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Sports Medicine
Published in: Sports Medicine 2/2014

01-02-2014 | Systematic Review

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

Authors: Sonika A. Patel, Jason Hageman, Carmen E. Quatman, Samuel C. Wordeman, Timothy E. Hewett

Published in: Sports Medicine | Issue 2/2014

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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.
Footnotes
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.
 
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Metadata
Title
Prevalence and Location of Bone Bruises Associated with Anterior Cruciate Ligament Injury and Implications for Mechanism of Injury: A Systematic Review
Authors
Sonika A. Patel
Jason Hageman
Carmen E. Quatman
Samuel C. Wordeman
Timothy E. Hewett
Publication date
01-02-2014
Publisher
Springer International Publishing
Published in
Sports Medicine / Issue 2/2014
Print ISSN: 0112-1642
Electronic ISSN: 1179-2035
DOI
https://doi.org/10.1007/s40279-013-0116-z

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