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Classification of Bone Bruises in Pediatric Patients With Anterior Cruciate Ligament Injuries
Hong-De Wang1, Jiahao Zhang1, Yuwan Li1
1Department of Sports Medicine, Beijing Key Laboratory of Sports Injuries, Institute of Sports Medicine, Peking University Third Hospital, Peking University, Beijing, China.
Insights
A new classification system for pediatric bone bruises after anterior cruciate ligament (ACL) tears helps estimate knee injury severity. This grading system correlates bone bruise patterns with associated ligament and meniscal injuries.
Area of Science:
- Orthopedic surgery
- Pediatric radiology
- Sports medicine
Background:
- Bone bruises are common findings on MRI in pediatric patients following an anterior cruciate ligament (ACL) tear.
- Understanding these bone bruises is crucial for assessing overall knee injury severity in this population.
Purpose of the Study:
- To develop a novel classification system for bone bruise patterns observed on MRI in pediatric patients with ACL tears.
- To correlate these patterns with injury severity and associated knee pathologies.
Main Methods:
- A retrospective review of a medical database identified 188 pediatric patients (≤17 years) with primary ACL tears and MRI within 4 weeks of injury.
- Bone bruises were classified based on depth (grades I-III) and location (types a-d) on sagittal and coronal MRI views.
Main Results:
- The classification identified 3 depth grades and 4 location types of bone bruises.
- A significant increase in collateral ligament injuries was observed from grade I to III bone bruises.
- All patients with grade III type c bone bruises also had meniscal lesions.
Conclusions:
- The developed classification system offers a valuable tool for estimating the severity of knee injuries in pediatric patients with ACL tears.
- This system aids in predicting associated lesions, which is beneficial for pre-operative planning.
Background:
Bone bruises are frequently found on magnetic resonance imaging (MRI) after an anterior cruciate ligament (ACL) tear in pediatric patients.
Purpose:
To establish a classification system for different bone bruise patterns to estimate the severity of a knee injury in pediatric patients with ACL tears.
Study Design:
Cross-sectional study; Level of evidence, 3.
Methods:
A medical database was retrospectively reviewed to identify all cases of primary ACL tears in patients who were aged ≤17 years at the time of the injury and underwent MRI at our institution within 4 weeks of the injury between January 2011 and December 2020. A total of 188 patients were identified (67 male, 121 female; mean age, 15.1 ± 1.4 years). Bone bruises were classified according to their depth and location on MRI in the sagittal and coronal planes.
Results:
The new classification system identified 3 grades of depth: grade I, the bone bruise was located within the epiphysis but did not reach the epiphyseal plate (n = 54 [35.3%]); grade II, the bone bruise was within the epiphysis that reached the epiphyseal plate (n = 55 [35.9%]); and grade III, the bone bruise was in both the epiphysis and metaphysis (n = 44 [28.8%]). The bone bruise location was classified into 4 types: type a, the deepest bone bruise area was in the lateral tibial plateau (n = 66 [43.1%]); type b, the deepest bone bruise area was in the lateral femoral condyle, commonly occurring in the lateral one-third to two-thirds of the lateral femoral condyle (n = 22 [14.4%]); type c, the bone bruise area had a similar depth in both the lateral femoral condyle and lateral tibial plateau (n = 54 [35.3%]); and type d, the bone bruise area was in the lateral tibial plateau and lateral femoral condyle and extended to the fibular head (n = 11 [7.2%]). The prevalence of collateral ligament injuries increased from grade I to III. All patients with grade III type c bone bruises had meniscal lesions.
Conclusion:
This new classification system provides a basis for estimating associated lesions of the knee before surgery.
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