Bone bruises in anterior cruciate ligament injured knee and long-term outcomes. A review of the evidence

Bone bruises in anterior cruciate ligament injured knee and long-term outcomes. A review of the evidence

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Rocco Papalia,1 Guglielmo Torre,1 Sebastiano Vasta,1 Biagio Zampogna,1 Douglas R Pedersen,2,3 Tank Vincenzo Denaro,1 Annunziato Amendola3 1Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University of Rome, Rome, Italy; 2Department of Biomedical Engineering, 3Department of Orthopaedics and Rehabilitation, University of Iowa, Iowa City, IA, USA Background: Bone bruises are frequently associated with anterior cruciate ligament (ACL) tears as a result of trauma or direct shear stress of the bone.Purpose: To review the evidence regarding the characteristics of the bone bruise associated with ACL tears, its relevance on clinical outcomes, and its progression over time.In particular, the long-term effects of the bone bruise on the knee osteochondral architecture and joint function were evaluated.Study design: Review; level of evidence: 4.Methods: An electronic search was performed on PubMed.

Combinations of keywords included: “bone bruise AND knee”; “bone bruise AND anterior cruciate ligament”; “bone bruise AND osteo-chondral defects”.Any level of evidence studies concerning bone bruises in patients with partial or complete ACL tears were retrieved.Results: A total of 25 studies were included; three of them investigated biomechanical parameters, seven were concerned with clinical outcomes, and 15 were radiological studies.Evaluation of the bone bruise is best performed using a fat-saturated T2-weighted fast spin echo exam or a short tau inversion recovery sequence where fat saturation is challenging.The location of the injury has been demonstrated to be more frequent in the Axle;Idler lateral compartment of the joint (lateral femoral condyle and lateral tibial plateau).

It is associated with ACL tears in approximately 70% of cases, often with collateral ligament or meniscal tears.Mid- and long-term outcomes demonstrated a complete healing of the marrow lesions at magnetic ρresonance imaging, but chondral defects detected with T1ρ sequences are still present 1 year after the ACL injury.Functional examination of the knee, through clinical International Knee Documentation Committee scores, did not show any correlation with the bone bruise.Conclusion: Although bone bruise presence yields to higher pain levels, no correlation with functional outcomes was reported.Most studies have a short-term follow-up (<2 years) compared to the length of time it takes to develop post-traumatic osteoarthritis, so it still remains unclear whether the initial joint injury and bone bruise have a direct relationship to long-term function.

Keywords: bone bruise, anterior cruciate ligament, magnetic resonance imaging, knee.