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The Association Between Bone Bruises and Concomitant Ligaments Injuries in Anterior Cruciate Ligament Injuries: A Systematic Review and Meta-analysis

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Abstract

Background

Bone bruises and concomitant ligament injuries after anterior cruciate ligament (ACL) injuries have attracted attention, but their correlation and potential clinical significance remain unclear.

Purpose

To assess the relationship between bone bruises and concomitant ligamentous injuries in ACL injuries.

Study design

Systematic review.

Methods

A comprehensive search of PubMed, Embase, Web of Science, and Cochrane Library was completed from inception to October 20, 2021. All articles that evaluated the relationship between bone bruises and related ligaments injuries were included. Methodological Index for Non-Randomized Studies (MINORS) was used for quality assessment as well as Review Manager 5.3 was used for data analysis.

Results

A total of 19 studies evaluating 3292 patients were included. After meta-analysis, anterolateral ligament (ALL) injuries were associated with bone bruising on the lateral tibial plateau (LTP) (RR = 2.33; 95% CI 1.44–3.77; p = 0.0006), lateral femoral condyle (LFC) (RR = 1.97; 95% CI 1.37–2.85; p = 0.0003) and medial tibial plateau (MTP) (RR = 1.62; 95% CI 1.24–2.11; p = 0.0004); Moreover, medial collateral ligament (MCL) injuries were associated with bone bruising on the femur (RR = 1.49; 95% CI 1.17–1.90; p = 0.001), and no statistical significance was found between bone bruising on the MTP and Kaplan fiber (KF) injuries (RR = 1.58; 95% CI 1.00–2.49; p = 0.05). Nonetheless, the current evidence did not conclude that bone bruises were associated with lateral collateral ligament (LCL) injuries.

Conclusion

For individuals with an ACL injury, bone bruises of the LTP, LFC, and MTP can assist in the diagnosis of ALL injuries. Furthermore, femoral bruising has potential diagnostic value for MCL injuries. Knowing these associations allows surgeons to be alert to ACL-related ligament injuries on MRI and during operations in future clinical practice.

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Acknowledgements

The authors would like to acknowledge the help of Wenjia Du in writing the discussion part by giving beneficial suggestions.

Funding

The National Natural Science Foundation of China (81874017, 81960403, and 82060405); Lanzhou Science and Technology Plan Program (20JR5RA320); Cuiying Scientific and Technological Innovation Program of Lanzhou University Second Hospital (CY2017-ZD02, CY2021-MS-A07).

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  1. Zhi Yi, Jin Jiang and Zhongcheng Liu contributed equally to this work.

Authors and Affiliations

  1. Department of Orthopaedics, Orthopaedic Clinical Research Center of Gansu Province, Intelligent Orthopaedic Industry Technology Center of Gansu Province, Lanzhou University Second Hospital, No. 82 Cuiyingmen, Chengguan District, Lanzhou, 730000, Gansu, People’s Republic of China

    Zhi Yi, Jin Jiang, Zhongcheng Liu, Hong Wang, Qiong Yi, Hongwei Zhan, Xiaoyuan Liang, Yongkang Niu, Dejian Xiang, Bin Geng, Yayi Xia & Meng Wu

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Yi, Z., Jiang, J., Liu, Z. et al. The Association Between Bone Bruises and Concomitant Ligaments Injuries in Anterior Cruciate Ligament Injuries: A Systematic Review and Meta-analysis. JOIO 57, 20–32 (2023). https://doi.org/10.1007/s43465-022-00774-6

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