased translational and anterolateral rotational instability of the ACL‐deficient knee

“…The occult fractures described in these studies were primarily of the bone bruise type, sometimes referred to as nondisplaced fractures. Their typical localization in the anterior to middle segment of the lateral femoral condyle (LFC) and the middle to posterior segment of the lateral tibial plateau (LTP) reflects the mechanism of injury to the ACL, in which the lateral tibial plateau subluxates anteriorly, resulting in a violent collision between the anterolateral aspect of the LFC and the posterolateral area of the tibial plateau (PLTP) [7, 8, 12, 22, 31, 40].…”