Correlation Between Patterns of Bone Marrow Edema and Their Associated Soft-Tissue Injuries, as seen on Magnetic Resonance Imaging of Knee joint in Patients with a Recent History of Trauma

Introduction: Bone bruise or bone marrow edema is a common innocuous finding in magnetic resonance imaging (MRI) knee ofpatients with trauma. The pattern of bone marrow edema provides insight into the mechanism of injury which, in turn, helps to evaluatethe injuries with a more discerning eye. Five basic mechanisms of knee injury which are commonly seen in MRI scan of knee traumapatients are pivot shift, dashboard injury, hyperextension, clip injury, and lateral patellar dislocation. Each of these mechanisms causescharacteristic bone marrow edema patterns and has associated soft-tissue injuries, following the musculoskeletal biomechanics.Aim: The purpose of this study is to assess the correlation between bone marrow edema patterns and associated soft-tissue injuries.Settings and Design: This is a cross-sectional study of 200 patients conducted at the Department of Radiodiagnosis andImaging, MGM Medical College and Associated Hospitals, Indore.Materials and Methods: MRI of 200 cases of recent knee injury was analyzed to determine bone marrow edema pattern. Thepattern of edema and soft-tissue injuries was plotted and analyzed to see a significant correlation.Statistical Analysis Used: Variables were expressed as percentages and comparison was done by Chi-square analysis. Twotailed P < 0.05 was considered statistically significant.Results: Significant correlation was seen between pivot shift injury and anterior cruciate ligament (ACL) tear, pivot shift injury andmedial meniscus tear, dashboard injury and posterior cruciate ligament (PCL) tear, lateral patellar dislocation and medial patellofemoralligament (MPFL) tear, and clip injury and medial collateral ligament (MCL) tear. Pivot shift was the most common bone marrowedema pattern, accounting for 55.5% of cases and hyperextension was the least common pattern, seen in only 3% of cases.Conclusion: The pattern of bone marrow edema can provide a road map to associated soft-tissue injuries which assist in finerevaluation and can help in creating better patient management outcomes.

Prediction of Subsequent Vertebral Collapse after Osteoporotic Thoracolumbar Vertebral Fractures / 대한골다공증학회지

OBJECTIVES: To evaluate the clinical significance of vertebral bone bruise (VBB) in terms of subsequent collapse after osteoporotic thoracolumbar vertebral fractures. METHODS: We reviewed 41 consecutive patients with 46 osteoporotic thoracolumbar vertebral fractures treated nonoperatively from March 2007 to February 2010. Anterior wedge angle (AWA) was measured on plain radiographs and the change of AWA between the initial and last measurement was used to represent the subsequent vertebral collapse. The size of VBB was measured and VBB ratio was calculated on T1-weighted sagittal MR image. RESULTS: The average VBB ratio was 49.1% and the average change of AWA was 7.1degrees. Only VBB ratio significantly correlated with the change of AWA (P<0.001, cc=0.660). The other factors such as age, initial AWA, and endplate status showed no significant correlation with the change of AWA (P=0.629, P=0.724, P=0.690, respectively). In DEXA group, no correlation was found between T-score and the change of AWA as well as between T-score and VBB ratio (P=0.548, P=0.370, respectively). Five fractures were diagnosed as delayed post-traumatic vertebral collapse. Their average VBB ratio was 71.2% which was significantly higher than that of the other subjects (P=0.015). The fractures with VBB ratio more than 60% was likely to progress to delayed post-traumatic vertebral collapse. CONCLUSIONS: VBB after osteoporotic thoracolumbar vertebral fracture was significantly correlated with subsequent vertebral collapse (cc=0.660). We recommend the patients with a large vertebral bone bruise, especially more than 60%, should be followed up meticulously for the early detection of delayed post-traumatic vertebral collapse.

Preliminary Study of Clinical Consequence of Type Ⅰ Bone Bruise in Acutely Sprained Knee / 中国康复理论与实践

@# Objective To evaluate prospectively clinical significance and consequence of type Ⅰ bone bruise in acutely sprained knee. Methods 23 outpatients were selected, meeting our criteria from 2005 to 2008. All the injured knees were immobilized with gypsum for 4 to 6 weeks, and the knee complaints and MRI were followed up regularly.Results 18 patients were followed up, averaged 24 months, the bone bruise showed notable resolution in average 3 months and vanished in 6.7 months averagely; the knee pain alleviated obviously in about 4.8 months; 5 out of 9 cases, who were more than 45 years old, still complained knee pain and uncomfortable after 2 years.Conclusion Grade Ⅰ knee sprain can lead to bone bruise in condyles of femur or tibia, and knee immobilization should be given to avoid the further damage; the bone bruise may be a precursor of knee osteoarthritis for people older than 45 years.

Bone SPECT after ACL Reconstruction: Prognostic Factors for Arthritis

PURPOSE: To evaluate prognostic factors for arthritis and usefulness of bone SPECT in reconstructed joint. MATERIAL AND METHOD: ACL reconstruction using bone-patellar tendon-bone graft was performed in fourteen patients from March 1996 to March 1997, and follow-up bone SPECT was done. The mean duration from ACL reconstruction to SPECT was 23 months. The knee was defined to be unstable when the difference of displacement measured using KT-2000 arthrometer was greater than 3 mm. Lesions were evaluated in sub-divided five compartments ; patello-femoral joint, anteromedial, anterolateral, postero-medial and posterolateral compartment of tibio-femoral joint. RESULT: Geographic bone bruise was found in 9 cases(15 compartments) of 14 patients and bone SPECT revealed increased uptake in all the compartments. Reticular type bone bruise was found in 6 cases(7 compartments) and no compartment revealed increased uptake. Partial meniscectomy was done in 9 cases(16 compartments), and 8 cases(13 compartments) of them revealed increased uptake. Six cases were unstable and four of them revealed increased uptake in the patello-femoral joint. Activity level was not correlated with hot uptake. CONCLUSIONS: Bone SPECT is a useful method to predict osteoarthritis after ACL reconstruction. Geo-graphic bone bruises at injury, meniscectomy and instability are important factors for prognosis after ACL reconstruction.

Clinical Implications of Bone Bruises on MRI in Acute Traumatic ACL or PCL Injury / 대한정형외과학회잡지

PURPOSE: Bone bruises of patients with acute traumatic knee injuries, that are not found on simple radiograph, can be found on magnetic resonance imaging (MRI). The purpose of this study is to evaluate the frequency and locations of bone bruises on MRI in acute traumatic anterior cruciate ligament (ACL) or posterior cruciate ligament (PCL) injury. MATERIALS AND METHODS: 25 and 19 MRls, in which acute traumatic ACL and PCL injury was pre sent and there was no abnormality in simple radiograph, were reviewed. MRI was taken within 51 days of injury. A bone bruise was determined as a geographic and nonlinear area of signal loss on T1 images and increased signal intensity on T2 images involving the subcortical bone. RESULTS: In 16 patients with bone bruises and acute ACL injury, bone bruises were found in the lateral compartment of the knee in 15 (93.8%) patients. The most common area was the lateral tibial plateau (11 cases, 68.8%) and the second was lateral femoral condyle (9 cases, 56.3%). In 5 patients with bone bruises and acute PCL injury, bone bruises were found in the lateral compartment of the knee in all 5 (100%) patients. The most common area was lateral tibial plateau (4 cases, 80%) and the second was lateral femoral condyle (2 cases, 40%). CONCLUSIONS: In patients with acute traumatic ACL or PCL injuries the bone bruises are often found on the lateral compartment of the knee, especially lateral tibial plateau and lateral femoral condyle on MRI.

MRI Findings of Bone Bruises Associated with Acute Anterior Cruciate Ligament Ruptures / 中国运动医学杂志

Objective To study the magnetic resonance imaging (MRI) characteristic of bone bruises associated with acute anterior cruciate ligament (ACL) ruptures and to investigate the correlation between bone bruises and cartilage lesions. Methods The MRI findings of 37 cases of acute ACL ruptures associated with bone bruises were studied retrospestively. The classification and distribution of bone bruises were analyzed and the cartilage lesions were also observed under arthroscopy. Results A total of 57 independent bone bruises(type Ⅰ:14, type Ⅱ:32, type Ⅲ:3, type Ⅳ:6 and type Ⅴ:2) were documented by MRI in the 37 patients. 54 (94.7%) bone bruises located in lateral joint compartment with involvement of lateral femoral condyle in 31 and lateral tibial plateau in 23. Nine cases (15.8%) of articular cartilage lesions were found under arthroscopy in the area overlying bone bruises. Conclusion Bone bruises associated with acute ACL ruptures mainly located in the lateral compartment of knee, especially in anterior portion of lateral femoral condyle and posterior portion of lateral tibial plateau. Arthroscopic cartilage lesions were not corresponding to bone bruises.