Patellotibial contusions: a rare cruciate ligament injury pattern

Patellotibial contusions are a recently described contusion pattern in anterior cruciate ligament (ACL) tears. The purposes or our study were to determine if patellotibial contusions are specific to ACL injuries, determine the internal derangements in patients demonstrating this contusion, and suggest a mechanism of injury.

We conducted a retrospective search of radiology reports over a 6-year period to identify patients with patellar edema described on magnetic resonance (MR) imaging. Only individuals with patellar and tibial edema were included in the study group. These MR examinations were then reviewed for associated internal derangements.

From March 2007 to June 2013, 1914 MR examinations of the knee were performed. Two hundred seventy-one reports described patellar edema. Seven individuals had edema of both the inferior pole of the patella and the anterior tibial plateau. Three individuals were involved in motor vehicle accidents (MVAs); 4 patients had a history of an axial load or sports-related injury. All 3 patients involved in MVAs had posterior cruciate ligament tears consistent with posterior translation of the tibia. The non-MVA individuals had tears of the ACL with internal derangements similar to other ACL deficient knees, however, with more widespread osseous contusions.

Patellotibial contusions are high-energy injuries resulting in cruciate ligament tears. These contusions occur exclusively in patients with ACL tears when individuals with a history of direct impaction to the knee are excluded. Axial loading of the extended knee may be an important mechanism of injury in these individuals.