Clinical consequences of bone bruise around the knee

Abstract

The aim of this study is to evaluate the relation between bone bruise and (peri-)articular derangement and to assess the impact of bone bruise on presentation and short term course of knee complaints. We recorded MR abnormalities in 664 consecutive patients with sub-acute knee complaints. Patients were divided in four groups: patients with and without intra-articular knee pathology, subdivided in patients with and without bone bruise. We assessed function and symptoms at the time of MR and 6 months thereafter. Bone bruises were diagnosed in 124 of 664 patients (18.7%). Patients with bone bruise had significantly more complete ACL, lateral meniscal, MCL and LCL tears. Both with and without intra-articular pathology patients with bone bruise had a significantly poorer function at the time of MR (Noyes score of, respectively, 313.21 versus 344.81 and 306.98 versus 341.19). Patients with bone bruise and intra-articular pathology showed significantly more decrease in activity (decrease of Tegner score from 6.28 to 2.12 versus 5.70–2.55). At 6 months there were no significant differences in clinical parameters between the four groups. We concluded that bone bruise in combination with MCL tear is an important cause of initial clinical impairment in patients with sub-acute knee complaints. Clinical improvement within 6 months is more pronounced than in patients without bone bruise.

Appendix

Noyes assessment of function

Activity	Scale	Points
Walking	Normal, unlimited	50
	Some limitations	40
	Only 1 km possible on even surface	30
	Less than 500 m possible	20
	Less than 100 m possible	0
Stairs	Normal, unlimited	50
	Some limitations	40
	Only 21–30 steps possible	30
	Only 11–20 steps possible	20
	Less than ten steps possible	0
Squatting/kneeling	Normal, unlimited	50
	Some limitations	40
	Only six to ten possible	30
	Only zero to five possible	20
	Impossible	0
Straight running	Fully competitive	100
	Some limitations, guarding	80
	Half-speed, definite limitations	70
	Less than 200 m	60
	Not able	50
Sprinting	Fully competitive	100
	Some limitations	80
	Half-speed, definite limitations	70
	Only a couple of times in short time period	60
	Not able	50
Jumping	Fully competitive	100
	Some limitations	80
	Half-speed, definite limitations	70
	Limitations in every sport	60
	Not able	50
Twisting/cutting	Fully competitive	100
	Some limitations	80
	Definite limitations	70
	Limitations in every sport	60
	Not able	50

Noyes assessment of symptoms

Symptom	Scale	Points
Pain	None	100
	Able to do moderate work/sports; pain with strenuous work/sports	80
	Able to do light work/sports; pain with moderate work/sports	60
	Able to do activities of daily living (ADL); pain with light work/sports	40
	Moderate pain (frequent, limiting) with ADL	20
	Severe pain (constant, not relieved) with ADL	0
Swelling	None	100
	Able to do moderate work/sports; swelling with strenuous work/sports	80
	Able to do light work/sports; swelling with moderate work/sports	60
	Able to do activities of daily living (ADL); swelling with light work/sports	40
	Moderate swelling (frequent, limiting) with ADL	20
	Severe swelling (constant, not relieved) with ADL	0
Instability/giving way	None	100
	Able to do moderate work/sports; instability with strenuous work/sports	80
	Able to do light work/sports; instability with moderate work/sports	60
	Able to do activities of daily living (ADL); instability with light work/sports	40
	Moderate instability (frequent, limiting) with ADL	20
	Severe instability (constant, not relieved) with ADL	0
Locking	No locking and no catching sensation	100
	Less than monthly catching sensation but no locking	80
	More than once a month catching sensation but less than monthly locking	60
	Monthly locking	40
	Weekly locking	20
	Daily locking	0

Tegner Activity Score

Activity	Points
Competitive sports	10
Soccer, national and international elite
Competitive sports	9
Soccer, lower divisions
Ice hockey
Wrestling
Gymnastics
Competitive sports	8
Bandy
Squash or badminton
Athletics (jumping, etc.)
Downhill skiing
Competitive sports	7
Tennis
Athletics (running)
Motorcross, speedway
Handball
Basketball
Recreational sports
Soccer
Bandy and ice hockey
Squash
Athletics (jumping)
Cross-country, both recreational and competitive
Recreational sports	6
Tennis and badminton
Handball
Basketball
Downhill skiing
Jogging, at least 5 times per week
Work	5
Heavy labor (e.g., building, forestry)
Competitive sports
Cycling
Cross-country skiing
Recreational sports
Jogging on uneven ground at least twice weekly
Work	4
Moderately heavy labor (e.g. truck driving, heavy domestic work)
Recreational sports
Cycling
Cross-country skiing
Jogging on even ground at least twice weekly
Work	3
Light labor (e.g. nursing)
Competitive and recreational sports
Swimming
Walking in forest possible
Work	2
Light labor
Walking on uneven ground possible but impossible to walk in forest
Work	1
Sedentary work
Walking on even ground possible
Sick leave or disability pension because of knee problems	0