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Hyperextension injuries of the knee: do patterns of bone bruising predict soft tissue injury?

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Abstract

Objective

To establish whether patterns of soft tissue injury following knee hyperextension are associated with post-traumatic ‘bone bruise’ distribution.

Materials and methods

Patients with a knee MRI within one year of hyperextension injury were identified at our institution over a 7 year period. MRIs, plain radiographs and clinical details of these patients were reviewed.

Results

Twenty-five patients were identified (median time from injury to MRI = 24 days). The most common sites of bone bruising were the anteromedial tibial plateau (48%) and anterolateral tibial plateau (44%). There were high rates of injury to the posterior capsule (52%), ACL (40%) and PCL (40%) but lower rates of injury to the menisci (20%), medial and lateral collateral ligaments (16%) and posterolateral corner (16%). Anterior tibial plateau oedema and rupture of the posterior capsule predicted cruciate ligament injury [OR = 10.5 (p = 0.02) and 24.0 (p = 0.001) respectively]. Whilst anterolateral tibial plateau oedema strongly predicted PCL injury [OR = 26.0, p = 0.003], ACL injury was associated with a variable pattern of bone bruising. Meniscal injury was unrelated to the extent or pattern of bone bruising. 5 out of 8 patients with a ‘double sulcus’ on the lateral radiograph had ACL injury. The presence of a double sulcus showed significant association with anteromedial kissing contusions (OR = 7.8, p = 0.03).

Conclusions

Following knee hyperextension, bone bruising patterns may be associated with cruciate ligament injury. Other structures are injured less frequently and have weaker associations with bone bruise distribution. The double sulcus sign is a radiographic marker that confers a high probability of ACL injury.

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References

  1. Kirialanis P, Malliou P, Beneka A, Giannakopoulos K. Occurrence of acute lower limb injuries in artistic gymnasts in relation to event and exercise phase. Br J Sports Med. 2003;37:137–9.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  2. Shea KG, Archibald-Seiffer N, Murdock E, Grimm NL, Jacobs JC Jr, Willick S, Van Houten H. Knee injuries in downhill skiers: a 6-year survey study. Orthop J Sports Med 2014;2:2325967113519741.

  3. Waldén M, Krosshaug T, Bjørneboe J, Andersen TE, Faul O, Hägglund M. Three distinct mechanisms predominate in non-contact anterior cruciate ligament injuries in male professional football players: a systematic video analysis of 39 cases. Br J Sports Med. 2015;49:1452–60.

    Article  PubMed  PubMed Central  Google Scholar 

  4. Mandalia V, Fogg AJB, Chari R, Murray J, Beale A, Henson JHL. Bone bruising of the knee. Clin Radiol. 2005;60:627–36.

    Article  CAS  PubMed  Google Scholar 

  5. Rangger C, Kathrein A, Freund MC, Klestil T, Kreczy A. Bone bruise of the knee: histology and cryosections in 5 cases. Acta Orthop Scand. 1998;69:291–4.

    Article  CAS  PubMed  Google Scholar 

  6. Ryu KN, Jin W, Ko YT, Yoon Y, Oh JH, Park YK, et al. Bone bruises: MR characteristics and histological correlation in the young pig. Clin Imaging. 2000;24:371–80.

    Article  CAS  PubMed  Google Scholar 

  7. Kapelov SR, Teresi LM, Bradley WG, Bucciarelli NR, Murakami DM, Mullin WJ, et al. Bone contusions of the knee: increased lesion detection with fast spin-echo MR imaging with spectroscopic fat saturation. Radiology. 1993;189:901–4.

    Article  CAS  PubMed  Google Scholar 

  8. Mandalia V, Henson JH. Traumatic bone bruising-a review article. Eur J Radiol. 2008;67:54–61.

    Article  CAS  PubMed  Google Scholar 

  9. Sahoo K, Garg A, Saha P, Dodia JV, Raj VR, Bhairagond SJ. Study of imaging pattern in bone marrow oedema in MRI in recent knee injuries and its correlation with type of knee injury. J Clin Diagn Res. 2016;10(4):TC06–11.

    CAS  PubMed  PubMed Central  Google Scholar 

  10. Sanders TG, Medynski MA, Feller JF, Lawhorn KW. Bone contusion patterns of the knee at MR imaging: footprint of the mechanism of injury. Radiographics. 2000;20:S135–51.

    Article  PubMed  Google Scholar 

  11. Bretlau T, Tuxøe J, Larsen L, Jørgensen U, Thomsen HS, Lausten GS. Bone bruise in the acutely injured knee. Knee Surg Sports Traumatol Arthrosc. 2002;10:96–101.

    Article  PubMed  Google Scholar 

  12. Perin B, Nardacchione R, Bonaga S, Angelini F, Girotto A, Giovagnoni A, et al. Acute knee block. Assessment with magnetic resonance, correlated with arthroscopy. Radiol Med. 1997;93(1–2):40–4.

    CAS  PubMed  Google Scholar 

  13. Wright RW, Phaneuf MA, Limbird TJ, Spindler KP. Clinical outcome of isolated subcortical trabecular fractures (bone bruise) detected on magnetic resonance imaging in knees. Am J Sports Med. 2000;28:663–7.

    Article  CAS  PubMed  Google Scholar 

  14. Bisson LJ, Kluczynski MA, Hagstrom LS, Marzo JM. A prospective study of the association between bone contusion and intra-articular injuries associated with acute anterior cruciate ligament tear. Am J Sports Med. 2013;41(8):1801–7.

    Article  PubMed  Google Scholar 

  15. Graf BK, Cook DA, De Smet AA, Keene JS. “bone bruises” on magnetic resonance imaging evaluation of anterior cruciate ligament injuries. Am J Sports Med. 1993;21:220–3.

    Article  CAS  PubMed  Google Scholar 

  16. Herbst E, Hoser C, Tecklenburg K, Filipovic M, Dallapozza C, Herbort M, et al. The lateral femoral notch sign following ACL injury: frequency, morphology and relation to meniscal injury and sports activity. Knee Surg Sports Traumatol Arthrosc. 2015;23(8):2250–8.

    Article  PubMed  Google Scholar 

  17. Jelić D, Masulović D. Bone bruise of the knee associated with the lesions of anterior cruciate ligament and menisci on magnetic resonance imaging. Vojnosanit Pregl. 2011;68:762–6.

    Article  PubMed  Google Scholar 

  18. Kim SY, Spritzer CE, Utturkar GM, Toth AP, Garrett WE, DeFrate LE. Knee kinematics during noncontact anterior cruciate ligament injury as determined from bone bruise location. Am J Sports Med. 2015;43(10):2515–21.

    Article  PubMed  PubMed Central  Google Scholar 

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

    Article  CAS  PubMed  Google Scholar 

  20. Chin YC, Wijaya R, Chong le R, Chang HC, Lee YH. Bone bruise patterns in knee injuries: where are they found? Eur J Orthop Surg Traumatol. 2014;24:1481–7.

    Article  PubMed  Google Scholar 

  21. Kaplan PA, Gehl RH, Dussault RG, Anderson MW, Diduch DR. 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;211:747–53.

    Article  CAS  PubMed  Google Scholar 

  22. Mair SD, Schlegel TF, Gill TJ, Hawkins RJ, Steadman JR. Incidence and location of bone bruises after acute posterior cruciate ligament injury. Am J Sports Med. 2004;32:1681–7.

    Article  PubMed  Google Scholar 

  23. Meyer EG, Baumer TG, Haut RC. Pure passive hyperextension of the human cadaver knee generates simultaneous bicruciate ligament rupture. J Biomech Eng. 2011;133:011012.

    Article  PubMed  Google Scholar 

  24. Song GY, Zhang H, Wang QQ, Zhang J, Li Y, Feng H. Bone contusions after acute noncontact anterior cruciate ligament injury are associated with knee joint laxity, concomitant meniscal lesions, and anterolateral ligament abnormality. Arthroscopy. 2016. https://doi.org/10.1016/j.arthro.2016.03.015.

  25. 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;93:1510–8.

    Article  PubMed  Google Scholar 

  26. Fornalski S, McGarry MH, Csintalan RP, Fithian DC, Lee TQ. Biomechanical and anatomical assessment after knee hyperextension injury. Am J Sports Med. 2008;36:80–4.

    Article  PubMed  Google Scholar 

  27. Boks SS, Vroegindeweij D, Koes BW, Bernsen RM, Hunink MG, Bierma-Zeinstra SM. MRI follow-up of posttraumatic bone bruises of the knee in general practice. AJR Am J Roentgenol. 2007;189:556–62.

    Article  PubMed  Google Scholar 

  28. Boks SS, Vroegindeweij D, Koes BW, Hunink MG, Bierma-Zeinstra SM. Follow-up of occult bone lesions detected at MR imaging: systematic review. Radiology. 2006;238:853–62.

    Article  PubMed  Google Scholar 

  29. Terzidis IP, Christodoulou AG, Ploumis AL, Metsovitis SR, Koimtzis M, Givissis P. The appearance of kissing contusion in the acutely injured knee in the athletes. Br J Sports Med. 2004;38:592–6.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  30. Rangger C, Klestil T, Kathrein A, Indester A, Hamid L. Influence of magnetic resonance imaging on indications for arthroscopy of the knee. Clin Orthop Relat Res. 1996;330:133–42.

    Article  Google Scholar 

  31. Davies NH, Niall D, King LJ, Lavelle J, Healy JC. Magnetic resonance imaging of bone bruising in the acutely injured knee—short-term outcome. Clin Radiol 2004;59:439-445.

    Article  CAS  PubMed  Google Scholar 

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

    Article  CAS  PubMed  Google Scholar 

  33. Park HJ, Lee SY, Chung EC, Rho MH, Ahn JH, Kim M, et al. The usefulness of the oblique coronal plane in knee MRI on the evaluation of the posterior cruciate ligament. Acta Radiol. 2014;55(8):961–8.

    Article  PubMed  Google Scholar 

  34. Winters K, Tregnonning R. Reliability of magnetic resonance imaging of the traumatic knee as determined by arthroscopy. N Z Med J. 2005;118(1209):U1301.

    PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, Chelsea and Westminster Hospital, London, UK

    A. M. Ali & C. E. R. Gibbons

  2. Department of Radiology, Chelsea and Westminster Hospital, London, UK

    J. K. Pillai & B. J. Roberton

  3. Department of Orthopaedic Surgery, Homerton University Hospital, London, UK

    V. Gulati

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  1. A. M. Ali
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  2. J. K. Pillai
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  3. V. Gulati
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Correspondence to A. M. Ali.

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Ali, A.M., Pillai, J.K., Gulati, V. et al. Hyperextension injuries of the knee: do patterns of bone bruising predict soft tissue injury?. Skeletal Radiol 47, 173–179 (2018). https://doi.org/10.1007/s00256-017-2754-y

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  • DOI: https://doi.org/10.1007/s00256-017-2754-y

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