title: A prospective study of the association between bone contusion and intra-articular injuries associated with acute anterior cruciate ligament tear.
abstract: BACKGROUND
  Bone bruising, commonly found on magnetic resonance imaging (MRI) after anterior cruciate ligament (ACL) injury, may be associated with intra-articular injuries, but little is known about this association.
  
  
  OBJECTIVE
  To examine demographic factors and intra-articular injuries associated with bone bruising in patients undergoing ACL reconstruction.
  
  
  METHODS
  Case-control study; Level of evidence, 3.
  
  
  METHODS
  Patients with ACL injury who had an MRI within 6 weeks and arthroscopy within 3 months of injury were included in this prospective study (N = 171). Presence and severity of bone bruising were determined from preoperative MRIs for each anatomic site: lateral femoral condyle (LFC), lateral tibial plateau (LTP), medial femoral condyle (MFC), and medial tibial plateau (MTP). Multiple logistic regression was used to calculate adjusted odds ratios (OR) and 95% confidence intervals (CI) for predictors of bruising and associations between bruising and intra-articular injuries found during arthroscopy. Outcomes included the presence of bruising and severity of lateral bruising (mild, moderate, severe vs none/minimal bruising).
  
  
  RESULTS
  Frequencies of bone bruising were as follows: 85% LTP, 77% LFC, 26% MTP, and 6% MFC. Patient age between 18 and 28 years (OR, 0.27; 95% CI, 0.09-0.82) and 29 years and older (OR, 0.18; 95% CI, 0.05-0.61) predicted less LFC bruising compared with patients aged 17 years and younger. Age (18-28 years: OR, 0.15; 95% CI, 0.03-0.66; ≥29 years: OR, 0.10; 95% CI, 0.02-0.68) and contact injuries (OR, 0.17; 95% CI, 0.04-0.78) predicted less moderate LFC bruising. Male sex predicted mild (OR, 6.16; 95% CI, 1.44-26.43), moderate (OR, 8.98; 95% CI, 1.96-41.19), and severe (OR, 15.66; 95% CI, 3.19-76.92) LFC bruising. Male sex also predicted mild LTP bruising (OR, 0.19; 95% CI, 0.05-0.83), and contact injuries predicted severe LTP bruising (OR, 5.01; 95% CI, 1.21-20.67). LFC bruising (OR, 2.57; 95% CI, 1.04-6.32) and LTP bruising (OR, 3.13; 95% CI, 1.06-9.23) were associated with lateral meniscal tears. Moderate (OR, 8.14; 95% CI, 1.93-34.27) and severe (OR, 15.30; 95% CI, 2.34-100.10) LTP bruising was associated with medial meniscal tears. MFC bruising and MTP bruising were not associated with any predictors or intra-articular injuries.
  
  
  CONCLUSIONS
  Bone bruising is more common and severe in young men, and lateral bone bruising is associated with lateral meniscal tears. Medial meniscal tears are associated with increased severity of LTP bruising.
authors.affiliation: Department of Orthopaedic Surgery, The State University of New York at Buffalo 4949 Harlem Rd, Amherst, NY 14226, USA. klbisson@aol.com
authors.forename: Leslie J
authors.initials: LJ
authors.lastname: Bisson
authors.forename: Melissa A
authors.initials: MA
authors.lastname: Kluczynski
authors.forename: Lindsey S
authors.initials: LS
authors.lastname: Hagstrom
authors.forename: John M
authors.initials: JM
authors.lastname: Marzo
mesh_terms: D000293:Adolescent; D000328:Adult; D000070598:Anterior Cruciate Ligament Injuries; D059549:Anterior Cruciate Ligament Reconstruction; D001182:Arthroscopy; D016022:Case-Control Studies; D003288:Contusions / Q000175:diagnosis / Q000209:etiology*; D005260:Female; D005269:Femur / Q000293:injuries*; D006801:Humans; D007718:Knee Injuries / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery; D016015:Logistic Models; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D011446:Prospective Studies; D012307:Risk Factors; D013977:Tibia / Q000293:injuries*; D000070600:Tibial Meniscus Injuries; D015599:Trauma Severity Indices; D055815:Young Adult
keywords: anterior cruciate ligament; bone bruise; knee; magnetic resonance imaging