Skip to main content
SpringerLink
Log in

Association between traumatic bone marrow abnormalities of the knee, the trauma mechanism and associated soft-tissue knee injuries

  • Musculoskeletal
  • Published:
European Radiology Aims and scope Submit manuscript

Abstract

Objectives

To determine the association between traumatic bone marrow abnormalities, the knee injury mechanism, and associated soft tissue injuries in a larger cohort than those in the published literature.

Method

Retrospective study including 220 patients with traumatic knee injuries. Knee MRIs were evaluated for trauma mechanism, soft tissue injury, and the location of bone marrow abnormalities. The locations of the abnormalities were correlated with trauma mechanisms and soft tissue injuries using the chi-square test with Bonferroni correction.

Results

One hundred and forty-four valgus injuries, 39 pivot shift injuries, 25 lateral patellar dislocations, 8 hyperextensions, and 4 dashboard injuries were included. Valgus and pivot shift injuries showed traumatic bone marrow abnormalities in the posterolateral regions of the tibia. Abnormalities after patellar dislocation were found in the anterolateral and centrolateral femur and patella. Hyperextension injuries were associated with abnormalities in almost all regions, and dashboard injuries were associated with changes in the anterior regions of the tibia and femur.

Conclusions

Our study provides evidence of associations between traumatic bone marrow abnormality patterns and different trauma mechanisms in acute knee injury, and reveals some overlap, especially of the two most common trauma mechanisms (valgus and pivot shift), in a large patient cohort.

Key Points

• Specific bone marrow oedema patterns after knee trauma were confirmed.

• New associations between bone marrow oedema patterns and knee trauma were shown.

• Bone marrow oedema patterns help in identifying associated soft tissue injuries.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Majewski MHS, Steinbrück K (2006) Epidemiology of athletic knee injuries: A 10-year study. Knee 13:184–188

    Article  CAS  PubMed  Google Scholar 

  2. Vellet AD, Marks PH, Fowler PJ, Munro TG (1991) Occult posttraumatic osteochondral lesions of the knee: prevalence, classification, and short-term sequelae evaluated with MR imaging. Radiology 178:271–276

    Article  CAS  PubMed  Google Scholar 

  3. Chin YC, Wijaya R, Chong LR, Chang HC, Lee YH (2013) Bone bruise patterns in knee injuries: where are they found? Eur J Orthop Surg Traumatol. doi:10.1007/s00590-013-1319-6

    PubMed  Google Scholar 

  4. Bisson LJ, Kluczynski MA, Hagstrom LS, Marzo JM (2013) A Prospective Study of the Association Between Bone Contusion and Intra-articular Injuries Associated With Acute Anterior Cruciate Ligament Tear. Am J Sports Med. doi:10.1177/0363546513490649

    PubMed Central  Google Scholar 

  5. Yoon KH, Yoo JH, Kim KI (2011) Bone contusion and associated meniscal and medial collateral ligament injury in patients with anterior cruciate ligament rupture. J Bone Joint Surg Am 93:1510–1518

    Article  PubMed  Google Scholar 

  6. Viskontas DG, Giuffre BM, Duggal N, Graham D, Parker D, Coolican M (2008) Bone bruises associated with ACL rupture: correlation with injury mechanism. Am J Sports Med 36:927–933

    Article  PubMed  Google Scholar 

  7. Twaddle BC, Hunter JC, Chapman JR, Simonian PT, Escobedo EM (1996) MRI in acute knee dislocation. A prospective study of clinical, MRI, and surgical findings. J Bone Joint Surg Br 78:573–579

    CAS  PubMed  Google Scholar 

  8. 8Hayes CW, Brigido MK, Jamadar DA, Propeck T (2000) Mechanism-based pattern approach to classification of complex injuries of the knee depicted at MR imaging. RadioGraphics 20 Spec No:S121–134

  9. Remer EM, Fitzgerald SW, Friedman H, Rogers LF, Hendrix RW, Schafer MF (1992) Anterior cruciate ligament injury: MR imaging diagnosis and patterns of injury. RadioGraphics 12:901–915

    Article  CAS  PubMed  Google Scholar 

  10. 10Sanders TG, Medynski MA, Feller JF, Lawhorn KW (2000) Bone contusion patterns of the knee at MR imaging: footprint of the mechanism of injury. RadioGraphics 20 Spec No:S135–151

  11. Ucar BY, Necmioglu S, Bulut M, Azboy I, Demirtas A, Gumus H (2012) Determining bone bruises of the knee with magnetic resonance imaging. Open Orthop J 6:464–467

    Article  PubMed  PubMed Central  Google Scholar 

  12. Peterfy CG, Guermazi A, Zaim S et al (2004) Whole-Organ Magnetic Resonance Imaging Score (WORMS) of the knee in osteoarthritis. Osteoarthritis Cartilage 12:177–190

    Article  CAS  PubMed  Google Scholar 

  13. Schweitzer ME, Tran D, Deely DM, Hume EL (1995) Medial collateral ligament injuries: evaluation of multiple signs, prevalence and location of associated bone bruises, and assessment with MR imaging. Radiology 194:825–829

    Article  CAS  PubMed  Google Scholar 

  14. Rubin DA (1997) MR imaging of the knee menisci. Radiol Clin N Am 35:21–44

    CAS  PubMed  Google Scholar 

  15. Landis JR, Koch GG (1977) The measurement of observer agreement for categorical data. Biometrics 33:159–174

    Article  CAS  PubMed  Google Scholar 

  16. Elias DA, White LM, Fithian DC (2002) Acute lateral patellar dislocation at MR imaging: injury patterns of medial patellar soft-tissue restraints and osteochondral injuries of the inferomedial patella. Radiology 225:736–743

    Article  PubMed  Google Scholar 

  17. Sonin AH, Fitzgerald SW, Friedman H, Hoff FL, Hendrix RW, Rogers LF (1994) Posterior cruciate ligament injury: MR imaging diagnosis and patterns of injury. Radiology 190:455–458

    Article  CAS  PubMed  Google Scholar 

  18. Sonin AH, Fitzgerald SW, Hoff FL, Friedman H, Bresler ME (1995) MR imaging of the posterior cruciate ligament: normal, abnormal, and associated injury patterns. RadioGraphics 15:551–561

    Article  CAS  PubMed  Google Scholar 

  19. Mink JH, Deutsch AL (1989) Occult cartilage and bone injuries of the knee: detection, classification, and assessment with MR imaging. Radiology 170:823–829

    Article  CAS  PubMed  Google Scholar 

  20. Zhang GY, Zheng L, Ding HY, Li EM, Sun BS, Shi H (2015) Evaluation of medial patellofemoral ligament tears after acute lateral patellar dislocation: comparison of high-frequency ultrasound and MR. Eur Radiol 25:274–281

    Article  PubMed  Google Scholar 

  21. Graf BK, Cook DA, De Smet AA, Keene JS (1993) "Bone bruises" on magnetic resonance imaging evaluation of anterior cruciate ligament injuries. Am J Sports Med 21:220–223

    Article  CAS  PubMed  Google Scholar 

  22. Van Dyck P, Clockaerts S, Vanhoenacker FM et al (2016) Anterolateral ligament abnormalities in patients with acute anterior cruciate ligament rupture are associated with lateral meniscal and osseous injuries. Eur Radiol. doi:10.1007/s00330-015-4171-8

    PubMed  Google Scholar 

  23. Mair SD, Schlegel TF, Gill TJ, Hawkins RJ, Steadman JR (2004) Incidence and location of bone bruises after acute posterior cruciate ligament injury. Am J Sports Med 32:1681–1687

    Article  PubMed  Google Scholar 

  24. Miller MD, Osborne JR, Gordon WT, Hinkin DT, Brinker MR (1998) The natural history of bone bruises. A prospective study of magnetic resonance imaging-detected trabecular microfractures in patients with isolated medial collateral ligament injuries. Am J Sports Med 26:15–19

    CAS  PubMed  Google Scholar 

  25. Geeslin AG, LaPrade RF (2010) Location of bone bruises and other osseous injuries associated with acute grade III isolated and combined posterolateral knee injuries. Am J Sports Med 38:2502–2508

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

The scientific guarantor of this publication is Dr. med. Erika J. Ulbrich. The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article. The authors state that this work has not received any funding. One of the authors has significant statistical expertise. Institutional Review Board approval was not required because according to local laws and institutional regulations, written informed consent was not necessary for this retrospective study. The study was compliant with the current Declaration of Helsinki and the Health Insurance Portability and Accountability Act (HIPAA). Methodology: retrospective, observational, performed at one institution.

Author information

Authors and Affiliations

  1. Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Ramistrasse 100, CH – 8091, Zurich, Switzerland

    Nicole Berger, Gustav Andreisek, Anissja T. Karer, Andrei Manoliu & Erika J. Ulbrich

  2. Department of Forensic Medicine and Radiology, Institute of Forensic Medicine, University of Zurich, Winterthurerstrasse 190/52, 8057, Zurich, Switzerland

    Nicole Berger

  3. Department of Trauma Surgery, University Hospital Zurich, Ramistrasse 100, 8091, Zurich, Switzerland

    Samy Bouaicha

  4. Department of Medical Imaging, Mount Sinai Hospital and the University Health Network, University of Toronto, 600 University Ave, Toronto, ON, M5G 1X5, Canada

    Ali Naraghi

  5. Epidemiology, Biostatistics and Prevention Institute, Department of Biostatistics, University of Zurich, Hirschengraben 84, 8001, Zurich, Switzerland

    Burkhardt Seifert

Authors
  1. Nicole Berger
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Gustav Andreisek
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Anissja T. Karer
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Samy Bouaicha
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Ali Naraghi
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Andrei Manoliu
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Burkhardt Seifert
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Erika J. Ulbrich
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Nicole Berger.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Berger, N., Andreisek, G., Karer, A.T. et al. Association between traumatic bone marrow abnormalities of the knee, the trauma mechanism and associated soft-tissue knee injuries. Eur Radiol 27, 393–403 (2017). https://doi.org/10.1007/s00330-016-4339-x

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00330-016-4339-x

Keywords

Search

Navigation