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Clinical consequences of bone bruise around the knee

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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.

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Correspondence to Patrice W. J. Vincken.

Appendix

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

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Vincken, P.W.J., ter Braak, B.P.M., van Erkel, A.R. et al. Clinical consequences of bone bruise around the knee. Eur Radiol 16, 97–107 (2006). https://doi.org/10.1007/s00330-005-2735-8

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Keywords

  • Knee
  • Knee
  • MR
  • Knee
  • Injuries
  • Knee
  • Ligaments
  • Menisci and cartilage