title: Which preoperative factors, including bone bruise, are associated with knee pain/symptoms at index anterior cruciate ligament reconstruction (ACLR)? A Multicenter Orthopaedic Outcomes Network (MOON) ACLR Cohort Study.
abstract: BACKGROUND
  Increased knee pain at the time of anterior cruciate ligament reconstruction may potentially predict more difficult rehabilitation, prolonged recovery, and/or be predictive of increased knee pain at 2 years.
  
  
  OBJECTIVE
  A bone bruise and/or other preoperative factors are associated with more knee pain/symptoms at the time of index anterior cruciate ligament reconstruction, and the presence of a bone bruise would be associated with specific demographic and injury-related factors.
  
  
  METHODS
  Cohort study (prevalence); Level of evidence, 2.
  
  
  METHODS
  In 2007, the Multicenter Orthopaedic Outcomes Network (MOON) database began to prospectively collect surgeon-reported magnetic resonance imaging bone bruise status. A multivariable analysis was performed to (1) determine if a bone bruise, among other preoperative factors, is associated with more knee symptoms/pain and (2) examine the association of factors related to bone bruise. To evaluate the association of a bone bruise with knee pain/symptoms, linear multiple regression models were fit using the continuous scores of the Knee injury and Osteoarthritis Outcome Score (KOOS) symptoms and pain subscales and the Short Form 36 (SF-36) bodily pain subscale as dependent variables. To examine the association between a bone bruise and risk factors, a logistic regression model was used, in which the dependent variable was the presence or absence of a bone bruise.
  
  
  RESULTS
  Baseline data for 525 patients were used for analysis, and a bone bruise was present in 419 (80%). The cohort comprises 58% male patients, with a median age of 23 years. The median Marx activity level was 13. Factors associated with more pain were higher body mass index (P < .0001), female sex (P = .001), lateral collateral ligament injury (P = .012), and older age (P = .038). Factors associated with more symptoms were a concomitant lateral collateral ligament injury (P = .014), higher body mass index (P < .0001), and female sex (P < .0001). Bone bruise is not associated with symptoms/pain at the time of index anterior cruciate ligament reconstruction. None of the factors included in the SF-36 bodily pain model were found to be significant. After controlling for other baseline factors, the following factors were associated with a bone bruise: younger age (P = .034) and not jumping at the time of injury (P = .006).
  
  
  CONCLUSIONS
  After anterior cruciate ligament injury, risk factors associated with a bone bruise are younger age and not jumping at the time of injury. Bone bruise is not associated with symptoms/pain at the time of index anterior cruciate ligament reconstruction.
authors.affiliation: Department of Orthopaedic Surgery and Rehabilitation, Vanderbilt University Medical School, Nashville, TN 37232-8300, USA. warren.dunn@vanderbilt.edu
authors.forename: Warren R
authors.initials: WR
authors.lastname: Dunn
authors.forename: Kurt P
authors.initials: KP
authors.lastname: Spindler
authors.forename: Annunziato
authors.initials: A
authors.lastname: Amendola
authors.forename: Jack T
authors.initials: JT
authors.lastname: Andrish
authors.forename: Christopher C
authors.initials: CC
authors.lastname: Kaeding
authors.forename: Robert G
authors.initials: RG
authors.lastname: Marx
authors.forename: Eric C
authors.initials: EC
authors.lastname: McCarty
authors.forename: Richard D
authors.initials: RD
authors.lastname: Parker
authors.forename: Frank E
authors.initials: FE
authors.lastname: Harrell
authors.forename: Angel Q
authors.initials: AQ
authors.lastname: An
authors.forename: Rick W
authors.initials: RW
authors.lastname: Wright
authors.forename: Robert H
authors.initials: RH
authors.lastname: Brophy
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Matava
authors.forename: David C
authors.initials: DC
authors.lastname: Flanigan
authors.forename: Laura J
authors.initials: LJ
authors.lastname: Huston
authors.forename: Morgan H
authors.initials: MH
authors.lastname: Jones
authors.forename: Michelle L
authors.initials: ML
authors.lastname: Wolcott
authors.forename: Armando F
authors.initials: AF
authors.lastname: Vidal
authors.forename: Brian R
authors.initials: BR
authors.lastname: Wolf
mesh_terms: D000293:Adolescent; D000328:Adult; D016118:Anterior Cruciate Ligament / Q000601:surgery*; D000070598:Anterior Cruciate Ligament Injuries; D001842:Bone and Bones / Q000293:injuries; D002358:Cartilage, Articular / Q000293:injuries; D015331:Cohort Studies; D003288:Contusions / Q000150:complications; D005260:Female; D006801:Humans; D007718:Knee Injuries / Q000473:pathology* / Q000601:surgery*; D007719:Knee Joint / Q000473:pathology* / Q000601:surgery*; D016014:Linear Models; D008297:Male; D049451:Nomograms; D019637:Orthopedic Procedures; D010146:Pain / Q000209:etiology*; D010147:Pain Measurement; D057234:Preoperative Period; D012307:Risk Factors; D055815:Young Adult