Abstract
PurposeThe presence and severity of bone bruise is more and more investigated in the non-contact anterior cruciate ligament (ACL) injury context. Recent studies have advocated a correlation between bone bruise and preoperative knee laxity. The aim of the present study was to investigate the correlation between bone bruise and preoperative rotatory knee laxity.MethodsTwenty-nine patients (29.1 ± 9.8 years) with MRI images at a maximum of 3 months after ACL injury (1.6 ± 0.8 months) were included. The bone bruise severity was evaluated according to the International Cartilage Repair Society (ICRS) scale for lateral femoral condyle, lateral tibial plateau, medial femoral condyle, and medial tibial plateau. The intraoperative rotational knee laxity was evaluated through a surgical navigation system in terms of internal–external rotation at 30° and 90° of knee flexion (IE30, IE90) and internal–external rotation and acceleration during pivot-shift test (PS IE, PS ACC). The KOOS score was also collected. The association between ICRS grade of bone bruise and rotational laxity or KOOS was investigated.ResultsSignificant correlation (p < 0.05) was found between the bone bruise severity on the medial tibial plateau and rotational laxity (IE90, PS IE, and PS ACC) and between the severity of bone bruise on femoral lateral condyle and KOOS-Symptoms sub-score. The presence of bone bruise on the medial tibial plateau was significantly associated with a lateral femoral notch sign > 2 mm (very strong odds ratio). No kinematical differences were found between none-to-deep and extensive-generalized lateral bone bruise, while higher IE30 and IE90 were found in extensive-generalized bicompartmental bone bruise than isolated extensive-generalized lateral bone bruise.ConclusionA severe bicompartmental bone bruise was related to higher rotatory instability in the intraoperative evaluation of ACL deficient knees. The severity of edema on the medial tibial plateau was directly correlated with higher intraoperative pivot shift, and the size of edema on the lateral femoral condyle was associated with lower preoperative clinical scores.Level of evidenceLevel II.
Highlights
Residual rotational instability after anterior cruciate ligament (ACL) reconstruction has been associated with lower clinical scores, impaired sport participation, and increased revision rate [1, 11, 23]
A significant negative correlation was found between the severity of Bone bruise (BB) on the femoral lateral condyle and KOOSSymptoms sub-score (Fig. 2)
Isolated extensive-generalized lateral BB and extensive-generalized bicompartmental BB differed for internal/external rotation at 30° of flexion (IE30) and internal/external rotation at 90° of flexion (IE90) (Table 4, Fig. 3)
Summary
Residual rotational instability after anterior cruciate ligament (ACL) reconstruction has been associated with lower clinical scores, impaired sport participation, and increased revision rate [1, 11, 23]. A relationship between lateral bone edema and preoperative rotatory knee laxity was advocated. Under similar hypothesis and methodology, Marot et al [24] excluded a relationship between bone contusions and ALL tears or rotatory knee instability in a more recent study. The latter studies’ main limitation was that knee laxity evaluation was based on clinical examination and not on instrumented quantitative measurements. Only the lateral compartment was investigated, overlooking a possible role of the medial bruises on knee laxity
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