Oedema or interisital fluid within marrow extracellular space similar to free fluid shows long T1 and T2 decay characteristics and appear hypointense on T1 and hyperintense on T2W. At the time the article was last revised Joshua Yap had At the time the article was created Henry Knipe had no recorded disclosures. Ready to get started? Hyperextension results in the "kissing" contusion pattern involving the anterior aspect of the proximal tibia and distal femur. {"url":"/signup-modal-props.json?lang=us"}, Knipe H, Hyperextension knee injury. 1996 Sep;(330):133-42 Knee Surg Sports Traumatol Arthrosc. PDFS Coronal: Bone marrow contusion at lateral femoral condyle and lateral tibial plateau in Pivot shift injury pattern. 99 0 obj Skeletal Radiol 32(11):639646, Flint J, Wade A, Giuliani J, Rue J (2014) Defining the terms acute and chronic in orthopaedic sports injuries: a systematic review. Rodriguez W, Vinson EN, Helms AC, Toth PA. MRI appearance of posterior cruciate ligament tears. Imaging the knee: Ligaments. Bone bruise patterns in knee injuries: where are they found? Results: 2023 Feb;19(1):107-112. doi: 10.1177/15563316221092320. The site is secure. Surgical Strategy for Anterior Tibial Plateau Fractures in Hyperextension Knee Injuries. Correlation between various pattern of bone marrow oedema and type/mode of injury. Grade 1 refers to the uniform-ly low normal meniscal signal, grade 2 de-scribes increased signal within the meniscus . An official website of the United States government. Meyer EG, Baumer TG, Haut RC. 2016. https://doi.org/10.1016/j.arthro.2016.03.015. The clip injury results in a prominent area of edema involving the lateral femoral condyle and a smaller area of edema involving the medial femoral condyle. Orthopedic radiology Philadelphia, Pa: Saunders, 1986; 502, 511. 2014;55(8):9618. Bisson LJ, Kluczynski MA, Hagstrom LS, Marzo JM. It is a rare (6.3% in this series) but significant injury, often associated with ligamentous or menisceal tears. Type / Mode of injury in Clip injury pattern. Sports Med. Disclaimer. PubMed no financial relationships to ineligible companies to disclose. Epub 2022 Aug 30. 2011;197 (3): 568-77. The spectrum of damage includes stretching, partial tearing, and complete rupture [4]. 2013 Aug;41(8):1801-7. doi: 10.1177/0363546513490649. steve stricker wrist lock; what channel are the st louis cardinals playing on today J Clin Diagn Res. The 32 bone contusions (16 kissing contusions) were located as follows: lateral femoral condyle (n = 14; 8 type I, 6 type II); lateral tibial condyle (n = 9; 3 type I, 1 type II, 5 type III); medial tibial condyle (n = 7; 2 type I, 5 type III); medial femoral condyle (n = 2; both type I). Contusions of both surfaces of the joint are known as kissing contusions. 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]. Texas Health Care Imaging is a radiology clinic located in Brownsville, TX. Patients with a knee MRI within one year of hyperextension injury were identified at our institution over a 7 year period. Movement across knee helps in doing daily activities including walking, sitting, and standing. 1993 Mar-Apr;21(2):220-3 33 0 obj Google Scholar, Department of Orthopaedic Surgery, Chelsea and Westminster Hospital, London, UK, Department of Radiology, Chelsea and Westminster Hospital, London, UK, Department of Orthopaedic Surgery, Homerton University Hospital, London, UK, You can also search for this author in <>/ExtGState<>/Font<>/ProcSet[/PDF/Text/ImageB]/XObject<>>>/Rotate 0/TrimBox[57.25999 58.11 666.34 848.69299]/Type/Page>> <>stream Sanders TG, Medynski MA, Feller JF, Lawhorn KW. Location of bone bruises and other osseous injuries associated with acute grade III isolated and combined posterolateral knee injuries. PubMed The lateral femoral notch sign (LFNS) and the kissing contusion (KC) are two indirect signs of anterior cruciate ligament (ACL) injuries. NAME, ADDRESS, E-MAIL ID OF THE CORRESPONDING AUTHOR: Dr. Ashish Garg, A-4, Ashok Nagar, Mandoli Road, Shahdara, Delhi-110093, India. Matrix in various sequences were listed as : T1 Saggital 307 x 384, T2 Axial - 314 x 448, T2 Saggital 314 x 448, PD Saggital 307 x 384, PD Coronal 355 x 384, PDFS Saggital 288 x 384, PDFS Coronal 311 x 384, MEDIC Axial 240 x 320. Radiology 184(3):855858, Dimitriou D, Reimond M, Foesel A et al (2021) The deep lateral femoral notch sign: a reliable diagnostic tool in identifying a concomitant anterior cruciate and anterolateral ligament injury. The notch depth of lateral femoral condyle in the experimental group (0.990.56mm) was significantly greater than that in the control group (0.490.28mm) (P<0.05). Br J Sports Med. 1030). PDFS Saggital: Bone marrow oedema in Intercondylar region tibia with subchondral cysts. endobj Bone contusions of the posterior lip of the medial tibial plateau (contrecoup injury) and associated internal derangements of the knee at MR imaging. Song GY, Zhang H, Wang QQ, Zhang J, Li Y, Feng H. Bone contusions after acute noncontact anterior cruciate ligament injury are associated with knee joint laxity, concomitant meniscal lesions, and anterolateral ligament abnormality. Background: Eur J Orthop Surg Traumatol. Article 1 Professor and HOD, Department of Radiology, Krishna Institute of Medical Science, Karad, Maharashtra, India. A 30-year-old woman with acute knee injury. [1] References [ edit] ^ Terzidis, I. P. (October 2004). 2016;10(4):TC0611. Am J Sports Med. Xie D, Murray J, Lartey R, Gaj S, Kim J, Li M, Eck BL, Winalski CS, Altahawi F, Jones MH, Obuchowski NA, Huston LJ, Harkins KD, Friel HT, Damon BM, Knopp MV, Kaeding CC, Spindler KP, Li X. Osteoarthritis Cartilage. Mechanism-based pattern approach to classification of complex injuries of the knee depicted at mr imaging. The most common symptom of a knee contusion is pain. Meniscal injury was unrelated to the extent or pattern of bone bruising. PubMed Central Shi H, Ding L, Jiang Y, Zhang H, Ren S, Hu X, Liu Z, Huang H, Ao Y. Orthop J Sports Med. bone contusion) can give clues for the mechanism and associated injuries. 2008;36:804. Liu ZY, Zhang JL, Liu C, Cao Q, Shen QJ, Zhao JC. [11] Anterior displacement of tibia refers to increased distance from the posterior cortex of the lateral tibial plateau to the posterior cortex of the femur. Patel SA, Hageman J, Quatman CE, Wordeman SC, Hewett TE. uuid:a4a67e17-1dd1-11b2-0a00-340827bd7200 In our study pivot shift pattern is noted in 78 cases (56.5%). official website and that any information you provide is encrypted Among the clip injury pattern, most common type/ mode of injury was two wheeler accident which was seen in 26 out of 39 cases (66.6%) [Table/Fig-7,,88]. see full revision history and disclosures, posterior soft tissue injuries involving the knee joint capsule, fibular attachment of soleus and distal semimembranosus tendon. Clin Radiol. Bone marrow contusion at posterior lip of medial tibial condyle was seen in 59 cases. Accessibility Jeli D, Masulovi D. Bone bruise of the knee associated with the lesions of anterior cruciate ligament and menisci on magnetic resonance imaging. 1995;19:7736. Hong CK, Lin YJ, Cheng TA, Chang CH, Hsu KL, Kuan FC, Su WR. Case Discussion. Google Scholar, Kanakamedala AC, Burnham JM, Pfeiffer TR et al (2018) Lateral femoral notch depth is not associated with increased rotatory instability in ACL-injured knees: a quantitative pivot shift analysis. Bone contusion and associated meniscal and medial collateral ligament injury in patients with anterior cruciate ligament rupture. Pivot shift injury in different location and its correlation with sports related injury and other type/mode of injury. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). A knee contusion is a bruised knee. Epub 2010 Sep 13. -, Radiology. Adult patients with ACL tears have greater tibial internal rotation in MRI compared to adolescent patients. 2011;133:011012. Sahoo K, Garg A, Saha P, Dodia JV, Raj VR, Bhairagond SJ. 2. We have included all the patients coming with acute knee injuries irrespective of type/mode of injury. 1998 Jun;69(3):291-4 Twenty-five patients were identified (median time from injury to MRI=24days). Shea KG, Archibald-Seiffer N, Murdock E, Grimm NL, Jacobs JC Jr, Willick S, Van Houten H. Knee injuries in downhill skiers: a 6-year survey study. Diagnostic value of the lateral femoral notch sign and kissing contusion in patients with anterior cruciate ligament injuries: a casecontrol study. Study was conducted between May 2014 to September 2015 with sample size of 200 patients, after taking the institutional ethical clearance. XZ contributed to part of the statistics of the article. Tensile load can cause ligament and tendon tears as well as avulsion fracture. PubMed Central PMC Chin YC, Wijaya R, Chong le R, Chang HC, Lee YH. -, Radiology. The double sulcus sign is a radiographic marker that confers a high probability of ACL injury. This case demonstrates a hyperextension knee injury consisting of partial posterior cruciate ligament tear proximal tibia epiphysis bone contusion and minor "kissing contusion" of the lateral femoral condyle posterior soft tissue injuries involving the knee joint capsule, fibular attachment of soleus and distal semimembranosus tendon It also was revealed that when the optimal cut-off point of LFNS was 0.72mm (area under the curve (AUC)=81%), the values of specificity and sensitivity were 67% and 84%, respectively. Terzidis et al., 20 conducted a study on acute knee injuries in 255 athletes with acutely injured knees, 219 MRIs were done within the first month after the injury and 36 within two to four months [13]. AJR Am J Roentgenol. Pivot shift injury depending on location and type/mode of injury. Bone marrow contusions are frequently identified at magnetic resonance imaging after an injury to the musculoskeletal system, and the mechanism of injury can be determined by studying the distribution of bone marrow edema, which enables one to predict with accuracy the specific soft-tissue abnormalities that are likely to be present. -, Arthroscopy. Google Scholar. 1 Kacey Court, Suite 100, Mechanicsburg, Pa, 17055. PubMed In six cases (4.3%) no pattern of bone marrow contusion could be explained and was categorized as unclassified pattern [Table/Fig-6]. Arch Orthop Trauma Surg. Objective: To determine the frequency, type, and distribution of kissing contusions occurring in association with injuries of the knee joint. Skeletal Radiol 44(3):385391, Herbst E, Hoser C, Tecklenburg K et al (2015) The lateral femoral notch sign following ACL injury: frequency, morphology and relation to meniscal injury and sports activity. <>/ExtGState<>/Font<>/ProcSet[/PDF/Text/ImageB]/XObject<>>>/Rotate 0/TrimBox[57.25999 58.11 666.34 848.69299]/Type/Page>> Bone bruising of the knee. 21033-6-01). The site is secure. Epub 2022 Nov 28. The posteromedial corner of the knee is a capsuloligamentous complex in the posterior aspect of the medial compartment. Wright RW, Phaneuf MA, Limbird TJ, Spindler KP. LF directed the writing of the article. The bone bruise or bone contusion are commonly used to define an occult bone alteration oedematous haemorrhagic due to trabecular microfractures as a result of a direct blow to the bone, application of compressive forces on contiguous bones with a consequent impact mechanism, and the action of a torsional force, and to stresses by traction on the subchondral bone by insertion of the ligament, tendon or capsular as occurs in traumatic avulsion [1]. PubMed 1999;211:74753. 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%). Other structures are injured less frequently and have weaker associations with bone bruise distribution. PubMed 2022. In our study, bone marrow oedema was seen in 138 cases (69%) out of 200 cases. In total 200 cases, bone marrow contusion was noted in 138 cases (69%) and absent contusion in 62 cases (31%). Bethesda, MD 20894, Web Policies uuid:a4a67e1a-1dd1-11b2-0a00-880000000000 Type I lesions are most common on the lateral femoral condyle and type III on the lateral tibial condyle. 2023-05-01T23:01:26-07:00 Radiographics. 1996;198:2058. This is a preview of subscription content, access via your institution. . Orthop J Sports Med. A prospective study of the association between bone contusion and intra-articular injuries associated with acute anterior cruciate ligament tear. 5 out of 8 patients with a 'double sulcus' on the lateral radiograph had ACL injury. In this case, patient has had a hyperextension external rotation injury of the knee as evidenced by the kissing bone marrow contusions in the anterior aspect of the lateral femoral condyle (LFC) and the lateral tibial plateau. In this study, the time gap between injury and doing MRI was not considered. Pure passive hyperextension of the human cadaver knee generates simultaneous bicruciate ligament rupture. 8600 Rockville Pike Contusions of both surfaces of the joint are known as kissing contusions.Objective: To determine the frequency, type, and distribution of kissing contusions occurring in association with injuries of the knee joint.Methods: 255 MRI examinations in athletes with acutely injured knees (197 men; 58 women; Related Papers Book an Appointment. 98 0 obj Reflecting presence of increased free water oedema, appears hyperintense on inversion recovery and fat suppressed images and shows increase diffusivity on Diffusion weighted images [10]. Increase in interstitial water content and hyperperfusion contributes to bone marrow oedema formation. The positive rate of KC in the experimental group (183/500) was markedly higher than that in the control group (3/500) (P<0.05). the contents by NLM or the National Institutes of Health. Would you like email updates of new search results? <>stream MacMahon PJ, Palmer WE. A prospective study of the association between bone contusion and intra-articular injuries associated with acute anterior cruciate ligament tear. Emerg Radiol 2:129134, Article 2007;189:55662. Kirialanis P, Malliou P, Beneka A, Giannakopoulos K. Occurrence of acute lower limb injuries in artistic gymnasts in relation to event and exercise phase. FOIA Bone marrow contusion was noted in 71 cases out of 255 cases (27.8%). 2023-05-01T23:01:26-07:00 Boks et al., conducted a study of the natural course of bone bruises in posttraumatic knees and to describe possible determinants of this course and concluded that Median healing time of bone bruises is 42.1 weeks [5]. The double sulcus sign is a radiographic marker that confers a high probability of ACL injury. MRI follow-up of posttraumatic bone bruises of the knee in general practice. 2015;23(8):22508. It is not necessary to obtain consent. Price excludes VAT (USA) Provided by the Springer Nature SharedIt content-sharing initiative, Over 10 million scientific documents at your fingertips, Not logged in J Bone Joint Surg Am 92(2):353360, Yu JS, Bosch E, Pathria MN et al (1995) The deep lateral femoral sulcus:correlation in 124 patients with anterior cruciate ligament tear. Compressive load causes bone marrow contusion and, if sufficient in magnitude, depressed cortical fracture. endobj 5 Resident, Department of Radiology, Krishna Institute of Medical Science, Karad, Maharashtra, India. Hyperextension injuries of the knee: do patterns of bone bruising predict soft tissue injury?. Am J Sports Med. 6 Resident, Department of Radiology, Krishna Institute of Medical Science, Karad, Maharashtra, India. bone contusion) can give clues for the mechanism and associated injuries. 10 0 obj By applying a biomechanical approach in MR interpretation, it is possible to detect lesions like ligament rupture and osseous contusion, to predict subtle but it might overlook important abnormalities. Arndt WA, Traux AL, Baranett FM, Simmon GE, Brown DC. no significant difference in location for different type/ mode of injury. The .gov means its official. Location of bone marrow contusion in hyperextension injury (4 cases) was - medial tibial and medial femoral condyle (2 cases) and anterior aspect of proximal tibia and femur (2cases). They can be used to diagnose ACL injuries. 8600 Rockville Pike Unable to load your collection due to an error, Unable to load your delegates due to an error. The purpose of this review is to illustrate the MRI findings of lateral patellar dislocation and concomitant injuries, such as kissing contusions of the medial patella and lateral femoral condyle; osteochondral and avulsion fractures; and injuries of the medial patellofemoral ligament/retinacular complex. Patient was placed in supine position with knee externally rotated 10-20 degree 21. Mechanism of traumatic knee injuries and MR findings. Archives of Orthopaedic and Trauma Surgery Among 46 cases, football was most common sports leading to injury followed by Kabaddi. Contusion is seen in the anterior aspect of the distal femur and proximal tibia or located in medial femoral and tibial condyle (valgus force applied). 2011 Aug 17;93(16):1510-8. doi: 10.2106/JBJS.J.01320. Arch Orthop Trauma Surg 143, 927934 (2023). sharing sensitive information, make sure youre on a federal In this study, inclusion criteria included history of knee injury within 6 weeks or suspected ACL injury [12]. Horizontal Rafting Plate for Treatment of the Tibial Plateau Fracture. Our team of experienced agents will hand hold the member through theentireprocess. Many patients coming with complain of pain following injury without radiographic evidence of fracture, MRI yields presence of extensive injury marrow which is characterised by marrow oedema and haemorrhage termed as bone bruise. endobj Google Scholar, Berthold DP, Muench LN, Herbst E et al (2021) High prevalence of a deep lateral femoral notch sign in patients with anterior cruciate ligament (ACL) and concomitant posterior root tears of the lateral meniscus. Type/Mode of injury in these cases are: impact during car accident in 4 cases, fall on flexed knee while playing cricket in 1 case, while getting downstairs in 1 case and fall from bike in flexed knee in 2 cases. Google Scholar. {"url":"/signup-modal-props.json?lang=us"}, Knipe H, Yap J, Al Kabbani A, et al. 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. Therefore, an influence by the number of bone bruises on healing time was marked; the higher the number, the more likely that there will be one slowly resolving lesion. The coronal lateral collateral ligament sign in the anterior cruciate ligament-injured knees was observed regardless of the knee laxity based on the quantitative measurements. MRI of the Pediatric Knee Pediatric Imaging Review. Google Scholar. government site. -. Mandalia V, Henson JH. 2022 Jan 11;17(1):17. doi: 10.1186/s13018-022-02912-0. Archives of Orthopaedic and Trauma Surgery, https://doi.org/10.1007/s00402-022-04366-9. Calvo-Gurry M, Hurley ET, Withers D, Vioreanu M, Moran R. Knee Surg Sports Traumatol Arthrosc. This was comparable to study conducted by Kirsch et al., in who reported transient lateral patellar dislocation in 2% cases with acute knee injuries and bone marrow contusion is noted in lateral femoral condyle in 81% and contusion in patella in 19% cases [15]. Pivot shift injury pattern according to Location of marrow oedema. Analysis of bone marrow oedema was done by a single observer based on MRI [9], its patterns were studied and possible type/mode of injury was determined before elucidating the history from the patient. The 32 bone contusions (16 kissing contusions) were located as follows: lateral femoral condyle (n = 14; 8 type I, 6 type II); lateral tibial condyle (n = 9; 3 type I, 1 type II, 5 type III); medial tibial condyle (n = 7; 2 type I, 5 type III); medial femoral condyle (n = 2; both type I). Article 2019. PubMed 2013;41(8):18017. Transient patellar dislocation is a common sports-related injury in young adults. A cross-sectional study was done on all patients referred to Krishna Hospital, Karad for MRI knee with history of recent (< 6 weeks) knee injury. <> This mechanism of injury involves other soft tissue structures like tears/posterior capsule and arcuate ligament, medial collateral ligament (MCL) and the menisci. T1W Saggital: Bone marrow oedema at Lateral femoral condyle in Clip injury pattern. Accessibility Sports Health. Bone contusion patterns of the knee at MR imaging: footprint of the mechanism of injury. MacMahon PJ, Palmer WE. Acute findings of a joint effusion and posterior tibial plateau contusion are present. Eight of the kissing contusions were associated with anterior cruciate ligament tears, three with menisceal tears, four were isolated lesions, and one was delayed, following a menisceal tear. Twenty-five patients were identified (median time from injury to MRI = 24 days). Most common type / mode of injury in patients with unclassified pattern in fall from bike (3 cases) followed by hit by car/ motor vehicle (2 cases) and injury while lifting heavy weight in 1 case [Table/Fig-13]. 36 0 obj Bone marrow bruise is ill defined subchondral reticular or stellate region of low signal intensity on T1 and high signal intensity on T2W images [6]. A deeper notch often indicates a more complex knee injury. In compressive load, bones collide leading to impaction. 2004;32:16817. Study of imaging pattern in bone marrow oedema in MRI in recent knee injuries and its correlation with type of knee injury. Bone marrow oedema on T2 weighted magnetic resonance (MR) images is recognized as an ill-defined hyperintensity in the bone marrow where standard radiographs showed nonspecific osteopenia or normal findings [3]. ACL tears are classified into three grades: Grade I ACL tears represent intraligamentous injury without a change in ligament length. The magnitude of the force is a major determinant of the imaging findings. On analysing the bone marrow contusion pattern, type/mode can be determined in most of cases. Contusions of both surfaces of the joint are known as kissing contusions. The diagnostic outcome of LFNS was not in agreement with that of KC, as there was a poor coincidence according to the Kappa coefficient (Kappa=0.155<0.4, P=0.035). PubMed Clin Imaging. LXC designed the study and was responsible for the paper. Five patterns of bone marrow contusion was noted in 138 cases: Clip injury in 39 cases (28.3%) [Table/Fig-1a&b], Pivot shift injury in 78 cases (56.5%) [Table/Fig-2a&b], Dashboard injury in eight cases (5.8%) [Table/Fig-3], Hyper extension injury in four cases (2.9%) [Table/Fig-4], Lateral patellar dislocation in three cases (2.2%) [Table/Fig-5]. Skeletal Radiology Contusions of both surfaces of the knee joint are known as kissing contusions. Bone marrow oedema may also show delayed enhancement following administration of gadolinium DTPA. Radiology. Google Scholar.
