The acutely ACL injured knee assessed by MRI: changes in joint fluid, bone marrow lesions, and cartilage during the first year

Frobell, Richard; Graverand, M.-P. Le; Buck, Robert J.; Roos, Ewa M.; Roos, Harald; Tamez-Peña, José G.; Tötterman, S.; Lohmander, L. Stefan

doi:10.1016/j.joca.2008.06.020

Cited by 137 publications

(154 citation statements)

References 35 publications

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“…Knees with depression fractures have posttraumatic BMLs of greater volumes; however, knees without such fractures are also affected by BMLs of various sizes. 30 Interestingly, we found that larger total knee BML volumes were related to higher levels of knee pain in knees without depression fractures but not in knees with depression fractures. This is not easily explained, although one possibility could be that impaction forces to subchondral bone produce more pain when the cortical bone remains intact than when it is depressed or even disrupted.…”

Section: Discussionmentioning

confidence: 56%

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Posttraumatic Bone Marrow Lesion Volume and Knee Pain Within 4 Weeks After Anterior Cruciate Ligament Injury

Driban

Lohmander

Frobell

2017

Journal of Athletic Training

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Context: After an anterior cruciate ligament (ACL) injury, a majority of patients have a traumatic bone marrow lesion (BML, or bone bruise). The clinical relevance of posttraumatic lesions remains unclear.Objective: To explore the cross-sectional associations between traumatic BML volume and self-reported knee pain and symptoms among individuals within 4 weeks of ACL injury.Design: Cross-sectional exploratory analysis of a randomized clinical trial.Setting: Orthopaedic departments at 2 hospitals in Sweden. Patients or Other Participants: As part of a randomized trial (knee anterior cruciate ligament nonoperative versus operative treatment [KANON] study), 121 young active adults (74% men, age ¼ 26 6 5 years, height ¼ 1.8 6 0.1 m, weight ¼ 76 6 13 kg) with an ACL tear were studied.Main Outcome Measure(s): The BML volume in the proximal tibia and distal femur was segmented using magnetic resonance images obtained within 4 weeks of injury. A radiologist evaluated the presence of depression fractures on the images. Pain and symptoms of the injured knee (Knee Injury and Osteoarthritis Outcome Score [KOOS] pain and symptoms subscales) were obtained the same day as imaging. We used linear regression models to assess the associations.Results: Most knees had at least 1 BML (96%), and the majority (57%) had a depression fracture. Whole-knee BML volume was not related to knee pain for the entire cohort (b ¼ À0.09, P ¼ .25). Among those without a depression fracture, larger whole-knee BML volume was associated with increased knee pain (b ¼ -0.46, P ¼ .02), whereas no association was found for those with a depression fracture (b ¼ 0.0, P ¼ .96). Larger medial (b ¼ -0.48, P ¼ .02) but not lateral (b ¼ -0.03, P ¼ .77) tibiofemoral BML volume was associated with greater pain. We found no association between BML volume and knee symptoms.Conclusions: We confirmed the absence of relationships between whole-knee BML volume and pain and symptoms within 4 weeks of ACL injury. Our findings extend previous reports in identifying weak associations between larger BML volume in the medial compartment and greater pain and between BML volume and greater pain among those without a depression fracture.Key Words: knee injuries, magnetic resonance imaging, sprains, trauma, patient-reported outcomes Key PointsWithin 4 weeks of anterior cruciate ligament injury, total-knee bone marrow lesion volume and self-reported pain and symptoms were not associated. More pain was weakly related to greater medial compartment and greater total-knee bone marrow lesion volume and to greater bone marrow lesion volume among participants without a depression fracture.

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Section: Discussionmentioning

confidence: 56%

“…30 In brief, a depression fracture was defined as a trabecular fracture (a line with low signal and parallel to the cortex) combined with depressed cortical bone.…”

Section: Depression Fracturesmentioning

confidence: 99%

Posttraumatic Bone Marrow Lesion Volume and Knee Pain Within 4 Weeks After Anterior Cruciate Ligament Injury

Driban

Lohmander

Frobell

2017

Journal of Athletic Training

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“…Excessive joint effusion in conjunction to ACL injury and reconstructive surgery has been documented previously, as joint fluid volumes after ACL injury and surgery [7], but without specific frequency data. In that study, factors such as age, sex and pre-injury activity level had no association to the given joint fluid volumes.…”

Section: Predictors For Effusion Three Months Post-operativelymentioning

confidence: 90%

“…In addition, three months after ACL reconstruction (ACLR), reconstructed knees were observed to have three times the amount of joint effusion as studied by MRI, compared to knees with ACL injury alone [7]. Excessive knee joint effusion, in itself, may be part of the process of joint cartilage degradation after joint trauma and surgery [8,9].…”

Section: Introductionmentioning

confidence: 99%

Post-operative bracing after ACL reconstruction has no effect on knee joint effusion. A prospective, randomized study

et al. 2015

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“…& It is important that we define specific types of OA such as that associated with aging [10], obesity [4], and trauma [3] and to understand how they differ in terms of causative mechanisms [2]. & A number of potential therapeutic compounds for OA are known [11] (Table 1).…”

Section: Snow Iv: Barriers and Opportunities For New Interventions In Oamentioning

confidence: 99%

Osteoarthritis: A Perspective from the Arthritis Foundation

Hardin

2012

HSS Jrnl

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The acutely ACL injured knee assessed by MRI: changes in joint fluid, bone marrow lesions, and cartilage during the first year

Cited by 137 publications

References 35 publications

Posttraumatic Bone Marrow Lesion Volume and Knee Pain Within 4 Weeks After Anterior Cruciate Ligament Injury

Posttraumatic Bone Marrow Lesion Volume and Knee Pain Within 4 Weeks After Anterior Cruciate Ligament Injury

Post-operative bracing after ACL reconstruction has no effect on knee joint effusion. A prospective, randomized study

Osteoarthritis: A Perspective from the Arthritis Foundation

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