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Yi Z, Jiang J, Liu J, Ma M, Chen Y, Teng F, Yang A, Liu Z, Geng B, Xia Y, Wu M. Prevalence and Site of Concomitant Osteochondral Injuries in Patients With Acute Lateral Patellar Dislocation: A Systematic Review and Meta-analysis. Orthop J Sports Med 2024; 12:23259671231220904. [PMID: 38274015 PMCID: PMC10809874 DOI: 10.1177/23259671231220904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 07/31/2023] [Indexed: 01/27/2024] Open
Abstract
Background Osteochondral injuries (OCIs) are common in patients with acute lateral patellar dislocation, which can produce both short- and long-;term adverse effects. However, the pattern of these injuries warrants further analysis, especially in relation to patient age. Purpose To determine the overall prevalence of concomitant OCIs as well as the prevalence differences based on location and age after acute lateral patellar dislocations. Study Design Systematic review; Level of evidence, 4. Methods A comprehensive search of PubMed, Embase, Web of Science, and Cochrane Library was completed from inception to July 20, 2022. All articles reporting the prevalence of OCI were included. The sample characteristics such as age, study design, magnetic resonance imaging diagnostic data, and the number of patients with OCI were extracted. The Methodological Index for Non-Randomized Studies (MINORS) was used for quality assessment. The overall and per-;site injury rates were calculated, and the prevalence was stratified by age-;group (≤16 and >16 years) and compared. Results The systematic review included 39 studies involving 3354 patients. MINORS scores were 11.94 ± 1.98 and 16 ± 3.46 in the noncomparative and comparative studies, respectively. The overall prevalence of bone bruises and OCI was 89.6% (95% CI, 77.4%-97.7%) and 48.8% (95% CI, 39.0%-58.7%), respectively. In both overall and >16-year-old patients, the lateral femoral condyle (LFC) was the most common site of bone bruise (90.5% [95% CI, 84.0%-95.6%] and 91.5% [95% CI, 84.3%-96.9%], respectively); however, the medial patellar bruise was more common in patients ≤16 years (89.2% [95% CI, 82.9%-94.4%]). Among the pooled sites of OCI, the medial patella accounted for the largest proportion (36.9% [95% CI, 28.0%-46.3%]). OCIs were more common in patients >16 years (52.6% [95% CI, 39.4%-65.6%]) than in patients ≤16 years (46.6% [95% CI, 33.2%-60.3%]). Conclusion Bone bruises on the LFC were most prevalent overall and in patients >16 years, whereas bone bruises on the medial patella were more prevalent in patients ≤16 years. OCIs were frequently seen in patients >16 years, with the most common site being the medial patella.
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Affiliation(s)
- Zhi Yi
- Department of Orthopaedics, Lanzhou University Second Hospital, Orthopedic Clinical Medical Research Center of Gansu Province, Intelligent Orthopedic Industry Technology Center of Gansu Province, Lanzhou, Gansu, China
| | - Jin Jiang
- Department of Orthopaedics, Lanzhou University Second Hospital, Orthopedic Clinical Medical Research Center of Gansu Province, Intelligent Orthopedic Industry Technology Center of Gansu Province, Lanzhou, Gansu, China
| | - Jinmin Liu
- Department of Orthopaedics, Lanzhou University Second Hospital, Orthopedic Clinical Medical Research Center of Gansu Province, Intelligent Orthopedic Industry Technology Center of Gansu Province, Lanzhou, Gansu, China
| | - Ming Ma
- Department of Orthopaedics, Lanzhou University Second Hospital, Orthopedic Clinical Medical Research Center of Gansu Province, Intelligent Orthopedic Industry Technology Center of Gansu Province, Lanzhou, Gansu, China
| | - Yi Chen
- Department of Orthopaedics, Lanzhou University Second Hospital, Orthopedic Clinical Medical Research Center of Gansu Province, Intelligent Orthopedic Industry Technology Center of Gansu Province, Lanzhou, Gansu, China
| | - Fei Teng
- Department of Orthopaedics, Lanzhou University Second Hospital, Orthopedic Clinical Medical Research Center of Gansu Province, Intelligent Orthopedic Industry Technology Center of Gansu Province, Lanzhou, Gansu, China
| | - Ao Yang
- Department of Orthopaedics, Lanzhou University Second Hospital, Orthopedic Clinical Medical Research Center of Gansu Province, Intelligent Orthopedic Industry Technology Center of Gansu Province, Lanzhou, Gansu, China
| | - Zhongcheng Liu
- Department of Orthopaedics, Lanzhou University Second Hospital, Orthopedic Clinical Medical Research Center of Gansu Province, Intelligent Orthopedic Industry Technology Center of Gansu Province, Lanzhou, Gansu, China
| | - Bin Geng
- Department of Orthopaedics, Lanzhou University Second Hospital, Orthopedic Clinical Medical Research Center of Gansu Province, Intelligent Orthopedic Industry Technology Center of Gansu Province, Lanzhou, Gansu, China
| | - Yayi Xia
- Department of Orthopaedics, Lanzhou University Second Hospital, Orthopedic Clinical Medical Research Center of Gansu Province, Intelligent Orthopedic Industry Technology Center of Gansu Province, Lanzhou, Gansu, China
| | - Meng Wu
- Department of Orthopaedics, Lanzhou University Second Hospital, Orthopedic Clinical Medical Research Center of Gansu Province, Intelligent Orthopedic Industry Technology Center of Gansu Province, Lanzhou, Gansu, China
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Toyooka S, Persson A, LaPrade RF, Engebretsen L, Moatshe G. Injury Patterns in Posterolateral Corner Knee Injury. Orthop J Sports Med 2023; 11:23259671231184468. [PMID: 37663094 PMCID: PMC10469253 DOI: 10.1177/23259671231184468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 04/13/2023] [Indexed: 09/05/2023] Open
Abstract
Background Posterolateral corner (PLC) knee injuries associated with different injury mechanisms are not well known. Purpose/Hypothesis This study sought to assess the patterns of associated injuries in the setting of PLC injury. The hypothesis was that there are recognizable injury patterns in PLC injuries that may correlate with injury mechanism. Study Design Cross-sectional study; Level of evidence, 3. Methods Patients who sustained a multiligament knee injury were retrospectively reviewed. Patients who sustained an acute grade 3 PLC injury and underwent surgery were enrolled in this study. A description of the PLC injury (location of the injury of the fibular collateral ligament [FCL], popliteus tendon, and/or popliteofibular ligament) and reported concomitant injuries (biceps femoris tendon or meniscal tears, cartilage pathology and/or peroneal nerve palsy, or bone bruises) were collected and classified based on intraoperative and magnetic resonance imaging (MRI) findings. Results Of 135 patients reviewed, 83 did not have PLC involvement and 13 were excluded due to insufficient MRI scans available. Thus, 39 patients were included in this study. For both the anterior cruciate ligament (ACL)-PLC and ACL-posterior cruciate ligament-PLC injury patterns, the most frequent injury pattern entailed a bone bruise of the anteromedial (AM) femur and tibia, an FCL tear from the fibular head, the popliteus tendon avulsed off the femur, a biceps femoris tendon torn off the fibular head, and a common peroneal nerve palsy. Conversely, when no bone bruise occurred on the AM femur and tibia, the FCL was injured on the femoral side and the popliteus tendon, biceps femoris, and peroneal nerve were not injured. Conclusion AM bone bruise was associated with a peroneal nerve injury in almost half of the patients, and peroneal nerve injury was not seen if there was no AM bone bruise.
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Affiliation(s)
- Seikai Toyooka
- Oslo Sports Trauma Research Center, Oslo, Norway
- Department of Orthopaedic Surgery, Teikyo University School of Medicine, Tokyo, Japan
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Brophy RH, Baker JC, Crain JM, Herzog MM, Stollberg B, Wojtys EM, Mack CD. MRI Findings Associated With Anterior Cruciate Ligament Tears in National Football League Athletes. Orthop J Sports Med 2023; 11:23259671231169190. [PMID: 37332531 PMCID: PMC10273788 DOI: 10.1177/23259671231169190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2023] [Accepted: 02/09/2023] [Indexed: 06/20/2023] Open
Abstract
Background Anterior cruciate ligament (ACL) tears are a high-frequency injury requiring a lengthy recovery in professional American football players. Concomitant pathology associated with ACL tears as identified on magnetic resonance imaging (MRI) is not well understood in these athletes. Purpose To describe the MRI findings of concomitant injuries associated with ACL tears among athletes in the National Football League (NFL). Study Design Cross-sectional study; Level of evidence, 3. Methods Of 314 ACL injuries in NFL athletes from 2015 through 2019, 191 complete MRI scans from the time of primary ACL injury were identified and reviewed by 2 fellowship-trained musculoskeletal radiologists. Data were collected on ACL tear type and location, as well as presence and location of bone bruises, meniscal tears, articular cartilage pathology, and concomitant ligament pathology. Mechanism data from video review were linked with imaging data to assess association between injury mechanism (contact vs noncontact) and presence of concomitant pathology. Results Bone bruises were evident in 94.8% of ACL tears in this cohort, most often in the lateral tibial plateau (81%). Meniscal, additional ligamentous, and/or cartilage injury was present in 89% of these knees. Meniscal tears were present in 70% of knees, lateral (59%) more than medial (41%). Additional ligamentous injury was present in 71% of all MRI scans, more often a grade 1/2 sprain (67%) rather than a grade 3 tear (33%), and most often involving the medial collateral ligament (MCL) (57%) and least often the posterior cruciate ligament (10%). Chondral damage was evident in 49% of all MRI scans, with ≥1 full-thickness defect in 25% of all MRI scans, most often lateral. Most (79%) ACL tears did not involve direct contact to the injured lower extremity. Direct contact injuries (21%) were more likely to have a concomitant MCL tear and/or medial patellofemoral ligament injury and less likely to have a medial meniscal tear. Conclusion ACL tears were rarely isolated injuries in this cohort of professional American football athletes. Bone bruises were almost always present, and additional meniscal, ligamentous, and chondral injuries were also common. MRI findings varied by injury mechanism.
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Affiliation(s)
- Robert H. Brophy
- Department of Orthopaedic Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Jon C. Baker
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Jana M. Crain
- National Orthopedic Imaging Associates California Advanced Medical Imaging Associates, San Francisco, California, USA
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Wu J, Wu C, Cai Z, Gu H, Liu L, Xia C, Lui S, Gong Q, Song B, Ai H. Ultra-small superparamagnetic iron oxide nanoparticles for intra-articular targeting of cartilage in early osteoarthritis. Regen Biomater 2023; 10:rbad052. [PMID: 37397872 PMCID: PMC10307945 DOI: 10.1093/rb/rbad052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 04/20/2023] [Accepted: 04/26/2023] [Indexed: 07/04/2023] Open
Abstract
Early diagnosis of osteoarthritis (OA) is critical for effective cartilage repair. However, lack of blood vessels in articular cartilage poses a barrier to contrast agent delivery and subsequent diagnostic imaging. To address this challenge, we proposed to develop ultra-small superparamagnetic iron oxide nanoparticles (SPIONs, 4 nm) that can penetrate into the matrix of articular cartilage, and further modified with the peptide ligand WYRGRL (particle size, 5.9 nm), which allows SPIONs to bind to type II collagen in the cartilage matrix and increase the retention of probes. Type II collagen in the cartilage matrix is gradually lost with the progression of OA, consequently, the binding of peptide-modified ultra-small SPIONs to type II collagen in the OA cartilage matrix is less, thus presenting different magnetic resonance (MR) signals in OA group from the normal ones. By introducing the AND logical operation, damaged cartilage can be differentiated from the surrounding normal tissue on T1 and T2 AND logical map of MR images, and this was also verified in histology studies. Overall, this work provides an effective strategy for delivering nanosized imaging agents to articular cartilage, which could potentially be used to diagnosis joint-related diseases such as osteoarthritis.
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Affiliation(s)
- Jun Wu
- Institute for Disaster Management and Reconstruction, Sichuan University, Chengdu 610207, China
- Medical Imaging Key Laboratory of Sichuan Province, School of Medical Imaging, North Sichuan Medical College, Nanchong 637000, China
| | - Changqiang Wu
- Correspondence address. Tel: +86 28 85413991, E-mail: (H.A.); (C.W.)
| | - Zhongyuan Cai
- National Engineering Research Center for Biomaterials, Sichuan University, Chengdu 610064, China
| | - Haojie Gu
- National Engineering Research Center for Biomaterials, Sichuan University, Chengdu 610064, China
| | - Li Liu
- National Engineering Research Center for Biomaterials, Sichuan University, Chengdu 610064, China
| | - Chunchao Xia
- Department of Radiology, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Su Lui
- Department of Radiology, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Qiyong Gong
- Department of Radiology, Huaxi MR Research Center (HMRRC), Frontiers Science Center for Disease-Related Molecular Network, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu 610041, China
- Functional and Molecular Imaging Key Laboratory of Sichuan Province, Key Laboratory of Transplant Engineering and Immunology, NHC, Research Unit of Psychoradiology, Chinese Academy of Medical Sciences, Chengdu 610064, China
- Department of Radiology, West China Xiamen Hospital of Sichuan University, Fujian, Xiamen 361000, China
| | - Bin Song
- Department of Radiology, West China Hospital, Sichuan University, Chengdu 610041, China
- Department of Radiology, Sanya People’s Hospital, Hainan, Sanya 572000, China
| | - Hua Ai
- Correspondence address. Tel: +86 28 85413991, E-mail: (H.A.); (C.W.)
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Galloway C, Ward H, Higbie S, Kleihege J, Kumaravel M, Lowe WR, Bailey L. Relationship Between Bone Bruise Volume and Patient Outcomes After ACL Reconstruction. Orthop J Sports Med 2023; 11:23259671221146205. [PMID: 36860772 PMCID: PMC9969447 DOI: 10.1177/23259671221146205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Accepted: 10/11/2022] [Indexed: 03/03/2023] Open
Abstract
Background Subchondral bone injuries, or bone bruises, are commonly observed on magnetic resonance imaging (MRI) after anterior cruciate ligament (ACL) injury. The current relationship between bone bruise volume and postsurgical outcomes remains poorly understood. Purpose To examine the influence of bone bruise volume on self-reported and objective functional outcomes at the time of return to play and 2 years following ACL reconstruction. Study Design Cohort study; Level of evidence, 3. Methods Clinical, surgical, and demographic data were obtained for a sample of convenience utilizing a single-surgeon ACL database (n = 1396). For 60 participants, femoral and tibial bone bruise volumes were estimated from preoperative MRI. Data obtained at the time of return to play included International Knee Documentation Committee (IKDC-2000) score, ACL-Return to Sport after Injury (ACL-RSI) score, and performance on an objective functional performance battery. Two-year follow-up data included graft reinjury rate, level of return to sport/activity, and self-reported knee function using the Single Assessment Numeric Evaluation (SANE). The forward stepwise linear regression was used to determine the relationship between bone bruise volume and patient function. Results The distribution of bone bruise injuries was as follows: lateral femoral condyle (76.7%), lateral tibial plateau (88.3%), medial femoral condyle (21.7%), and medial tibial plateau (26.7%). Mean total bone bruise volume of all compartments was 7065.7 ± 6226.6 mm3. At the 2-year follow up, there were no significant associations between total bone bruise volume and time of return to play (P = .832), IKDC-2000 score (P = .200), ACL-RSI score (P = .370), or SANE score (P = .179). Conclusion The lateral tibial plateau was the most frequent site to sustain bone bruise injury. Preoperative bone bruise volume was not associated with delayed time to return to sport or self-reported outcomes at time of return to play or at 2 years postoperatively. Registration NCT03704376 (ClinicalTrials.gov identifier).
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Affiliation(s)
- Connor Galloway
- Department of Sports Medicine and Rehabilitation, Memorial Hermann
Rockets Sports Medicine Institute, Houston, Texas, USA
| | - Hallie Ward
- Department of Sports Medicine and Rehabilitation, Memorial Hermann
Rockets Sports Medicine Institute, Houston, Texas, USA
| | - Steven Higbie
- Department of Sports Medicine and Rehabilitation, Memorial Hermann
Rockets Sports Medicine Institute, Houston, Texas, USA.,Steven Higbie, PT, DPT, SCS, CSCS, Department of Sports Medicine
and Rehabilitation, Memorial Hermann Rockets Sports Medicine Institute, 6400
Fannin Street, Suite 1600, Houston, TX 77030, USA (
)
| | - Jacquelyn Kleihege
- Department of Sports Medicine and Rehabilitation, Memorial Hermann
Rockets Sports Medicine Institute, Houston, Texas, USA
| | - Manickam Kumaravel
- Department of Diagnostic and Interventional Imaging, McGovern
Medical School at UT Health, Houston, Texas, USA
| | - Walter R. Lowe
- Department of Orthopaedic Surgery, McGovern Medical School at UT
Health, Houston, Texas, USA
| | - Lane Bailey
- Department of Sports Medicine and Rehabilitation, Memorial Hermann
Rockets Sports Medicine Institute, Houston, Texas, USA
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Byrd JM, Colak C, Yalcin S, Winalski C, Briskin I, Farrow LD, Jones MH, Miniaci AA, Parker RD, Rosneck JT, Saluan PM, Strnad GJ, Spindler KP. Posteromedial Tibial Bone Bruise After Anterior Cruciate Ligament Injury: An MRI Study of Bone Bruise Patterns in 208 Patients. Orthop J Sports Med 2022; 10:23259671221120636. [PMID: 36276425 PMCID: PMC9580091 DOI: 10.1177/23259671221120636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 05/24/2022] [Indexed: 11/05/2022] Open
Abstract
Background: Bone bruise patterns after anterior cruciate ligament (ACL) rupture may predict the presence of intra-articular pathology and help explain the mechanism of injury. Lateral femoral condyle (LFC) and lateral tibial plateau (LTP) bone bruises are pathognomic to ACL rupture. There is a lack of information regarding medial tibial plateau (MTP) and medial femoral condyle (MFC) bone bruises. Purpose: To summarize the prevalence and location of MTP bone bruises with acute ACL rupture and to determine the predictors of MTP bone bruises. Study Design: Cross-sectional study; Level of evidence, 3. Methods: Inclusion criteria were patients who underwent ACL reconstruction between February 2015 and November 2017, magnetic resonance imaging (MRI) within 90 days of injury, and participation in the database. Exclusion criteria included previous ipsilateral surgery, multiligamentous injuries, and incomplete imaging. Due to the large number of cases remaining (n = 600), 150 patients were selected randomly from each year included in the study, for a total of 300 patients. Two readers independently reviewed injury MRI scans using the Costa-Paz bone bruise grading system. Logistic regression was used to identify factors associated with MTP bone bruises. Results: Included were 208 patients (mean age, 23.8 years; mean body mass index, 25.6). The mechanism of injury was noncontact in 59% of injuries, with over half from soccer, basketball, and football. The median time from injury to MRI scan was 12 days. Of the 208 patients, 98% (203/208) had a bone bruise, 79% (164/208) had an MTP bone bruise, and 83% (172/208) had bruises in both medial and lateral compartments. The most common pattern, representing 46.6% of patients (97/208), was a bruise in all 4 locations (MFC, LFC, MTP, and LTP). Of the 164 MTP bruises, 160 (98%) involved the posterior third of the plateau, and 161 were grade 1. The presence of an MFC bruise was the only independent risk factor for an MTP bruise (odds ratio, 3.71). The resulting nomogram demonstrated MFC bruise, sport, and mechanism of injury were the most important predictors of an MTP bruise. Conclusion: MTP bruise after acute ACL rupture was as prevalent as lateral bruises. The presence of a posterior MTP bruise suggested anterior tibial translation at the time of injury and could portend more medial compartment pathology at the time of injury than previously recognized.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | - Kurt P. Spindler
- Kurt P. Spindler, MD, Department of Orthopaedic Surgery, Cleveland Clinic Florida Region, 3250 Meridian Pkwy, Krupa Building, Weston, FL 33331, USA (; )
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Wang KJ, Cao Y, Gao CY, Song ZQ, Zeng M, Gong HL, Wen J, Xiao S. Resumption of school after lockdown in COVID-19 pandemic: Three case reports. World J Clin Cases 2022; 10:9428-9433. [PMID: 36159429 PMCID: PMC9477658 DOI: 10.12998/wjcc.v10.i26.9428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2022] [Revised: 06/09/2022] [Accepted: 08/05/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Students in the 9th grade of junior high school in Changsha were under a 75 d lockdown due to the coronavirus disease 2019 (COVID-19) pandemic. After the resumption of school post-lockdown, the 9th grade students in Changsha faced the entrance physical examination test for senior high school.
CASE SUMMARY We report on 3 cases of occult fracture on the same site in adolescents of the same grade since resumption of school after the lockdown from the COVID-19 pandemic. Three students in the 9th grade of junior high school who were facing the physical examination in 2 wk were diagnosed with an occult fracture of the distal femur.
CONCLUSION It is recommended that the students, parents, education providers and policy makers should all pay attention to the physical exercise of students when the resumption of school after lockdown occurs and they should be aware of occult fractures when the adolescents have pain after physical exercise.
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Affiliation(s)
- Kong-Jian Wang
- Department of Pediatric Orthopedic, Hunan Provincial People's Hospital, The First Affiliated Hospital of Hunan Normal University, Changsha 410013, Hunan Province, China
- Department of Orthopedic, The Affiliated Yueyang Hospital of Hunan Normal University, Yueyang 414000, Hunan Province, China
| | - Yang Cao
- Department of Pediatric Orthopedic, Hunan Provincial People's Hospital, The First Affiliated Hospital of Hunan Normal University, Changsha 410013, Hunan Province, China
- Department of Orthopedic, The Affiliated Yueyang Hospital of Hunan Normal University, Yueyang 414000, Hunan Province, China
| | - Chun-Yang Gao
- Department of Orthopedic, The Affiliated Yueyang Hospital of Hunan Normal University, Yueyang 414000, Hunan Province, China
| | - Zhen-Qi Song
- Department of Pediatric Orthopedic, Hunan Provincial People's Hospital, The First Affiliated Hospital of Hunan Normal University, Changsha 410013, Hunan Province, China
| | - Ming Zeng
- Department of Pediatric Orthopedic, Hunan Provincial People's Hospital, The First Affiliated Hospital of Hunan Normal University, Changsha 410013, Hunan Province, China
| | - Hao-Li Gong
- Department of Pediatric Orthopedic, Hunan Provincial People's Hospital, The First Affiliated Hospital of Hunan Normal University, Changsha 410013, Hunan Province, China
| | - Jie Wen
- Department of Pediatric Orthopedic, Hunan Provincial People's Hospital, The First Affiliated Hospital of Hunan Normal University, Changsha 410013, Hunan Province, China
| | - Sheng Xiao
- Department of Pediatric Orthopedic, Hunan Provincial People's Hospital, The First Affiliated Hospital of Hunan Normal University, Changsha 410013, Hunan Province, China
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Moran J, Katz LD, Schneble CA, Li DT, Kahan JB, Wang A, Porrino J, Fosam A, Cheng R, Jokl P, Hewett TE, Medvecky MJ. A Novel MRI Mapping Technique for Evaluating Bone Bruising Patterns Associated With Noncontact ACL Ruptures. Orthop J Sports Med 2022; 10:23259671221088936. [PMID: 35480066 PMCID: PMC9036340 DOI: 10.1177/23259671221088936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Accepted: 01/21/2022] [Indexed: 11/20/2022] Open
Abstract
Background: Bone bruise patterns in the knee can aid in understanding the mechanism of injury in anterior cruciate ligament (ACL) ruptures. There is no universally accepted magnetic resonance imaging (MRI) mapping technique to describe the specific locations of bone bruises. Hypothesis: The authors hypothesized that (1) our novel mapping technique would show high interrater and intrarater reliability for the location of bone bruises in noncontact ACL-injured knees and (2) the bone bruise patterns reported from this technique would support the most common mechanisms of noncontact ACL injury, including valgus stress, anterior tibial translation, and internal tibial rotation. Study Design: Cross-sectional study; Level of evidence, 3. Methods: Included were 43 patients who underwent ACL reconstruction between 2018 and 2020, with MRI within 30 days of the injury on a 3.0-T scanner, documentation of a noncontact mechanism of injury, and no concomitant or previous knee injuries. Images were retrospectively reviewed by 2 radiologists blinded to all clinical data. The locations of bone bruises were mapped on fat-suppressed T2-weighted coronal and sagittal images using a novel technique that combined the International Cartilage Repair Society (ICRS) tibiofemoral articular cartilage surgical lesions diagram and the Whole-Organ Magnetic Resonance Imaging Scoring (WORMS) mapping system. Reliability between the reviewers was assessed using the intraclass correlation coefficient (ICC), where ICC >0.90 indicated excellent agreement. Results: The interrater and intrarater ICCs were 0.918 and 0.974, respectively, for femoral edema mapping and 0.979 and 0.978, respectively, for tibial edema mapping. Significantly more bone bruises were seen within the lateral femoral condyle compared with the medial femoral condyle (67% vs 33%; P < .0001), and more bruises were seen within the lateral tibial plateau compared with the medial tibial plateau (65% vs 35%; P < .0001). Femoral bruises were almost exclusively located in the anterior/central regions (98%) of the condyles as opposed to the posterior region (2%; P < .0001). Tibial bruises were localized to the posterior region (78%) of both plateaus as opposed to the anterior/central regions (22%; P < .0001). Conclusion: The combined mapping technique offered a standardized and reliable method for reporting bone bruises in noncontact ACL injuries. The contusion patterns identified using this technique were indicative of the most commonly reported mechanisms for noncontact ACL injuries.
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Affiliation(s)
- Jay Moran
- Yale School of Medicine, New Haven, Connecticut, USA
| | - Lee D. Katz
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, Connecticut, USA
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Connecticut, USA
| | - Christopher A. Schneble
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, Connecticut, USA
| | - Don T. Li
- Yale School of Medicine, New Haven, Connecticut, USA
| | - Joseph B. Kahan
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, Connecticut, USA
| | - Annie Wang
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Connecticut, USA
| | - Jack Porrino
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Connecticut, USA
| | - Andin Fosam
- Yale School of Medicine, New Haven, Connecticut, USA
| | - Ryan Cheng
- Yale University, New Haven, Connecticut, USA
| | - Peter Jokl
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, Connecticut, USA
| | | | - Michael J. Medvecky
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, Connecticut, USA
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de Bakker CM, Knowles NK, Walker RE, Manske SL, Boyd SK. Independent changes in bone mineralized and marrow soft tissues following acute knee injury require dual-energy or high-resolution computed tomography for accurate assessment of bone mineral density and stiffness. J Mech Behav Biomed Mater 2022; 127:105091. [DOI: 10.1016/j.jmbbm.2022.105091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Revised: 12/12/2021] [Accepted: 01/12/2022] [Indexed: 11/16/2022]
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Current trends in the anterior cruciate ligament part II: evaluation, surgical technique, prevention, and rehabilitation. Knee Surg Sports Traumatol Arthrosc 2022; 30:34-51. [PMID: 34865182 DOI: 10.1007/s00167-021-06825-z] [Citation(s) in RCA: 27] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Accepted: 11/23/2021] [Indexed: 12/14/2022]
Abstract
Clinical evaluation and management of anterior cruciate ligament (ACL) injury is one of the most widely researched topics in orthopedic sports medicine, giving providers ample data on which to base their practices. The ACL is also the most commonly treated knee ligament. This study reports on current topics and research in clinical management of ACL injury, starting with evaluation, operative versus nonoperative management, and considerations in unique populations. Discussion of graft selection and associated procedures follows. Areas of uncertainty, rehabilitation, and prevention are the final topics before a reflection on the current state of ACL research and clinical management of ACL injury. Level of evidence V.
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11
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Moran J, Katz LD, Schneble CA, Li D, Kahan JB, Wang A, Porrino J, Jokl P, Hewett TE, Medvecky MJ. Injury to the Meniscofemoral Portion of the Deep MCL Is Associated with Medial Femoral Condyle Bone Marrow Edema in ACL Ruptures. JB JS Open Access 2021; 6:JBJSOA-D-21-00069. [PMID: 34841192 PMCID: PMC8613370 DOI: 10.2106/jbjs.oa.21.00069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Background The primary goal of the present study was to investigate injury to the deep medial collateral ligament (MCL), specifically the meniscofemoral ligament (MFL) portion, and its association with medial femoral condyle (MFC) bone marrow edema in acute anterior cruciate ligament (ACL) ruptures. The secondary goal was to examine the association between MFL injury and medial meniscal tears (MMTs) in these same patients. Methods Preoperative magnetic resonance imaging (MRI) scans of 55 patients who underwent ACL reconstruction surgery were retrospectively reviewed by 2 board-certified musculoskeletal radiologists. MRI scans were examined for MFC edema at the insertion site of the MFL. This site on the MFC was referred to as the central-femoral-medial-medial (C-FMM) zone based on the coronal and sagittal locations on MRI. The presence or absence of bone marrow edema within this zone was noted. The prevalence, grade, and location of superficial MCL and MFL injuries were also recorded on MRI. The correlations between MFL injuries and the presence of MFC bone marrow edema were examined. Lastly, the presence and location of MMTs were also recorded on MRI and were confirmed on arthroscopy, according to the operative notes. Results On MRI, 40 (73%) of the 55 patients had MFL injuries. MFL injuries were significantly more common than superficial MCL injuries (p = 0.0001). Of the 27 patients with C-FMM bruising, 93% (25 patients) had MFL tears (p < 0.00001). In addition, of the 40 patients with an MFL injury, 63% (25 patients) had C-FMM bruising (p = 0.0251). Chi-square testing showed that MMTs and MFL injuries were significantly associated, with 12 (100%) of 12 patients with MMTs also having a concomitant MFL injury (p = 0.0164). Conclusions The prevalence of MFL injury in ACL ruptures is high and MFC bone marrow edema at the MFL insertion site should raise suspicion of injury. MFL injuries can present with clinically normal medial ligamentous laxity in ACL ruptures. Additionally, MFL injuries were significantly associated with posterior horn MMTs, which have been shown in the literature to be a potential risk factor for ACL graft failure. Clinical Relevance As deep MCL injuries are difficult to detect on physical examination, our findings suggest that the reported MFC edema in ACL ruptures can act as an indirect sign of MFL injury and may aid in the clinical detection. Additionally, due to the anatomical connection of the deep MCL and the meniscocapsular junction of the posterior horn of the medial meniscus, if an MFL injury is suspected through indirect MFC edema at the insertion site, the posterior horn of the medial meniscus should also be assessed for injury, as there is an association between the 2 injuries in ACL ruptures.
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Affiliation(s)
- Jay Moran
- Yale School of Medicine, New Haven, Connecticut
| | - Lee D Katz
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, Connecticut.,Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Connecticut
| | - Christopher A Schneble
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, Connecticut
| | - Don Li
- Yale School of Medicine, New Haven, Connecticut
| | - Joseph B Kahan
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, Connecticut
| | - Annie Wang
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Connecticut
| | - Jack Porrino
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Connecticut
| | - Peter Jokl
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, Connecticut
| | | | - Michael J Medvecky
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, Connecticut
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Xu Z, Chen Y, Zhu J, Zhang L, Wu P. Comparison of the Use of Magnetic Resonance Imaging of Partial Anterior Cruciate Ligament Tears Using Maximum Knee Flexion in the Lateral Decubitus Position with Routine Knee Positioning. Med Sci Monit 2021; 27:e932228. [PMID: 34593750 PMCID: PMC8491558 DOI: 10.12659/msm.932228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Background This study assessed magnetic resonance imaging (MRI) of acute and chronic partial anterior cruciate ligament (ACL) tears using maximum knee flexion in the lateral decubitus position compared with routine knee positioning in 204 patients at a single center. Material/Methods Based on the time interval from injury to MRI examination, the 204 patients in this study were divided into 3 groups: subacute (6 weeks to 3 months), intermediate (3 months to 1 year), and chronic (>1 year). All patients received both routine MRI (MRI R) and maximum knee flexion in the lateral decubitus position MRI (MRI S) examination, followed by knee arthroscopy. Three radiologists blinded to patient groups evaluated the MRI scans and made a diagnosis. Results of knee arthroscopy were referenced as the criterion standard. The sensitivity and specificity of MRI R and MRI S groups were calculated and compared. Results The MRI S diagnostic rate was comparable to that of knee arthroscopy. MRI S had significantly higher sensitivity than MRI R for partial ACL tears, especially in the intermediate group (P<0.01). Conclusions MRI of partial ACL tears using maximum knee flexion in the lateral decubitus position improved the diagnostic rate relative to routine MRI examination, particularly in patients in the intermediate group.
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Affiliation(s)
- Zijun Xu
- Department of Radiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China (mainland)
| | - Yichao Chen
- Department of Orthopedics, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China (mainland)
| | - Jianghua Zhu
- Department of Equipment, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China (mainland)
| | - Lin Zhang
- Department of Radiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China (mainland)
| | - Peng Wu
- Department of Orthopeadics, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China (mainland)
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Shi H, Ding L, Jiang Y, Zhang H, Ren S, Hu X, Liu Z, Huang H, Ao Y. Comparison Between Soccer and Basketball of Bone Bruise and Meniscal Injury Patterns in Anterior Cruciate Ligament Injuries. Orthop J Sports Med 2021; 9:2325967121995844. [PMID: 33912617 PMCID: PMC8050764 DOI: 10.1177/2325967121995844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Accepted: 11/20/2020] [Indexed: 11/17/2022] Open
Abstract
Background: The varying effectiveness of anterior cruciate ligament (ACL) injury
prevention programs between soccer and basketball may be due to differences
in sport-specific injury mechanisms. Bone bruise patterns may provide
information regarding injury mechanisms. Purpose: To compare bone bruise and meniscal injury patterns for ACL injuries
sustained in soccer versus basketball. Study Design: Cross-sectional study; Level of evidence, 3. Methods: Clinical notes, operative reports, and magnetic resonance imaging scans were
reviewed for patients who sustained a noncontact ACL rupture while playing
soccer or basketball between August 2016 and August 2018. The presence,
location, and signal intensity of bone bruises on the tibia and femur were
documented, and patterns were classified according to the location of the
bone bruise in the lateral-medial direction. The meniscal and bone bruise
injury patterns and the specific bone bruise locations were compared between
the soccer and basketball groups. Results: Overall, 138 patients were included (56 with soccer-related and 82 with
basketball-related ACL injury). No significant difference between the groups
was observed in bone bruise patterns (P = .743) or meniscal
injury patterns (P = .952). Bone bruise on the lateral side
only of both the femur and the tibia was the most common pattern in both
soccer (41.9%) and basketball (47.0%) groups; the most common meniscal
injury type was an isolated lateral meniscal injury in both soccer (50.0%)
and basketball (45.0%) groups. For patients with bone bruises on both the
lateral and the medial sides of both the femur and the tibia (BF+BT), the
bone bruise signal intensity on the lateral side of the femur
(P < .001) and tibia (P = .009) was
significantly higher than that on the medial side for both groups. The bone
bruises on the lateral side of the femur (P < .001) and
tibia (P = .002) were significantly more anterior than
those on the medial side for patients with the BF+BT pattern. Conclusion: No significant differences in bone bruise location or meniscal injury type
were detected when comparing ACL injuries sustained during soccer versus
basketball. The study results suggest a similar biomechanical loading
pattern for ACL injuries in these sports.
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Affiliation(s)
- Huijuan Shi
- School of Biological Science and Medical Engineering, Beijing Advanced Innovation Centre for Biomedical Engineering, Beihang University, Beijing, China.,Institute of Sports Medicine, Peking University Third Hospital, Beijing Key Laboratory of Sports Injuries, Beijing, China
| | - Li Ding
- School of Biological Science and Medical Engineering, Beijing Advanced Innovation Centre for Biomedical Engineering, Beihang University, Beijing, China
| | - Yanfang Jiang
- Institute of Sports Medicine, Peking University Third Hospital, Beijing Key Laboratory of Sports Injuries, Beijing, China
| | - Haocheng Zhang
- School of Biological Science and Medical Engineering, Beijing Advanced Innovation Centre for Biomedical Engineering, Beihang University, Beijing, China
| | - Shuang Ren
- Institute of Sports Medicine, Peking University Third Hospital, Beijing Key Laboratory of Sports Injuries, Beijing, China
| | - Xiaoqing Hu
- Institute of Sports Medicine, Peking University Third Hospital, Beijing Key Laboratory of Sports Injuries, Beijing, China
| | - Zhenlong Liu
- Institute of Sports Medicine, Peking University Third Hospital, Beijing Key Laboratory of Sports Injuries, Beijing, China
| | - Hongshi Huang
- Institute of Sports Medicine, Peking University Third Hospital, Beijing Key Laboratory of Sports Injuries, Beijing, China
| | - Yingfang Ao
- School of Biological Science and Medical Engineering, Beijing Advanced Innovation Centre for Biomedical Engineering, Beihang University, Beijing, China.,Institute of Sports Medicine, Peking University Third Hospital, Beijing Key Laboratory of Sports Injuries, Beijing, China
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Kim-Wang SY, Scribani MB, Whiteside MB, DeFrate LE, Lassiter TE, Wittstein JR. Distribution of Bone Contusion Patterns in Acute Noncontact Anterior Cruciate Ligament-Torn Knees. Am J Sports Med 2021; 49:404-409. [PMID: 33411563 PMCID: PMC8214466 DOI: 10.1177/0363546520981569] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Bone contusions are commonly observed on magnetic resonance imaging (MRI) in individuals who have sustained a noncontact anterior cruciate ligament (ACL) injury. Time from injury to image acquisition affects the ability to visualize these bone contusions, as contusions resolve with time. PURPOSE To quantify the number of bone contusions and their locations (lateral tibial plateau [LTP], lateral femoral condyle [LFC], medial tibial plateau [MTP], and medial femoral condyle [MFC]) observed on MRI scans of noncontact ACL-injured knees acquired within 6 weeks of injury. STUDY DESIGN Cross-sectional study; Level of evidence, 3. METHODS We retrospectively reviewed clinic notes, operative notes, and imaging of 136 patients undergoing ACL reconstruction. The following exclusion criteria were applied: MRI scans acquired beyond 6 weeks after injury, contact ACL injury, and previous knee trauma. Fat-suppressed fast spin-echo T2-weighted MRI scans were reviewed by a blinded musculoskeletal radiologist. The number of contusions and their locations (LTP, LFC, MTP, and MFC) were recorded. RESULTS Contusions were observed in 135 of 136 patients. Eight patients (6%) had 1 contusion, 39 (29%) had 2, 41 (30%) had 3, and 47 (35%) had 4. The most common contusion patterns within each of these groups were 6 (75%) with LTP for 1 contusion, 29 (74%) with LTP/LFC for 2 contusions, 33 (80%) with LTP/LFC/MTP for 3 contusions, and 47 (100%) with LTP/LFC/MTP/MFC for 4 contusions. No sex differences were detected in contusion frequency in the 4 locations (P > .05). Among the participants, 50 (37%) had medial meniscal tears and 52 (38%) had lateral meniscal tears. CONCLUSION The most common contusion patterns observed were 4 locations (LTP/LFC/MTP/MFC) and 3 locations (LTP/LFC/MTP).
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Affiliation(s)
- Sophia Y Kim-Wang
- Department of Orthopaedic Surgery, Duke University, Durham, North Carolina, USA.,Department of Biomedical Engineering, Duke University, Durham, North Carolina, USA
| | | | | | - Louis E DeFrate
- Department of Orthopaedic Surgery, Duke University, Durham, North Carolina, USA.,Department of Biomedical Engineering, Duke University, Durham, North Carolina, USA.,Department of Mechanical Engineering and Materials Science, Duke University, Durham, North Carolina, USA
| | - Tally E Lassiter
- Department of Orthopaedic Surgery, Duke University, Durham, North Carolina, USA
| | - Jocelyn R Wittstein
- Department of Orthopaedic Surgery, Duke University, Durham, North Carolina, USA
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Color-coded virtual non-calcium dual-energy CT for the depiction of bone marrow edema in patients with acute knee trauma: a multireader diagnostic accuracy study. Eur Radiol 2019; 30:141-150. [DOI: 10.1007/s00330-019-06304-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2019] [Revised: 05/16/2019] [Accepted: 06/05/2019] [Indexed: 10/26/2022]
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16
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Bone bruise in anterior cruciate ligament rupture entails a more severe joint damage affecting joint degenerative progression. Knee Surg Sports Traumatol Arthrosc 2019; 27:44-59. [PMID: 29869683 PMCID: PMC6510815 DOI: 10.1007/s00167-018-4993-4] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2017] [Accepted: 05/30/2018] [Indexed: 01/13/2023]
Abstract
PURPOSE During anterior cruciate ligament (ACL) injury, the large external forces responsible for ligament rupture cause a violent impact between tibial and femoral articular cartilage, which is transferred to bone resulting in bone bruise detectable at MRI. Several aspects remain controversial and await evidence on how this MRI finding should be managed while addressing the ligament lesion. Thus, the aim of the present review was to document the evidence of all available literature on the role of bone bruise associated with ACL lesions. METHODS A systematic review of the literature was performed on bone bruise associated with ACL injury. The search was conducted in September 2017 on three medical electronic databases: PubMed, Web of Science, and the Cochrane Collaboration. Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines were used. Relevant articles were studied to investigate three main aspects: prevalence and progression of bone bruise associated with ACL lesions, its impact on the knee in terms of lesion severity and joint degeneration progression over time and, finally, the influence of bone bruise on patient prognosis in terms of clinical outcome. RESULTS The search identified 415 records and, after an initial screening according to the inclusion/exclusion criteria, 83 papers were used for analysis, involving a total of 10,047 patients. Bone bruise has a high prevalence (78% in the most recent papers), with distinct patterns related to the mechanism of injury. This MRI finding is detectable only in a minority of cases the first few months after trauma, but its presence and persistence have been correlated to a more severe joint damage that may affect the degenerative progression of the entire joint, with recent evidence suggesting possible effects on long-term clinical outcome. CONCLUSION This systematic review of the literature documented a growing interest on bone bruise associated with ACL injury, highlighting aspects which could provide to orthopaedic surgeons evidence-based suggestions in terms of clinical relevance when dealing with patients affected by bone bruise following ACL injury. However, prospective long-term studies are needed to better understand the natural history of bone bruise, identifying prognostic factors and targets of specific treatments that should be developed in light of the overall joint derangements accompanying ACL lesions. LEVELS OF EVIDENCE IV, Systematic review of level I-IV studies.
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17
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Gómez JE, Molina DD, Rettig SD, Kan JH. Bone Bruises in Children and Adolescents Not Associated With Ligament Ruptures. Orthop J Sports Med 2018; 6:2325967118786960. [PMID: 30109238 PMCID: PMC6083756 DOI: 10.1177/2325967118786960] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Background: Clinical characteristics of uncomplicated bone bruises (ie, not associated with a ligament rupture, meniscal tear, or fracture of the knee) in young athletes have scarcely been reported. Purpose: To identify mechanisms of injury, characterize bone bruise patterns, and identify clinical factors relating to recovery in young patients suffering uncomplicated bone bruises about the knee. Study Design: Case series; Level of evidence, 4. Methods: A review of clinical records and magnetic resonance imaging (MRI) findings of patients seen at a single institution was completed. Results: We identified 62 children and teenagers (mean age, 13.9 years; range, 8-18 years) who had a total of 101 bone bruises on MRI. The injuries occurred during a variety of organized and recreational sporting activities, the most common being football, basketball, and soccer. The majority (61.4%) of bone bruises occurred as a result of noncontact mechanisms. Patients reported a mean pain scale score of 6.3 of 10 (range, 2-10) on presentation. Frequent clinical findings included non–joint-line tenderness (64.5%), limited range of motion (58.1%), joint-line tenderness (54.8%), and positive meniscal signs (50.0%). The majority of bone bruises (61.4%) were located medially, and the most common bone bruise type was subcortical (58.4%), followed by medullary/reticular (35.6%) and articular impaction (5.9%). The only factor related to time to recovery was mechanism of injury; patients reporting a noncontact mechanism required significantly more time to recover than those reporting a contact mechanism (mean, 99.7 ± 74.8 vs 65.7 ± 38.8 days, respectively; F = 3.753, P = .049). Conclusion: In this case series of 62 pediatric patients with non–anterior cruciate ligament (ACL) bone bruises, the majority occurred in the medial compartment, suggesting that these bone bruises result from a mechanism distinct from the pivot-shift mechanism, classically thought to cause ACL injuries.
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Affiliation(s)
- Jorge E. Gómez
- Texas Children’s Hospital, Baylor College of Medicine, Houston, Texas, USA
| | - Daren D. Molina
- Texas Children’s Hospital, Baylor College of Medicine, Houston, Texas, USA
| | - Shaylon D. Rettig
- Children’s Hospital of San Antonio, Baylor College of Medicine, San Antonio, Texas, USA
| | - J. Herman Kan
- Texas Children’s Hospital, Baylor College of Medicine, Houston, Texas, USA
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Aravindh P, Wu T, Chan CX, Wong KL, Krishna L. Association of Compartmental Bone Bruise Distribution With Concomitant Intra-articular and Extra-articular Injuries in Acute Anterior Cruciate Ligament Tears After Noncontact Sports Trauma. Orthop J Sports Med 2018; 6:2325967118767625. [PMID: 29780838 PMCID: PMC5954320 DOI: 10.1177/2325967118767625] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Background: Anterior cruciate ligament (ACL) injuries are frequently associated with bone bruises, and their presence may be associated with concomitant intra- and extra-articular injuries. Purpose: To investigate the prevalence and pattern of distribution of bone bruises in patients with acute ACL tears from noncontact sports trauma and their association with specific intra- and extra-articular injuries. Study Design: Cross-sectional study; Level of evidence, 3. Methods: A total of 168 patients underwent magnetic resonance imaging (MRI) within 6 weeks of sustaining an ACL tear. Information regarding their demographics as well as MRI evidence of bone bruise patterns and associated injuries was carefully documented. Univariate and multivariate logistic regression analyses were performed to determine the association between bone bruises and concomitant intra- and extra-articular injuries seen on MRI. Results: Bone bruises were observed in 155 (92.3%) of 168 patients. The prevalence of bone bruises was 83.9%, 78.6%, 56.5%, and 29.8% on the lateral tibial plateau, lateral femoral condyle, medial tibial plateau, and medial femoral condyle, respectively. A total of 110 (65.5%) patients had bone bruises in both the medial and lateral compartments of the knee, 41 (24.4%) had isolated lateral compartment bone bruises, 4 (2.4%) had isolated medial compartment bone bruises, and 13 (7.7%) did not have any bone bruises. None of the demographic factors were significantly associated with the presence or absence of bone bruises. The presence of bone bruises was significantly associated with lateral meniscal injuries (P = .05). Lateral compartment bone bruises were significantly associated with lateral meniscal injuries (P = .034), while bone bruises affecting both the lateral and medial compartments were significantly associated with medial collateral ligament (MCL) injuries (P = .044) and lateral collateral ligament (LCL) injuries (P = .038) in addition to lateral meniscal injuries (P = .022). Conclusion: Bone bruises are common in patients with acute ACL tears after noncontact sports injuries. The compartmental distribution of bone bruises is associated with concomitant intra- and extra-articular injuries. Bone bruises involving the lateral compartment of the knee are associated with lateral meniscal injuries, while bone bruises involving both the lateral and medial compartments of the knee are associated with MCL and LCL injuries in addition to lateral meniscal injuries.
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Affiliation(s)
- Palaniswamy Aravindh
- Division of Sports Medicine and Surgery, Department of Orthopaedic Surgery, National University Hospital, National University Health System, Singapore
| | - Tianyi Wu
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Chloe Xiaoyun Chan
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Keng Lin Wong
- Division of Sports Medicine and Surgery, Department of Orthopaedic Surgery, National University Hospital, National University Health System, Singapore
| | - Lingaraj Krishna
- Division of Sports Medicine and Surgery, Department of Orthopaedic Surgery, National University Hospital, National University Health System, Singapore
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Ali AM, Pillai JK, Gulati V, Gibbons CER, Roberton BJ. Hyperextension injuries of the knee: do patterns of bone bruising predict soft tissue injury? Skeletal Radiol 2018; 47:173-179. [PMID: 28856482 DOI: 10.1007/s00256-017-2754-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2017] [Revised: 07/31/2017] [Accepted: 08/02/2017] [Indexed: 02/02/2023]
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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Affiliation(s)
- A M Ali
- Department of Orthopaedic Surgery, Chelsea and Westminster Hospital, London, UK.
| | - J K Pillai
- Department of Radiology, Chelsea and Westminster Hospital, London, UK
| | - V Gulati
- Department of Orthopaedic Surgery, Homerton University Hospital, London, UK
| | - C E R Gibbons
- Department of Orthopaedic Surgery, Chelsea and Westminster Hospital, London, UK
| | - B J Roberton
- Department of Radiology, Chelsea and Westminster Hospital, London, UK
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Klengel A, Stumpp P, Klengel S, Böttger I, Rönisch N, Kahn T. Detection of Traumatic Bone Marrow Lesions after Knee Trauma: Comparison of ADC Maps Derived from Diffusion-weighted Imaging with Standard Fat-saturated Proton Density–weighted Turbo Spin-Echo Sequences. Radiology 2017; 283:469-477. [DOI: 10.1148/radiol.2016160306] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Alexis Klengel
- From the Department of Diagnostic and Interventional Radiology, University Hospital Leipzig, Liebigstr 20, 04103 Leipzig, Germany (A.K., P.S., T.K.); and Department of Radiology, Medical Service Center RadCom, Riesa, Germany (S.K., I.B., N.R.)
| | - Patrick Stumpp
- From the Department of Diagnostic and Interventional Radiology, University Hospital Leipzig, Liebigstr 20, 04103 Leipzig, Germany (A.K., P.S., T.K.); and Department of Radiology, Medical Service Center RadCom, Riesa, Germany (S.K., I.B., N.R.)
| | - Steffen Klengel
- From the Department of Diagnostic and Interventional Radiology, University Hospital Leipzig, Liebigstr 20, 04103 Leipzig, Germany (A.K., P.S., T.K.); and Department of Radiology, Medical Service Center RadCom, Riesa, Germany (S.K., I.B., N.R.)
| | - Ina Böttger
- From the Department of Diagnostic and Interventional Radiology, University Hospital Leipzig, Liebigstr 20, 04103 Leipzig, Germany (A.K., P.S., T.K.); and Department of Radiology, Medical Service Center RadCom, Riesa, Germany (S.K., I.B., N.R.)
| | - Nadja Rönisch
- From the Department of Diagnostic and Interventional Radiology, University Hospital Leipzig, Liebigstr 20, 04103 Leipzig, Germany (A.K., P.S., T.K.); and Department of Radiology, Medical Service Center RadCom, Riesa, Germany (S.K., I.B., N.R.)
| | - Thomas Kahn
- From the Department of Diagnostic and Interventional Radiology, University Hospital Leipzig, Liebigstr 20, 04103 Leipzig, Germany (A.K., P.S., T.K.); and Department of Radiology, Medical Service Center RadCom, Riesa, Germany (S.K., I.B., N.R.)
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21
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Effects of Bone Bruise on Patients’ Pain after Acute Knee Trauma. JOURNAL OF ORTHOPEDIC AND SPINE TRAUMA 2017. [DOI: 10.5812/jost.9547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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22
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Pedersen DR, El-Khoury GY, Thedens DR, Saad-Eldine M, Phisitkul P, Amendola A. Bone contusion progression from traumatic knee injury: association of rate of contusion resolution with injury severity. Open Access J Sports Med 2017; 8:9-15. [PMID: 28203112 PMCID: PMC5293505 DOI: 10.2147/oajsm.s118811] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Bone contusions are frequently encountered in magnetic resonance imaging (MRI) evaluation of knee anterior cruciate ligament (ACL) injuries. Their role as indicators of injury severity remains unclear, primarily due to indeterminate levels of joint injury forces and to a lack of preinjury imaging. PURPOSE The purpose of this study was to 1) quantify bone contusion pathogenesis following traumatic joint injuries using fixed imaging follow-ups, and 2) assess the feasibility of using longitudinal bone contusion volumes as an indicator of knee injury severity. STUDY DESIGN Prospective sequential MRI follow-ups of a goat cohort exposed to controlled stifle trauma in vivo were compared to parallel clinical MRI follow-ups of a human ACL tear patient series. METHODS Reproducible cartilage impact damage of various energy magnitudes was applied in a survival goat model, coupled with partial resection of anterior portions of medial menisci. Both emulate injury patterns to the knee osteochondral structures commonly encountered in human ACL injury imaging as well as instability from resultant ligament laxity. Longitudinal clinical MRI sequences portrayed stifle bone contusion evolution through 6 months after the inciting event. RESULTS In the first 2 weeks, biological response variability dominated the whole-joint response with no apparent correlation to trauma severity. Control goats subjected to partial meniscectomy alone exhibited minimal bone response. Thereafter, 0.6 J impact bone contusions portrayed a faster rate of resolution than those induced by 1.2 J cartilage impacts. CONCLUSION Bone contusion sizes combined with time of persistence are likely better measures of joint injury severity than isolated bone contusion volume.
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Affiliation(s)
| | | | - Dan R Thedens
- Department of Electrical and Computer Engineering, University of Iowa, Iowa City, IA
| | | | | | - Annunziato Amendola
- Department of Orthopaedics and Sports Medicine, Duke University Medical School, Durham, NC, USA
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van Meer BL, Oei EHG, Meuffels DE, van Arkel ERA, Verhaar JAN, Bierma-Zeinstra SMA, Reijman M. Degenerative Changes in the Knee 2 Years After Anterior Cruciate Ligament Rupture and Related Risk Factors: A Prospective Observational Follow-up Study. Am J Sports Med 2016; 44:1524-33. [PMID: 26965680 DOI: 10.1177/0363546516631936] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Anterior cruciate ligament (ACL) rupture is a well-known risk factor for development of knee osteoarthritis. Early identification of those patients at risk and early identification of the process of ACL rupture leading to osteoarthritis may aid in preventing the onset or progression of osteoarthritis. PURPOSE To identify early degenerative changes as assessed on magnetic resonance imaging (MRI) after 2-year follow-up in patients with a recent ACL rupture and to evaluate which determinants are related to these changes. STUDY DESIGN Cohort study; Level of evidence, 2. METHODS Included in this study were 154 adults aged between 18 and 45 years with acute ACL rupture diagnosed by physical examination and MRI, without previous knee trauma or surgery, and without osteoarthritic changes on radiographs. A total of 143 patients completed the 2-year follow-up, and the results in this study apply to these 143 patients. All patients were treated according to the Dutch guideline on ACL injury. Of the 143 patients, 50 patients were treated nonoperatively during the 2-year follow-up period. Main outcome was early degenerative changes assessed on MRI defined as progression of cartilage defects and osteophytes in tibiofemoral and patellofemoral compartments. Patient characteristics, activity level, functional instability, treatment type, and trauma-related variables were evaluated as determinants. RESULTS The median time between MRI at baseline and MRI at 2-year follow-up was 25.9 months (interquartile range, 24.7-26.9 months). Progression of cartilage defects in the medial and lateral tibiofemoral compartments was present in 12% and 27% of patients, and progression of osteophytes in tibiofemoral and patellofemoral compartments was present in 10% and 8% of patients, respectively. The following determinants were positively significantly associated with early degenerative changes: male sex (odds ratio [OR], 4.43; 95% CI, 1.43-13.66; P = .010), cartilage defect in the medial tibiofemoral compartment at baseline (OR, 3.66; 95% CI, 1.04-12.95; P = .044), presence of bone marrow lesions in the medial tibiofemoral compartment 1 year after trauma (OR, 5.19; 95% CI, 1.56-17.25; P = .007), joint effusion 1 year after trauma (OR, 4.19; 95% CI, 1.05-16.72; P = .042), and presence of meniscal tears (OR, 6.37; 95% CI, 1.94-20.88; P = .002). When the patients were categorized into 3 treatment groups (nonoperative, reconstruction <6 months after ACL rupture, and reconstruction ≥6 months after ACL rupture), there was no significant relationship between the treatment options and the development of early degenerative changes. CONCLUSION Two years after ACL rupture, early degenerative changes were assessed on MRI. Concomitant medial cartilage defect and meniscal injury, male sex, persistent bone marrow lesions in the medial tibiofemoral compartment, and joint effusion are risk factors for degenerative changes.
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Affiliation(s)
- Belle L van Meer
- Department of Orthopaedic Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands Department of Sports Medicine, Medical Center Haaglanden, The Hague, the Netherlands
| | - Edwin H G Oei
- Department of Radiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Duncan E Meuffels
- Department of Orthopaedic Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Ewoud R A van Arkel
- Department of Orthopaedic Surgery, Medical Center Haaglanden, The Hague, the Netherlands
| | - Jan A N Verhaar
- Department of Orthopaedic Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Sita M A Bierma-Zeinstra
- Department of Orthopaedic Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands Department of General Practice, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Max Reijman
- Department of Orthopaedic Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
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24
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Smith AD, Morton AJ, Winter MD, Colahan PT, Ghivizzani S, Brown MP, Hernandez JA, Nickerson DM. MAGNETIC RESONANCE IMAGING SCORING OF AN EXPERIMENTAL MODEL OF POST-TRAUMATIC OSTEOARTHRITIS IN THE EQUINE CARPUS. Vet Radiol Ultrasound 2016; 57:502-14. [PMID: 27198611 DOI: 10.1111/vru.12369] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2015] [Revised: 02/25/2016] [Accepted: 02/29/2016] [Indexed: 12/17/2022] Open
Abstract
Magnetic resonance imaging (MRI) is the most sensitive imaging modality to detect the early changes of osteoarthritis. Currently, there is no quantifiable method to tract these pathological changes over time in the horse. The objective of this experimental study was to characterize the progression of MRI changes in an equine model of post-traumatic osteoarthritis using a semiquantitative scoring system for whole-organ evaluation of the middle carpal joint. On day 0, an osteochondral fragment was created in one middle carpal joint (OCI) and the contralateral joint (CON) was sham-operated in 10 horses. On day 14, study horses resumed exercise on a high-speed treadmill until the completion of the study (day 98). High-field MRI examinations were performed on days 0 (preosteochondral fragmentation), 14, and 98 and scored by three blinded observers using consensus agreement. Images were scored based on 15 independent articular features, and scores were compared between and within-groups. On days 14 and 98, OCI joints had significantly (P ≤ 0.05) higher whole-organ median scores (29.0 and 31.5, respectively), compared to CON joints (21.5 and 20.0, respectively). On day 14, OCI joints showed significant increases in high-signal bone lesion scores, and osteochondral fragment number and size. On day 98, high-signal bone lesion, low-signal bone lesion, osteophyte formation, cartilage signal abnormality, subchondral bone irregularity, joint effusion, and synovial thickening scores were significantly increased in OCI joints. Study results suggest that the MRI whole-organ scoring system reported here may be used to identify onset and progression of pathological changes following osteochondral injury.
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Affiliation(s)
- Andrew D Smith
- Department of Large Animal Clinical Sciences, University of Florida College of Veterinary Medicine, University of Florida, Gainesville, FL, 32608
| | - Alison J Morton
- Department of Large Animal Clinical Sciences, University of Florida College of Veterinary Medicine, University of Florida, Gainesville, FL, 32608.
| | - Matthew D Winter
- Department of Small Animal Clinical Sciences, University of Florida College of Veterinary Medicine, University of Florida, Gainesville, FL, 32608
| | - Patrick T Colahan
- Department of Large Animal Clinical Sciences, University of Florida College of Veterinary Medicine, University of Florida, Gainesville, FL, 32608
| | - Steve Ghivizzani
- Department of Orthopaedics and Rehabilitation, University of Florida College of Medicine, Univeristy of Florida, Gainesville, FL, 32608
| | - Murray P Brown
- Department of Large Animal Clinical Sciences, University of Florida College of Veterinary Medicine, University of Florida, Gainesville, FL, 32608
| | - Jorge A Hernandez
- Department of Large Animal Clinical Sciences, University of Florida College of Veterinary Medicine, University of Florida, Gainesville, FL, 32608
| | - David M Nickerson
- Department of Statistics, University of Central Florida, Orlando, FL, 32816
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Tufts LS, Shet K, Liang F, Majumdar S, Li X. Quantification of bone marrow water and lipid composition in anterior cruciate ligament-injured and osteoarthritic knees using three-dimensional magnetic resonance spectroscopic imaging. Magn Reson Imaging 2015; 34:632-7. [PMID: 26723848 DOI: 10.1016/j.mri.2015.12.034] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2015] [Accepted: 12/18/2015] [Indexed: 01/06/2023]
Abstract
PURPOSE To quantitatively evaluate longitudinal changes in water and lipid in knee bone marrow with and without bone marrow edema-like lesions (BMELs) in subjects with acutely ruptured anterior cruciate ligaments (ACLs) or osteoarthritis (OA) using three-dimensional magnetic resonance spectroscopic imaging (3D MRSI). MATERIAL AND METHODS Ten ACL and 10 OA subjects who presented with BMEL and seven BMEL-free controls were scanned at 3T. All ACL and OA subjects had one-year follow-up scans. 3D MRSI was acquired in BMEL and adjacent bone marrow, and water content (WC) and unsaturated lipid index (UI) were calculated in each region of interest. RESULTS At baseline, ACL BMEL WC was significantly higher than ACL non-BMEL, OA BMEL, and control WC; ACL non-BMEL WC, ACL BMEL UI, and OA BMEL WC were significantly higher than control. ACL BMEL WC decreased significantly one year post-reconstruction; UI decreased non-significantly (p=0.09). No significant changes in OA BMEL or ACL and OA non-BMEL WC and UI were observed. CONCLUSION 3D MRSI is a powerful method of quantitatively assessing the biochemical composition of bone marrow in OA and ACL-injured knees, which may serve as imaging markers to improve comprehension of primary and secondary OA pathology.
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Affiliation(s)
- Lauren S Tufts
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, 185 Berry St, Suite 350, San Francisco, CA 94107.
| | - Keerthi Shet
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, 185 Berry St, Suite 350, San Francisco, CA 94107.
| | - Fei Liang
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, 185 Berry St, Suite 350, San Francisco, CA 94107.
| | - Sharmila Majumdar
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, 185 Berry St, Suite 350, San Francisco, CA 94107.
| | - Xiaojuan Li
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, 185 Berry St, Suite 350, San Francisco, CA 94107.
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26
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Ebraheim NA, Zhang J, Liu J, Gregory O, Johnson J, Blevins AL. Preliminary Result of Percutaneous Screw Fixation for Bone Bruise of the Tibial Plateau. Orthopedics 2015; 38:747-50. [PMID: 26652322 DOI: 10.3928/01477447-20151119-05] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2014] [Accepted: 10/13/2014] [Indexed: 02/03/2023]
Abstract
This study reports the preliminary results of surgical treatment of bone bruise of the tibial plateau. Twelve patients underwent percutaneous screw fixation with a mean follow-up of 15 months. The mean duration of surgery was 15 minutes. Preoperatively, 1 week postoperatively, 1 month postoperatively, 6 months postoperatively, and 12 months postoperatively, the mean visual analog scale scores were 7.3, 2.6, 1.2, 0.6, and 0.5, respectively. The mean Hospital for Special Surgery scores were 56, 78, 89, 95, and 98, respectively. In selective patients with bone bruise, the percutaneous screw fixation is feasible to resolve pain and prevent compression of the articular surface.
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27
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Papalia R, Torre G, Vasta S, Zampogna B, Pedersen DR, Denaro V, Amendola A. Bone bruises in anterior cruciate ligament injured knee and long-term outcomes. A review of the evidence. Open Access J Sports Med 2015; 6:37-48. [PMID: 25733936 PMCID: PMC4340462 DOI: 10.2147/oajsm.s75345] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
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 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 resonance 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.
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Affiliation(s)
- Rocco Papalia
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University of Rome, Rome, Italy
| | - Guglielmo Torre
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University of Rome, Rome, Italy
| | - Sebastiano Vasta
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University of Rome, Rome, Italy
| | - Biagio Zampogna
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University of Rome, Rome, Italy
| | - Douglas R Pedersen
- Department of Biomedical Engineering, University of Iowa, Iowa City, IA, USA ; Department of Orthopaedics and Rehabilitation, University of Iowa, Iowa City, IA, USA
| | - Vincenzo Denaro
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University of Rome, Rome, Italy
| | - Annunziato Amendola
- Department of Orthopaedics and Rehabilitation, University of Iowa, Iowa City, IA, USA
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28
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Abstract
BACKGROUND The development of bone marrow edema in body regions adjacent to joints can have many causes and a differentiation is not possible using magnetic resonance imaging (MRI). DEFINITION Bone marrow edema is not necessarily an indication for microfractures. The definition of bone marrow edema is a purely radiological description. There is no uniform classification of bone marrow edema. The clinical significance, therapy and course are heterogeneous; therefore, there are no uniform recommendations for therapy. DIAGNOSTICS A bone marrow edema visible in MRI does not always lead to certain inferences regarding the pathogenesis. In order to be able to detect fractures it is necessary to carry out a biopsy and a histological examination. CONCLUSION The interpretation of MRI results and the derivation of a therapy in every case need a balanced assessment of the MRI results, medical history, clinical investigations and clinical symptoms.
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Affiliation(s)
- C Rangger
- Klinik für Orthopädie und Unfallchirurgie, Krankenhaus Nord West, Steinbacher Hohl 2-26, 60488, Frankfurt, Deutschland,
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29
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Filardo G, Kon E, Tentoni F, Andriolo L, Di Martino A, Busacca M, Di Matteo B, Marcacci M. Anterior cruciate ligament injury: post-traumatic bone marrow oedema correlates with long-term prognosis. INTERNATIONAL ORTHOPAEDICS 2015; 40:183-90. [PMID: 25653174 DOI: 10.1007/s00264-015-2672-3] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/03/2014] [Accepted: 01/04/2015] [Indexed: 11/28/2022]
Abstract
PURPOSE Bone marrow oedema (BME) in the knee is a feature of several pathological conditions, and it has been described with high frequency in patients with acute anterior cruciate ligament (ACL) injury. The aim of this study is to evaluate the significance of BME, assessed in MRIs performed for ACL injury, with regards to clinical outcome and return to sport. METHODS A total of 134 patients (98 men, 36 women) with ACL tear and MRI knee scan within six months from trauma were analysed. The presence of BME was evaluated on MRI images considering: extension and hyperintensity, the WORMS score oedema classification, and measuring the BME area. The clinical results were documented by IKDC-subjective score and the sport activity level by Tegner score at a minimum of five years follow up. RESULTS BME was present in 74 knees (55.2 %), with a mean area of 523 ± 370 mm². The presence of BME showed a gradual decrease over time (p = 0.008), being detectable in MRIs performed more than three months after trauma in just 25.0 % of cases. Although 54 % of the patients without BME after three months returned to their previous sport level, no patients with oedema reached a full sport recovery (p = 0.01). In the group that underwent ACL reconstruction, the BME area was significantly correlated with a return to the previous sport level at the mid/long-term follow-up (p = 0.038). CONCLUSIONS BME is a common finding, which decreases over time after injury. However, when BME is still detectable it correlates with clinical prognosis, and even in sport-active patients undergoing ACL reconstruction, a higher BME area is a negative predictive factor for a successful outcome at the mid/long-term follow-up.
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Affiliation(s)
- Giuseppe Filardo
- II Orthopaedic and Traumatologic Clinic-Biomechanics and Technology Innovation Laboratory, Rizzoli Orthopaedic Institute, Via Di Barbiano, 1/10, 40136, Bologna, Italy
| | - Elizaveta Kon
- Nano-Biotechnology Laboratory, Rizzoli Orthopaedic Institute, Bologna, Italy
| | - Francesco Tentoni
- II Orthopaedic and Traumatologic Clinic-Biomechanics and Technology Innovation Laboratory, Rizzoli Orthopaedic Institute, Via Di Barbiano, 1/10, 40136, Bologna, Italy
| | - Luca Andriolo
- II Orthopaedic and Traumatologic Clinic-Biomechanics and Technology Innovation Laboratory, Rizzoli Orthopaedic Institute, Via Di Barbiano, 1/10, 40136, Bologna, Italy
| | - Alessandro Di Martino
- II Orthopaedic and Traumatologic Clinic-Biomechanics and Technology Innovation Laboratory, Rizzoli Orthopaedic Institute, Via Di Barbiano, 1/10, 40136, Bologna, Italy
| | - Maurizio Busacca
- Radiology and Diagnostic Imaging Department, Rizzoli Orthopaedic Institute, Bologna, Italy
| | - Berardo Di Matteo
- II Orthopaedic and Traumatologic Clinic-Biomechanics and Technology Innovation Laboratory, Rizzoli Orthopaedic Institute, Via Di Barbiano, 1/10, 40136, Bologna, Italy.
| | - Maurilio Marcacci
- II Orthopaedic and Traumatologic Clinic-Biomechanics and Technology Innovation Laboratory, Rizzoli Orthopaedic Institute, Via Di Barbiano, 1/10, 40136, Bologna, Italy
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30
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Kijowski R, Roemer F, Englund M, Tiderius CJ, Swärd P, Frobell RB. Imaging following acute knee trauma. Osteoarthritis Cartilage 2014; 22:1429-43. [PMID: 25278054 DOI: 10.1016/j.joca.2014.06.024] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2014] [Revised: 04/21/2014] [Accepted: 06/03/2014] [Indexed: 02/02/2023]
Abstract
Joint injury has been recognized as a potent risk factor for the onset of osteoarthritis. The vast majority of studies using imaging technology for longitudinal assessment of patients following joint injury have focused on the injured knee joint, specifically in patients with anterior cruciate ligament injury and meniscus tears where a high risk for rapid onset of post-traumatic osteoarthritis is well known. Although there are many imaging modalities under constant development, magnetic resonance (MR) imaging is the most important instrument for longitudinal monitoring after joint injury. MR imaging is sensitive for detecting early cartilage degeneration and can evaluate other joint structures including the menisci, bone marrow, tendons, and ligaments which can be sources of pain following acute injury. In this review, focusing on imaging following acute knee trauma, several studies were identified with promising short-term results of osseous and soft tissue changes after joint injury. However, studies connecting these promising short-term results to the development of osteoarthritis were limited which is likely due to the long follow-up periods needed to document the radiographic and clinical onset of the disease. Thus, it is recommended that additional high quality longitudinal studies with extended follow-up periods be performed to further investigate the long-term consequences of the early osseous and soft tissue changes identified on MR imaging after acute knee trauma.
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Affiliation(s)
- R Kijowski
- Department of Radiology, University of Wisconsin, Madison, WI, USA.
| | - F Roemer
- Department of Radiology, University of Erlangen-Nuremberg, Erlangen, Germany; Department of Radiology, Boston University, Boston, MA, USA
| | - M Englund
- Department of Orthopedics, Clinical Sciences Lund, Lund, Sweden; Clinical Epidemiology Research and Training Unit, Boston University, Boston, MA, USA
| | - C J Tiderius
- Department of Orthopedics, Clinical Sciences Lund, Lund, Sweden
| | - P Swärd
- Department of Orthopedics, Clinical Sciences Lund, Lund, Sweden
| | - R B Frobell
- Department of Orthopedics, Clinical Sciences Lund, Lund, Sweden
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31
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Ai S, Qu M, Glazebrook KN, Liu Y, Rhee PC, Leng S, McCollough CH. Use of dual-energy CT and virtual non-calcium techniques to evaluate post-traumatic bone bruises in knees in the subacute setting. Skeletal Radiol 2014; 43:1289-95. [PMID: 24913554 DOI: 10.1007/s00256-014-1913-7] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2014] [Revised: 05/06/2014] [Accepted: 05/08/2014] [Indexed: 02/02/2023]
Abstract
OBJECTIVE The purpose of this study was to determine the ability of dual-energy computed tomography (DECT) and virtual non-calcium (VNCa) imaging to detect magnetic resonance imaging (MRI)-demonstrated bone bruises several weeks after unilateral knee injury. MATERIALS AND METHODS Patients with unilateral knee injury and MRI-confirmed bone bruises who had undergone a DECT scan of both knees were retrospectively identified. Two radiologists evaluated VNCa images for bruises in four regions per knee without knowing the MRI results. The mean CT numbers were calculated for the lesion-positive and lesion-negative regions of the injured knee, and the contralateral knee. RESULTS Fourteen patients with a total of 36 regions positive for bone bruises on MRI were identified. The median delay between injury and DECT was 37 days (range, 11-99 days). The mean CT numbers in VNCa images for lesion-positive and lesion-negative regions were -7.6 ± 24.9 HU and -58.2 ± 19.5 HU, respectively. There were no significant differences in mean CT number between the lesion-negative regions in the injured knee and the contralateral knee. No resolution of bruising was seen before week 5, and bone bruising was still identifiable in one out of the two patients scanned at 10 weeks following injury. CONCLUSIONS DECT and VNCa images can identify bone bruising for at least 10 weeks after injury.
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Affiliation(s)
- Songtao Ai
- Department of Radiology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
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Chotel F, Seil R, Greiner P, Chaker MM, Berard J, Raux S. The difficult diagnosis of cartilaginous tibial eminence fractures in young children. Knee Surg Sports Traumatol Arthrosc 2014; 22:1511-6. [PMID: 23636131 DOI: 10.1007/s00167-013-2518-8] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2012] [Accepted: 04/22/2013] [Indexed: 11/25/2022]
Abstract
PURPOSE Anterior tibial eminence fracture is the main mode of ACL failure in patients with open physes. In young children, purely cartilaginous avulsions of the tibial ACL insertion are possible. The aim of this study was to focus on patients referred for misdiagnosed cartilaginous tibial eminence fractures. METHODS Ten young patients with cartilaginous tibial eminence fractures were identified in the hospital database. Six of them were misdiagnosed and included in this retrospective case series. Clinical data at the time of injury, radiographs and MRI were analysed in order to evaluate the causes which could have led to inappropriate management. RESULTS The patients' median age at the time of injury was 7 years (5-8.5). The main cause of injury was a low-energy domestic accident (n = 4). Radiographs at the time of injury were normal (n = 4) or showed a very thin ossification (n = 2). The traditional MRI findings of ACL injuries were all negative. On T2 sequences, an epiphyseal fluid signal allowed for a retrospective diagnosis. Cartilaginous tibial eminence fractures were regularly prolonged posteriorly giving a 'double-PCL sign' in 4 of the 6 patients. On a median of 6 months (2.5-48) after the injury, patients were referred for repeat giving ways (n = 5) and/or limitation of extension or hyperextension (n = 4). Symptoms were related to non-union, ossification and secondary enlargement of the avulsed fragment. CONCLUSIONS Post-traumatic knee joint effusions in children aged 9 or younger, even occurring after a low energy trauma and with normal radiographs, should suggest a cartilaginous tibial eminence fracture. Systematic MRI examinations should be mandatory in these patients in whom the avulsed fragment may appear as a double-PCL sign. During follow-up, new radiographs are recommended. A better knowledge of this rare entity should allow us to avoid misdiagnosis and to perform an early refixation of the avulsed fragment.
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Affiliation(s)
- Franck Chotel
- Department of Pediatric Orthopaedic Surgery, Lyon University Hospital for Mother and Children, Université Claude Bernard Lyon I, 59 Boulevard Pinel, 69677, Bron, France,
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Wittstein J, Vinson E, Garrett W. Comparison Between Sexes of Bone Contusions and Meniscal Tear Patterns in Noncontact Anterior Cruciate Ligament Injuries. Am J Sports Med 2014; 42:1401-7. [PMID: 24668872 DOI: 10.1177/0363546514527415] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Valgus load has been linked to female predominance and mechanism for noncontact anterior cruciate ligament (ACL) injuries. Magnetic resonance imaging (MRI) studies reporting frequent medial contusions in noncontact ACL injuries suggest anterior translation rather than a valgus mechanism. HYPOTHESIS Bone contusion and meniscal tear patterns differ between sexes. STUDY DESIGN Case series; Level of evidence, 4. METHODS This study included a review of clinic notes, operative reports, and MRI of patients younger than 20 years who underwent acute primary ACL reconstruction for a noncontact injury between January 1, 2005, and January 1, 2010. A blinded musculoskeletal MRI radiologist reported the incidence of medial and lateral femoral and tibial bone contusions on MRI, as well as the severity of medial versus lateral tibial contusions. The location of the bone contusions and meniscal tears and the maximal tibial contusion severity were compared through chi-square analysis (statistical significance, P < .05). RESULTS A total of 73 patients met inclusion criteria: 28 males, 45 females; mean age, 16.1 ± 1.7 years (males), 16.5 ± 1.7 years (females). No significant differences were noted between sexes for location of tibial contusions (P = .32), femoral contusions (P = .44), or meniscal tears (P = .715). The most common tibial contusion pattern was to have both medial and lateral tibial contusions, in both male (57%) and female (60%) patients. The most common femoral contusion pattern was lateral only in females (62%) and both medial and lateral in males (50%). The percentage of female (29%) and male (29%) patients with isolated medial meniscal tears was nearly identical. More males (29%) than females (18%) had isolated lateral meniscal tears (P = .72). No significant difference in the relative severity of the tibial contusions was noted (P = .246). The lateral tibial contusion was rated as being more severe than the medial in the majority of females (64%) and males (57%). CONCLUSION No significant differences were detected between sexes with noncontact ACL injuries for location of tibial or femoral contusions or meniscal tears or for severity of medial versus lateral tibial contusions. The MRI data were not consistent with the valgus collapse mechanism of injury.
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Affiliation(s)
- Jocelyn Wittstein
- Division of Orthopaedic Surgery, Bassett Healthcare Network, Cooperstown, New York, USA
| | - Emily Vinson
- Department of Radiology, Musculoskeletal MRI Division, Duke University Medical Center, Durham, North Carolina, USA
| | - William Garrett
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina, USA
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Guda T, Labella C, Chan R, Hale R. Quality of bone healing: Perspectives and assessment techniques. Wound Repair Regen 2014; 22 Suppl 1:39-49. [DOI: 10.1111/wrr.12167] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2013] [Accepted: 01/28/2014] [Indexed: 11/30/2022]
Affiliation(s)
- Teja Guda
- Dental Trauma Research Detachment; US Army Institute of Surgical Research; Fort Sam Houston
- Wake Forest Institute for Regenerative Medicine; Winston-Salem North Carolina
- Biomedical Engineering; University of Texas at San Antonio; San Antonio Texas
| | - Carl Labella
- Dental Trauma Research Detachment; US Army Institute of Surgical Research; Fort Sam Houston
| | - Rodney Chan
- Dental Trauma Research Detachment; US Army Institute of Surgical Research; Fort Sam Houston
| | - Robert Hale
- Dental Trauma Research Detachment; US Army Institute of Surgical Research; Fort Sam Houston
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Total knee arthroplasty MRI featuring slice-encoding for metal artifact correction: reduction of artifacts for STIR and proton density-weighted sequences. AJR Am J Roentgenol 2014; 201:1315-24. [PMID: 24261373 DOI: 10.2214/ajr.13.10531] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The purpose of this article is to compare slice-encoding for metal artifact correction (SEMAC) sequences versus optimized standard MRI sequences in patients with total knee arthroplasty (TKA). SUBJECTS AND METHODS Forty-two patients with TKA underwent 1.5-T MRI. Sequences optimized for metal implant imaging (SEMAC) were compared with standard sequences optimized with high bandwidth for STIR and proton density (PD)-weighted images. In 29 patients, CT was available as reference standard. Signal void and insufficient fat saturation were quantified. Qualitative criteria (anatomy, distortion, blurring, and noise) were assessed on a 5-point scale (1, no artifacts; 5, severe artifacts) by two readers. Abnormal imaging findings were noted. A Student t test and a Wilcoxon signed rank test was used for statistics. RESULTS Signal void areas and insufficient fat saturation were smaller for the SEMAC sequences than for the optimized standard sequences (p ≤ 0.005 for all comparisons). Depiction of anatomic structures was better on STIR with SEMAC versus standard sequences optimized with high bandwidth (score range, 2.9-3.7 vs 4.2-4.9) and on PD-weighted imaging with SEMAC versus standard sequences optimized with high bandwidth (score range, 2.5-3.5 vs 3.1-3.8), which was statistically significant (p < 0.001 to p = 0.007 for different structures). Distortion and noise were lower for SEMAC than for the standard sequences (p ≤ 0.001), whereas no technique had a clear advantage for blurring. Detection of abnormal imaging findings was markedly increased for the SEMAC technique (p < 0.001) and was most pronounced for STIR images (98 and 74 findings for STIR with SEMAC for readers 1 and 2, respectively, vs 37 and 37 findings for readers 1 and 2, respectively, for STIR with standard sequences optimized with high bandwidth). Sensitivity for detection of periprosthetic osteolysis was improved for STIR with SEMAC (100% and 86% for readers 1 and 2, respectively) compared with STIR with standard sequences optimized with high bandwidth (14% and 29% for readers 1 and 2, respectively). CONCLUSION SEMAC sequences showed a statistically significant artifact reduction. The detection of clinically relevant findings such as periprosthetic osteolysis was markedly improved.
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Role of SPECT/CT Compared With MRI in the Diagnosis and Management of Patients With Wrist Trauma Occult Fractures. Clin Nucl Med 2014; 39:8-13. [DOI: 10.1097/rlu.0b013e31828164da] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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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; 41:1801-7. [PMID: 23744907 DOI: 10.1177/0363546513490649] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
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. PURPOSE To examine demographic factors and intra-articular injuries associated with bone bruising in patients undergoing ACL reconstruction. STUDY DESIGN 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. CONCLUSION 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.
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Affiliation(s)
- Leslie J Bisson
- Department of Orthopaedic Surgery, The State University of New York at Buffalo 4949 Harlem Rd, Amherst, NY 14226, USA.
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Abstract
Acute bone bruises of the talus after ankle injury need to be managed differently from osteochondral defects. Bone bruises have a benign course, but there may be persistent edema. A bone bruise should not delay rehabilitation unless symptoms persist or significant edema is close to the subchondral plate. Osteochondral defects have a less predictable prognosis, and rehabilitation should aim at promoting healing of the subchondral fracture. A period of nonweight bearing reduces the cyclical pressure load through the fissure and promotes healing. Surgery should be reserved for chronic symptomatic lesions or for those patients undergoing lateral ligament reconstruction.
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Yoon JP, Yoo JH, Chang CB, Kim SJ, Choi JY, Yi JH, Kim TK. Prediction of chronicity of anterior cruciate ligament tear using MRI findings. Clin Orthop Surg 2013; 5:19-25. [PMID: 23467216 PMCID: PMC3582867 DOI: 10.4055/cios.2013.5.1.19] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2012] [Accepted: 06/29/2012] [Indexed: 11/06/2022] Open
Abstract
Background The estimation of anterior cruciate ligament (ACL) tear is required in certain cases involving legal and financial administration, such as the worker's compensation and/or insurance. The aim of this study is to propose and evaluate a quantitative evaluation instrument to estimate the chronicity of the ACL tear, based on the four magnetic resonance imaging (MRI) findings. Methods One hundred and fifty one cases of complete ACL tear confirmed by arthroscopy were divided into 4 groups according to the time from ACL injury to MRI acquisition: acute (< 6 weeks), subacute (6 weeks to 3 months), intermediate (3 months to 1 year), and chronic (> 1 year). The four MRI findings including ACL morphology, joint effusion, posterior cruciate ligament angle, and bone bruise were analyzed for temporal changes among the 4 groups. Binary logistic regression equations were formulated using the MRI findings to estimate the chronicity of ACL tear in a quantitative manner, and the accuracy of the formulated regression equations was evaluated. Results The four MRI findings showed substantial temporal correlation with the time-limits of ACL injury to be included in the estimation model. Three predictive binary logistic equations estimated the probability of the ACL injury for the three cutoff time-limits of 6 weeks, 3 months, and 1 year with accuracies of 82.1%, 89.4%, and 89.4%, respectively. Conclusions A series of predictive logistic equations were formulated to estimate the chronicity of ACL tear using 4 MRI findings with chronological significance.
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Affiliation(s)
- Jong Pil Yoon
- Department of Orthopaedic Surgery, Kyungpook National University Hospital, Daegu, Korea
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Uçar BY, Necmioğlu S, Bulut M, Azboy I, Demirtaş A, Gümüş H. Determining bone bruises of the knee with magnetic resonance imaging. Open Orthop J 2012; 6:464-7. [PMID: 23166573 PMCID: PMC3497884 DOI: 10.2174/1874325001206010464] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2012] [Revised: 10/07/2012] [Accepted: 10/14/2012] [Indexed: 11/22/2022] Open
Abstract
Introduction Injuries that develop secondary to minor traumas and cannot be detected via direct examination methods, but are detected via advanced imaging methods, such as magnetic resonance (MR) imaging, are called occult bone injuries or bone bruises. In such injuries, diagnostic arthroscopy usually does not reveal any pathology. MR imaging methods are quite beneficial for the diagnosis of such clinical conditions, which cause acute pain and restriction of motion. The present study aimed to assess occult bone injuries via MR imaging in patients who presented with minor knee trauma. Patients and Methods Twelve patients who presented with minor knee trauma were included in the study. Etiological factors in these patients included walking a long distance, falls, and minor trauma. All patients underwent physical examinations, direct radiological imaging, MR imaging, and diagnostic arthroscopy. Results Direct radiographs of the patients showed no pathological fracture. Bone marrow changes detected on the MR images were classified according to Lynch’s classification as Type I lesions in nine patients and Type II lesions in three patients. Conclusion We suggest that MR imaging methods should be the gold standard for the diagnosis of minor traumatic bruise injuries of the knee.
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Affiliation(s)
- Bekir Yavuz Uçar
- Department of Orthopaedic & Traumatology, Medical Faculty, Dicle University, Turkey
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Kijowski R, Sanogo ML, Lee KS, Muñoz del Río A, McGuine TA, Baer GS, Graf BK, De Smet AA. Short-term Clinical Importance of Osseous Injuries Diagnosed at MR Imaging in Patients with Anterior Cruciate Ligament Tear. Radiology 2012; 264:531-41. [DOI: 10.1148/radiol.12112171] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
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Tsai CH, Hsu CJ, Hung CH, Hsu HC. Primary traumatic patellar dislocation. J Orthop Surg Res 2012; 7:21. [PMID: 22672660 PMCID: PMC3511801 DOI: 10.1186/1749-799x-7-21] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2011] [Accepted: 04/02/2012] [Indexed: 01/03/2023] Open
Abstract
Acute traumatic patellar dislocation is a common injury in the active and young adult populations. MRI of the knee is recommended in all patients who present with acute patellar dislocation. Numerous operative and non-operative methods have been described to treat the injuries; however, the ideal management of the acute traumatic patellar dislocation in young adults is still in debate. This article is intended to review the studies to the subjects of epidemiology, initial examination and management.
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Affiliation(s)
- Chun-Hao Tsai
- Department of Orthopaedic Surgery, China Medical University Hospital, School of Medicine, China Medical University, Taichung, Taiwan
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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. [PMID: 22046881 DOI: 10.2298/vsp1109762j] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND/AIM Bone bruise is a common finding in acutely injured knee examined by magnetic resonance (MR). The aim of the study was to determine the association of bone bruise frequency with postinjury lesions of anterior cruciate ligament (ACL) and menisci. Bone bruise involves posttraumatic bone marrow change with hemorrhages, edema and microtrabecular fractures without disruption of adjacent cortices or articular cartilage. MR imaging is a method of choice for detecting bone bruises which can not be seen on conventional radiographic techniques. METHODS A representative review of 120 MR examinations for the acute knee trauma was conducted. All the patients were examined within one month of trauma. All MR examinations were performed by using a 0.3T MR unit. RESULTS Posttraumatic bone bruise was seen in 39 (32.5%) patients out of 120. Three patients had fracture of the cortex, so-called "occult" fracture (not seen on plain radiography). We analyzed only bone bruises without these fractures of the cortex. Bone bruise was associated with the lesion of ACL in 27 (69%) patients. In 28 (72%) patients bone bruise was in combination with the lesion of menisci. Only two patients with bone bruise had neither ACL nor menisci lesions. There were 78 patients without bone bruise but 33 (43%) of them had lesions of ACL and 49 (63%) had lesions of menisci. CONCLUSION Bone bruise is best seen in STIR (Short TI Inversion Recovery) images and is very often found in acute knee trauma. Very often it is associated with posttraumatic lesions of ACL and menisci, so attention must be paid to this when bone bruise is seen. The difference in frequency of internal structures of the knee lesions in patients with bone bruise is highly statistically significant as compared to patients with no bone bruise.
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Abstract
A patient often initially presents to an orthopedic surgeon with the magnetic resonance image (MRI) ordered by his or her primary care physician in hand. Often, a significant period of time elapses after injury before the patient is assessed by the orthopedic surgeon; therefore, the initial MRI may be considered outdated because of a new injury or a change in symptoms or because the orthopedist may prefer a new study, a stronger magnet, or a special imaging protocol. However, the decision to repeat a knee MRI is presently an arbitrary one because no clinical guidelines exist to justify this practice.All repeat knee MRIs performed at our academic institution in the past 9 years were retrospectively examined. Inclusion criterion was repeat MRI of the same knee with no surgical intervention. The formal radiology reports were grouped into 3 categories: change, no change, and unclear. Knee pathology was further grouped into 6 categories indicating what specific structures were pathological or injured. Logistic regression analysis was used to test the association of time vs category or condition change between MRIs. Of 3501 knee MRI studies, 88 patients had a total of 101 repeat MRIs. The average number of days between repeats for those with category or condition change was 612 vs 504 for those with no change. Age, sex, and time between MRIs were not significantly associated with a category or condition change. Repeat knee MRI prior to surgical intervention is becoming more prevalent and may have clinical merit. A further prospective study is warranted.
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Affiliation(s)
- Paul A Rath
- Department of Orthopaedic Surgery and Rehabilitation, University of Texas Medical Branch, Galveston, Texas, USA
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[Medical appraisal of anterior cruciate ligament ruptures]. Unfallchirurg 2011; 116:238-45. [PMID: 21909738 DOI: 10.1007/s00113-011-2079-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
BACKGROUND Anterior cruciate ligament tears are one of the most common human ligament ruptures. The assessment of such ruptures is particularly difficult because most ACL injuries involve minimal to no contact. The steps of the assessment are presented with the necessary requirements. METHOD Criteria for determining the cause of anterior cruciate ligament ruptures are discussed against the background of our experience and the literature. Different definitions of causality apply to German statutory accident insurance (workers' compensation) on the one hand and to private accident insurance on the other. RESULTS The assessment of disability within the scope of workers' compensation in most cases results in "under 10 to 30%", while in private accident insurance it is rated as 1/10 to 1/20 degree of disablement.
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Frobell RB. Change in cartilage thickness, posttraumatic bone marrow lesions, and joint fluid volumes after acute ACL disruption: a two-year prospective MRI study of sixty-one subjects. J Bone Joint Surg Am 2011; 93:1096-103. [PMID: 21776546 DOI: 10.2106/jbjs.j.00929] [Citation(s) in RCA: 99] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Little is known about early morphologic change occurring with an acute injury of the anterior cruciate ligament. Magnetic resonance imaging was used in this study to investigate the two-year change in cartilage thickness, bone marrow lesions, and joint fluid of knees with acute anterior cruciate ligament injury treated surgically or nonsurgically and to identify factors associated with these changes. METHODS Sixty-one subjects (sixteen women and forty-five men with a mean age of twenty-six years) with acute anterior cruciate ligament injury to a previously uninjured knee were examined with use of a 1.5-T magnetic resonance imaging scanner at baseline and at three, six, twelve, and twenty-four months after the injury. Thirty-four subjects received rehabilitation and early anterior cruciate ligament reconstruction (a median of 44.5 days after the injury), eleven subjects received rehabilitation and a delayed anterior cruciate ligament reconstruction (408 days), and sixteen received rehabilitation alone. Morphologic measures were obtained from computer-assisted segmentation of magnetic resonance images. Factors tested for association were age, sex, activity level, treatment, and osteochondral fracture at baseline. RESULTS After twenty-four months, significant cartilage thinning occurred in the trochlea of the femur (mean, -4.3%; standard response mean = 0.88), whereas significant cartilage thickening occurred in the central medial aspect of the femur (mean, +2.7%; standard response mean = 0.46). A younger age at the time of injury was a risk factor for thickening in the central medial aspect of femur, whereas older age at injury was a risk factor for thinning in the trochlea of the femur. Treatment of the torn anterior cruciate ligament was not related to these changes nor was activity level or an osteochondral fracture at baseline. Posttraumatic bone marrow lesions in the lateral aspect of the tibia resolved completely in fifty-four of fifty-eight knees (median, six months) and lesions in the lateral aspect of the femur resolved completely in forty-four of forty-seven knees (median, three months); however, thirty new bone marrow lesions developed in the lateral aspect of twenty-one knees over the two-year period. None of the factors were related to the development of bone marrow lesions. CONCLUSIONS Morphologic change as visualized on magnetic resonance imaging occurs in the knee over the first two years after acute anterior cruciate ligament injury as demonstrated by cartilage thickening (central medial aspect of the femur), cartilage thinning (trochlea of the femur), the resolution of posttraumatic bone marrow lesions in the lateral part of the knee, and the development of new bone marrow lesions laterally. Age and male sex were independent risk factors for change in cartilage morphology.
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Affiliation(s)
- Richard B Frobell
- Department of Orthopedics, Clinical Sciences Lund, Lund University, Lund, Sweden.
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Strickland CD, Kijowski R. Morphologic Imaging of Articular Cartilage. Magn Reson Imaging Clin N Am 2011; 19:229-48. [DOI: 10.1016/j.mric.2011.02.009] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Abstract
Athletic traumatic hip subluxations are rare. Classic radiographic features have been well described. This case highlights the potential pitfalls of immediate magnetic resonance imaging. Femoral head contusions and acetabular rim fractures are common associated findings usually apparent with magnetic resonance imaging (MRI). However, in this case an MRI done 3 hours post injury failed to show any edema in either location, making the appearance of these findings on subsequent MRIs difficult to interpret. An acute MRI more than 48 hours post injury may have been more helpful.
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Affiliation(s)
- David C Flanigan
- Department of Orthopedics, The Ohio State University, Columbus, Ohio, USA,Address for correspondence: Dr. David C. Flanigan, Department of Orthopaedics, The Ohio State University, 2050 Kenny Road, Columbus, OH 43221, USA. E-mail:
| | - Arthur A De Smet
- Department of Orthopedic Surgery and Rehabilitation, Division of Sports Medicine, University of Wisconsin Hospital and Clinics, Madison, Wisconsin, USA
| | - Ben Graf
- Department of Orthopedic Surgery and Rehabilitation, Division of Sports Medicine, University of Wisconsin Hospital and Clinics, Madison, Wisconsin, USA
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Theologis AA, Kuo D, Cheng J, Bolbos RI, Carballido-Gamio J, Ma CB, Li X. Evaluation of bone bruises and associated cartilage in anterior cruciate ligament-injured and -reconstructed knees using quantitative t(1ρ) magnetic resonance imaging: 1-year cohort study. Arthroscopy 2011; 27:65-76. [PMID: 21035995 PMCID: PMC3011041 DOI: 10.1016/j.arthro.2010.06.026] [Citation(s) in RCA: 78] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2009] [Revised: 04/19/2010] [Accepted: 06/28/2010] [Indexed: 02/02/2023]
Abstract
PURPOSE To quantitate bone marrow edema-like lesions (BMELs) and the radiologic properties of cartilage in knees with acute anterior cruciate ligament (ACL) injuries using T(1ρ) magnetic resonance imaging over a 1-year period. METHODS Nine patients with ACL injuries were studied. Magnetic resonance imaging scans were acquired within 8 weeks of the injury, after which ACL reconstruction surgery was performed. Images were then acquired 0.5, 6, and 12 months after reconstructions. The volume and signal intensity of BMELs were quantified at baseline and follow-up examinations. T(1ρ) values were quantified in cartilage overlying the BMEL (OC) and compared with surrounding cartilage at all time points. RESULTS BMELs were most commonly found in the lateral tibia and lateral femoral condyle. Nearly 50% of BMELs resolved over a 1-year period. The T(1ρ) values of the OC in the lateral tibia, medial tibia, and medial femoral condyle were elevated compared with respective regions in surrounding cartilage at all time points; the difference was significant only in the lateral tibia (P < .05). The opposite results were found in the lateral femoral condyle. For the medial tibia and medial femoral condyle, none of the time periods was significantly different. The percent increase in T(1ρ) values of OC in the lateral tibia was significantly correlated with BMEL volume (r = 0.74, P < .05). At 1 year, the OC in the lateral tibia, medial tibia, and medial femoral condyle showed increased T(1ρ) values despite improvement of BMEL. CONCLUSIONS In patients after ACL tear and reconstruction, (1) the cartilage overlying BMEL in the lateral tibia experiences persistent T(1ρ) signal changes immediately after acute injuries and at 1-year follow-up despite BMEL improvement, (2) the superficial layers of the overlying cartilage show greater matrix damage than the deep layers, and (3) the volume of the BMEL may predict the severity of the overlying matrix's damage in the lateral tibia. T(1ρ) is capable of quantitatively and noninvasively monitoring this damage and detecting early cartilage changes in the lateral tibia over time. LEVEL OF EVIDENCE Level IV, therapeutic case series.
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Affiliation(s)
- Alexander A. Theologis
- School of Medicine, University of California, San Francisco (UCSF), San Francisco, CA, USA,Musculoskeletal Quantitative Imaging Research, Department of Radiology, UCSF, San Francisco, CA, USA
| | - Daniel Kuo
- Musculoskeletal Quantitative Imaging Research, Department of Radiology, UCSF, San Francisco, CA, USA
| | - Jonathan Cheng
- Musculoskeletal Quantitative Imaging Research, Department of Radiology, UCSF, San Francisco, CA, USA
| | - Radu I. Bolbos
- Musculoskeletal Quantitative Imaging Research, Department of Radiology, UCSF, San Francisco, CA, USA
| | - Julio Carballido-Gamio
- Musculoskeletal Quantitative Imaging Research, Department of Radiology, UCSF, San Francisco, CA, USA
| | - C. Benjamin Ma
- Department of Orthopaedic Surgery, UCSF, San Francisco, CA, USA
| | - Xiaojuan Li
- Musculoskeletal Quantitative Imaging Research, Department of Radiology, UCSF, San Francisco, CA, USA,Corresponding Author Contact Information: Xiaojuan Li, Ph.D University of California, San Francisco School of Medicine Department of Radiology China Basin Landing, 185 Berry Street, Suite 350 San Francisco, CA 94107 Phone: (415) 353-4909 Fax: (415) 353-3438
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