Anterior cruciate ligament injury: post-traumatic bone marrow oedema correlates with long-term prognosis
Giuseppe Filardo1, Elizaveta Kon2, Francesco Tentoni1
1II Orthopaedic and Traumatologic Clinic-Biomechanics and Technology Innovation Laboratory, Rizzoli Orthopaedic Institute, Via Di Barbiano, 1/10, 40136, Bologna, Italy.
Purpose:
Bone marrow oedema (BME) in the knee is a feature of several pathological conditions, and it has been described with high frequency in patients with acute anterior cruciate ligament (ACL) injury. The aim of this study is to evaluate the significance of BME, assessed in MRIs performed for ACL injury, with regards to clinical outcome and return to sport.
Methods:
A total of 134 patients (98 men, 36 women) with ACL tear and MRI knee scan within six months from trauma were analysed. The presence of BME was evaluated on MRI images considering: extension and hyperintensity, the WORMS score oedema classification, and measuring the BME area. The clinical results were documented by IKDC-subjective score and the sport activity level by Tegner score at a minimum of five years follow up.
Results:
BME was present in 74 knees (55.2 %), with a mean area of 523 ± 370 mm². The presence of BME showed a gradual decrease over time (p = 0.008), being detectable in MRIs performed more than three months after trauma in just 25.0 % of cases. Although 54 % of the patients without BME after three months returned to their previous sport level, no patients with oedema reached a full sport recovery (p = 0.01). In the group that underwent ACL reconstruction, the BME area was significantly correlated with a return to the previous sport level at the mid/long-term follow-up (p = 0.038).
Conclusions:
BME is a common finding, which decreases over time after injury. However, when BME is still detectable it correlates with clinical prognosis, and even in sport-active patients undergoing ACL reconstruction, a higher BME area is a negative predictive factor for a successful outcome at the mid/long-term follow-up.
Insights
Bone marrow oedema (BME) in the knee is common after anterior cruciate ligament (ACL) injury and decreases over time. Persistent BME, however, negatively impacts clinical outcomes and return to sport, even after ACL reconstruction.
Area of Science:
- Orthopedic surgery
- Sports medicine
- Radiology
Background:
- Bone marrow oedema (BME) is frequently observed in acute anterior cruciate ligament (ACL) injuries.
- BME's impact on clinical outcomes and return to sport following ACL injury requires further elucidation.
Purpose of the Study:
- To evaluate the significance of BME, detected via MRI, in relation to clinical outcomes and return to sport in patients with ACL injury.
- To assess the correlation between BME characteristics (extension, hyperintensity, area) and patient recovery.
Main Methods:
- Analysis of 134 patients with ACL tear and MRI scans within six months of trauma.
- Evaluation of BME presence, extension, hyperintensity, WORMS score, and area on MRI.
- Clinical outcomes assessed using IKDC subjective score and Tegner score at a minimum five-year follow-up.
Main Results:
- BME was present in 55.2% of knees, with a mean area of 523 mm².
- BME decreased over time, detectable in only 25% of MRIs >3 months post-trauma.
- No patients with BME after three months returned to their previous sport level, compared to 54% without BME.
- BME area correlated negatively with return to sport after ACL reconstruction (p=0.038).
Conclusions:
- BME is a common finding post-ACL injury that diminishes over time.
- Persistent BME correlates with poorer clinical prognosis and reduced return to sport.
- Increased BME area is a negative predictor for successful outcomes in sport-active patients undergoing ACL reconstruction.
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