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Document Title: Mair-AJSM-Oct04.shtml
Article Title: Incidence and Location of Bone Bruises After Acute Posterior Cruciate Ligament Injury
Authors: Scott D. Mair, MD, Theodore F. Schlegel, MD, Thomas J. Gill, MD, Richard J. Hawkins, MD and J. Richard Steadman, MD
Publication: American Journal of Sports Medicine, Baltimore, Maryland
Date: October 2004
Volume 32, pages 1681-1687
Keywords: posterior cruciate ligament, PCL, bone-bruising, articular-cartilage damage, ACL tearing, anterior cruciate ligament, collateral ligament tearing, LCL, PCL, MRI, magnetic-resonance imaging.
(Reference-denoting numbers appear in the same font and point size as the document text. As with all Knee Library documents, this article is provided in full-text form, complete with all figures and tables.)
Comments: This article describes the occurrence of bone bruising in knees which have incurred PCL tearing. Note that bone bruising is also a very common accompaniment to ACL tearing. In essence, bone-bruising is a very forceful and violent crushing of the articular-cartilage-covered bone surfaces, resulting from the sudden smashing-together of the bones during an injury involving high kinetic energy. (Remember that kinetic energy increases with speed squared. As an example, if running speed is taken to be four times that of walking speed, then the injuries during direction changes will be 16 times as bad.) Bone bruises can engender pain for months on end, and technically do not heal. Rather, they sort of scar over, as the original hyaline articular cartilage is replaced with suboptimal fibrocartilage. (The underlying microtrabecular bone does not really recover from having been smashed up. If the crushing was severe, the contour of the articular surface is disrupted to the extent that surgical attempts at recontouring might be recommended.) Bone bruises are well-correlated with increased predisposition to osteoarthritis. Note that PCL injuries can occur via a variety of means, including posterior shearing (car-dashboard injury), injurious hyperextension, and hyperflexion, sideways forcing, and twisting. Meanwhile, ACL injuries can occur via sideways forcing, twisting, anterior shearing, and twisting. Clearly, there are many circumstances under which multiple ligaments can be injured. Although ACL and PCL injuries only occur simultaneously if the injury is extremely severe (e.g. total knee dislocation, as might occur in a motor-vehicle crash or a high-speed alpine-skiing incident), it is quite common to tear one of the cruciate ligaments in conjunction with a collateral ligament. The nature and extent of the ligamentous tears also gives insight into where bone bruising might be expected. Likewise, certain bone-bruising patterns tend to be indicative of which types of ligamentous injurious might be anticipated. (Another excellent article on this topic is Potter-AJSM-Apr06.shtml.)
ABSTRACT
Background: In patients suffering from an anterior cruciate ligament injury, the incidence and location of bone bruises are well documented. This study reports data regarding bone bruises after acute posterior cruciate ligament injury.
Hypothesis: Bone bruises associated with posterior cruciate ligament injury are common, and their location differs from those seen with anterior cruciate ligament injury.
Study Design: Retrospective cohort study.
Methods: Thirty-five consecutive patients were identified as having a grade II or III posterior cruciate ligament tear, with an intact anterior cruciate ligament, in which a magnetic resonance imaging scan had been obtained within 20 days of injury. Magnetic resonance imaging scans were reviewed to document bone bruises, associated medial or lateral ligamentous injury, and meniscal and chondral abnormalities.
Results: Of the 35 patients, 29 (83%) had a bone bruise in at least one location. Bone bruises were found throughout the joint, more widely dispersed than is commonly seen with anterior cruciate ligament injury. Also, 29 patients had magnetic resonance imaging findings of associated ligamentous injury. Lateral bone bruises were associated with medial collateral ligament injury, whereas medial bone bruises correlated with posterolateral injury.
Conclusions: The incidence of bone bruises associated with posterior cruciate ligament injury is similar to that seen with anterior cruciate ligament injury. Their location is more widely dispersed. The location of a bone bruise should lead to careful magnetic resonance imaging inspection and physical examination for ligamentous injury to the opposite side of the joint. Truly isolated posterior cruciate ligament injuries are rare, as most occur with osseous and some degree of associated ligamentous injury.
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