Skip to main content

Advertisement

Log in

Prevalence and Location of Bone Bruises Associated with Anterior Cruciate Ligament Injury and Implications for Mechanism of Injury: A Systematic Review

  • Systematic Review
  • Published:
Sports Medicine Aims and scope Submit manuscript

Abstract

Background

Bone bruising is commonly observed on magnetic resonance imaging (MRI) after non-contact anterior cruciate ligament (ACL) injury.

Objectives

The primary objective of this study was to determine if the location and prevalence of tibial and femoral bone bruises after ACL injury can be explained by specific injury mechanism(s). The secondary objective was to determine whether the bone-bruise literature supports sex-specific injury mechanism(s). We hypothesized that most studies would report bone bruising in the lateral femoral condyle (LFC) and on the posterior lateral tibial plateau (LTP).

Methods

MEDLINE, PubMed, and SCOPUS were searched for studies that reported bone bruise prevalence and location in ACL-injured subjects. Sex differences in bone-bruise patterns were assessed. Time from injury to imaging was assessed to account for confounding effects on bone-bruise size and location.

Results

Thirty-eight studies met the inclusion/exclusion criteria. Anterior–posterior location of bone bruises within the tibiofemoral compartment was assessed in 11 studies. Only five of these studies reported bone-bruise locations on both the tibia and the femur. The most common bone-bruise combination in all five studies was on the LFC and the posterior LTP. Sex differences were only assessed in three studies, and only one reported significantly greater prevalence of LTP bruising in females.

Conclusion

Bone-bruise patterns in the current literature support a valgus-driven ACL injury mechanism; however, more studies should report the specific locations of tibial and femoral bone bruises. There is insufficient evidence in the literature to determine whether there are sex-specific bone-bruise patterns in ACL-injured subjects.

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

Access this article

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

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

Notes

  1. This mechanism, also known as the multiplanar valgus loading injury mechanism, involves a valgus load applied to the knee during various states of flexion combined with internal rotation of the femur and external rotation of the tibia. The rupture of the ACL is then followed by anterior subluxation of the tibia relative to the femur that results in an impact of the LFC against the posterior aspect of the LFC.

  2. This mechanism is associated with antero-lateral tibial and LFC contusions.

  3. This mechanism is associated with antero-medial tibial and LFC contusions.

  4. After the lateral aspects of the tibia and femur collide during the ACL injury, the knee reduces and goes into compensatory varus alignment. This results in the collision between the medial aspects of the tibia and femur.

  5. This refers to the lateral compartment of either the tibia or femur.

References

  1. National Federation of State High School Associations. 2002 high school participation survey. Indianapolis: National Federation of State High School Associations; 2002.

  2. Hewett TE, Myer GD, Ford KR, et al. Biomechanical measures of neuromuscular control and valgus loading of the knee predict anterior cruciate ligament injury risk in female athletes: a prospective study. Am J Sports Med. 2005;33(4):492–501.

    Article  PubMed  Google Scholar 

  3. Ferretti A, Papandrea P, Conteduca F, et al. Knee ligament injuries in volleyball players. Am J Sports Med. 1992;20(2):203–7.

    Article  CAS  PubMed  Google Scholar 

  4. Gray J, Taunton JE, McKenzie DC, et al. A survey of injuries to the anterior cruciate ligament of the knee in female basketball players. Int J Sports Med. 1985;6(6):314–6.

    Article  CAS  PubMed  Google Scholar 

  5. Hutchinson MR, Ireland ML. Knee injuries in female athletes. Sports Med. 1995;19(4):288–302.

    Article  CAS  PubMed  Google Scholar 

  6. Zelisko JA, Noble HB, Porter M. A comparison of men’s and women’s professional basketball injuries. Am J Sports Med. 1982;10(5):297–9.

    Article  CAS  PubMed  Google Scholar 

  7. Krosshaug T, Nakamae A, Boden BP, et al. Mechanisms of anterior cruciate ligament injury in basketball: video analysis of 39 cases. Am J Sports Med. 2007;35(3):359–67.

    Article  PubMed  Google Scholar 

  8. Speer KP, Spritzer CE, Bassett FH 3rd, et al. Osseous injury associated with acute tears of the anterior cruciate ligament. Am J Sports Med. 1992;20(4):382–9.

    Article  CAS  PubMed  Google Scholar 

  9. Kaplan PA, Gehl RH, Dussault RG, et al. Bone contusions of the posterior lip of the medial tibial plateau (contrecoup injury) and associated internal derangements of the knee at MR imaging. Radiology. 1999;211(3):747–53.

    Article  CAS  PubMed  Google Scholar 

  10. Rosen MA, Jackson DW, Berger PE. Occult osseous lesions documented by magnetic resonance imaging associated with anterior cruciate ligament ruptures. Arthroscopy. 1991;7(1):45–51.

    Article  CAS  PubMed  Google Scholar 

  11. Speer KP, Warren RF, Wickiewicz TL, et al. Observations on the injury mechanism of anterior cruciate ligament tears in skiers. Am J Sports Med. 1995;23(1):77–81.

    Article  CAS  PubMed  Google Scholar 

  12. Spindler KP, Schils JP, Bergfeld JA, et al. Prospective study of osseous, articular, and meniscal lesions in recent anterior cruciate ligament tears by magnetic resonance imaging and arthroscopy. Am J Sports Med. 1993;21(4):551–7.

    Article  CAS  PubMed  Google Scholar 

  13. Vellet AD, Marks PH, Fowler PJ, et al. Occult posttraumatic osteochondral lesions of the knee: prevalence, classification, and short-term sequelae evaluated with MR imaging. Radiology. 1991;178(1):271–6.

    CAS  PubMed  Google Scholar 

  14. Quatman CE, Kiapour A, Myer GD, et al. Cartilage pressure distributions provide a footprint to define female anterior cruciate ligament injury mechanisms. Am J Sports Med. 2011;39(8):1706–13.

    Article  PubMed Central  PubMed  Google Scholar 

  15. Sanders TG, Medynski MA, Feller JF, et al. Bone contusion patterns of the knee at MR imaging: footprint of the mechanism of injury. Radiographics. 2000;20(Spec No):S135–51.

    Google Scholar 

  16. Spindler KP, Kuhn JE, Dunn W, et al. Reading and reviewing the orthopaedic literature: a systematic, evidence-based medicine approach. J Am Acad Orthop Surg. 2005;13(4):220–9.

    PubMed  Google Scholar 

  17. Graf BK, Cook DA, De Smet AA, et al. “Bone bruises” on magnetic resonance imaging evaluation of anterior cruciate ligament injuries. Am J Sports Med. 1993;21(2):220–3.

    Article  CAS  PubMed  Google Scholar 

  18. Kaneko K, Demouy EH, Brunet ME. Correlation between occult bone lesions and meniscoligamentous injuries in patients with traumatic knee joint disease. Clin Imaging. 1993;17(4):253–7.

    Article  CAS  PubMed  Google Scholar 

  19. Viskontas DG, Giuffre BM, Duggal N, et al. Bone bruises associated with ACL rupture: correlation with injury mechanism. Am J Sports Med. 2008;36(5):927–33.

    Article  PubMed  Google Scholar 

  20. Stein V, Li L, Lo G, et al. Pattern of joint damage in persons with knee osteoarthritis and concomitant ACL tears. Rheumatol Int. 2012;32(5):1197–208.

    Article  PubMed Central  PubMed  Google Scholar 

  21. Halinen J, Koivikko M, Lindahl J, et al. The efficacy of magnetic resonance imaging in acute multi-ligament injuries. Int Orthop. 2009;33(6):1733–8.

    Article  PubMed Central  PubMed  Google Scholar 

  22. Lee K, Siegel MJ, Lau DM, et al. Anterior cruciate ligament tears: MR imaging-based diagnosis in a pediatric population. Radiology. 1999;213(3):697–704.

    Article  CAS  PubMed  Google Scholar 

  23. McCauley TR, Moses M, Kier R, et al. MR diagnosis of tears of anterior cruciate ligament of the knee: importance of ancillary findings. Am J Roentgenol. 1994;162(1):115–9.

    Article  CAS  Google Scholar 

  24. Fayad LM, Parellada JA, Parker L, et al. MR imaging of anterior cruciate ligament tears: is there a gender gap? Skeletal Radiol. 2003;32(11):639–46.

    Article  PubMed  Google Scholar 

  25. Stein LN, Fischer DA, Fritts HM, et al. Occult osseous lesions associated with anterior cruciate ligament tears. Clin Orthop Relat Res. 1995;313:187–93.

    PubMed  Google Scholar 

  26. Yoon KH, Yoo JH, Kim KI. Bone contusion and associated meniscal and medial collateral ligament injury in patients with anterior cruciate ligament rupture. J Bone Joint Surg Am. 2011;93(16):1510–8.

    PubMed  Google Scholar 

  27. Zeiss J, Paley K, Murray K, et al. Comparison of bone contusion seen by MRI in partial and complete tears of the anterior cruciate ligament. J Comput Assist Tomogr. 1995;19(5):773–6.

    Article  CAS  PubMed  Google Scholar 

  28. Dimond PM, Fadale PD, Hulstyn MJ, et al. A comparison of MRI findings in patients with acute and chronic ACL tears. Am J Knee Surg. 1998;11(3):153–9.

    CAS  PubMed  Google Scholar 

  29. Tung GA, Davis LM, Wiggins ME, et al. Tears of the anterior cruciate ligament: primary and secondary signs at MR imaging. Radiology. 1993;188(3):661–7.

    CAS  PubMed  Google Scholar 

  30. Engebretsen L, Arendt E, Fritts HM. Osteochondral lesions and cruciate ligament injuries: MRI in 18 knees. Acta Orthop Scand. 1993;64(4):434–6.

    Article  CAS  PubMed  Google Scholar 

  31. Van Dyck P, Gielen JL, Vanhoenacker FM, et al. Stable or unstable tear of the anterior cruciate ligament of the knee: an MR diagnosis? Skeletal Radiol. 2012;41(3):273–80.

    Article  PubMed  Google Scholar 

  32. Quelard B, Sonnery-Cottet B, Zayni R, et al. Preoperative factors correlating with prolonged range of motion deficit after anterior cruciate ligament reconstruction. Am J Sports Med. 2010;38(10):2034–9.

    Article  PubMed  Google Scholar 

  33. Collins MS, Unruh KP, Bond JR, et al. Magnetic resonance imaging of surgically confirmed anterior cruciate ligament graft disruption. Skeletal Radiol. 2008;37(3):233–43.

    Article  PubMed  Google Scholar 

  34. Hernandez-Molina G, Guermazi A, Niu J, et al. Central bone marrow lesions in symptomatic knee osteoarthritis and their relationship to anterior cruciate ligament tears and cartilage loss. Arthritis Rheum. 2008;58(1):130–6.

    Article  PubMed Central  PubMed  Google Scholar 

  35. Snearly WN, Kaplan PA, Dussault RG. Lateral-compartment bone contusions in adolescents with intact anterior cruciate ligaments. Radiology. 1996;198(1):205–8.

    CAS  PubMed  Google Scholar 

  36. Bretlau T, Tuxoe J, Larsen L, et al. Bone bruise in the acutely injured knee. Knee Surg Sports Traumatol Arthrosc. 2002;10(2):96–101.

    Article  PubMed  Google Scholar 

  37. Hayes CW, Brigido MK, Jamadar DA, et al. Mechanism-based pattern approach to classification of complex injuries of the knee depicted at MR imaging. Radiographics. 2000;20(Spec No):S121–34.

    Google Scholar 

  38. Jelic D, Masulovic D. Bone bruise of the knee associated with the lesions of anterior cruciate ligament and menisci on magnetic resonance imaging. Vojnosanit Pregl. 2011;68(9):762–6.

    Google Scholar 

  39. Kobayashi H, Kanamura T, Koshida S, et al. Mechanisms of the anterior cruciate ligament injury in sports activities: a twenty-year clinical research of 1,700 athletes. J Sports Sci Med. 2010:669–75.

  40. Potter HG, Jain SK, Ma Y, et al. Cartilage injury after acute, isolated anterior cruciate ligament tear: immediate and longitudinal effect with clinical/MRI follow-up. Am J Sports Med. 2012;40(2):276–85

    Google Scholar 

  41. Frobell RB. Change in cartilage thickness, posttraumatic bone marrow lesions, and joint fluid volumes after acute ACL disruption: a two-year prospective MRI study of sixty-one subjects. J Bone Joint Surg Am. 2011;93(12):1096–103.

    Google Scholar 

  42. Bolbos RI, Ma CB, Link TM, et al. In vivo T1rho quantitative assessment of knee cartilage after anterior cruciate ligament injury using 3 Tesla magnetic resonance imaging. Invest Radiol. 2008;43(11):782–8.

    Google Scholar 

  43. Frobell RB, Roos HP, Roos EM, et al. The acutely ACL injured knee assessed by MRI: are large volume traumatic bone marrow lesions a sign of severe compression injury? Osteoarthritis Cartilage. 2008;16(7):829–36.

    Google Scholar 

  44. Hanypsiak BT, Spindler KP, Rothrock CR, et al. Twelve-year follow-up on anterior cruciate ligament reconstruction: long-term outcomes of prospectively studied osseous and articular injuries. Am J Sports Med. 2008;36(4):671–7.

    Google Scholar 

  45. Li X, Ma BC, Bolbos RI, et al. Quantitative assessment of bone marrow edema-like lesion and overlying cartilage in knees with osteoarthritis and anterior cruciate ligament tear using MR imaging and spectroscopic imaging at 3 Tesla. J Magn Reson Imaging. 2008;28(2):453–61.

    Google Scholar 

  46. Nishimori M, Deie M, Adachi N, et al. Articular cartilage injury of the posterior lateral tibial plateau associated with acute anterior cruciate ligament injury. Knee Surg Sports Traumatol Arthrosc. 2008;16(3):270–4.

    Google Scholar 

  47. Chen WT, Shih TT, Tu HY, et al. Partial and complete tear of the anterior cruciate ligament. Acta Radiol. 2002;43(5):511–6.

    Google Scholar 

  48. Costa-Paz M, Muscolo DL, Ayerza M, et al. Magnetic resonance imaging follow-up study of bone bruises associated with anterior cruciate ligament ruptures. Arthroscopy. 2001;17(5):445–9.

    Google Scholar 

  49. Munshi M, Davidson M, MacDonald PB, et al. The efficacy of magnetic resonance imaging in acute knee injuries. Clin J Sport Med. 2000;10(1):34–9.

    Google Scholar 

  50. Nawata K, Teshima R, Suzuki T. Osseous lesions associated with anterior cruciate ligament injuries. Assessment by magnetic resonance imaging at various periods after injuries. Arch Orthop Trauma Surg. 1993;113(1):1–4.

    Google Scholar 

  51. Mink JH, Deutsch AL. Occult cartilage and bone injuries of the knee: detection, classification, and assessment with MR imaging. Radiology. 1989;170(3 Pt 1):823–9.

    Google Scholar 

  52. Zeiss J, Paley K, Murray K, et al. Comparison of bone contusion seen by MRI in partial and complete tears of the anterior cruciate ligament. J Comput Assist Tomogr. 1995;19(5):773–6.

    Google Scholar 

  53. Rosen MA, Jackson DW, Berger PE. Occult osseous lesions documented by magnetic resonance imaging associated with anterior cruciate ligament ruptures. Arthroscopy. 1991;7(1):45–51.

    Google Scholar 

  54. Halinen J, Koivikko M, Lindahl J, et al. The efficacy of magnetic resonance imaging in acute multi-ligament injuries. Int Orthop. 2009;33(6):1733–8

    Google Scholar 

  55. Lee K, Siegel MJ, Lau DM, et al. Anterior cruciate ligament tears: MR imaging-based diagnosis in a pediatric population. Radiology. 1999;213(3):697–704.

    Google Scholar 

  56. McCauley TR, Moses M, Kier R, et al. MR diagnosis of tears of anterior cruciate ligament of the knee: importance of ancillary findings. AJR Am J Roentgenol. 1994;162(1):115–9.

    Google Scholar 

Download references

Acknowledgements

The authors would like to acknowledge M.M. Manring, PhD, for his contributions to the editing process and manuscript preparation. The authors report no conflicts of interest. No funding was received in support of this manuscript.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Timothy E. Hewett.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Patel, S.A., Hageman, J., Quatman, C.E. et al. Prevalence and Location of Bone Bruises Associated with Anterior Cruciate Ligament Injury and Implications for Mechanism of Injury: A Systematic Review. Sports Med 44, 281–293 (2014). https://doi.org/10.1007/s40279-013-0116-z

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s40279-013-0116-z

Keywords

Navigation