"skipMainNavigation"
closeDrawerMenuopenDrawerMenu
Search
Quick Search in Journals
Quick Search anywhere
Advanced Search
RadioGraphics
Menu
  • Information
    • Previous
    Next
    Knee - Continuing Medical Education

    Bone Contusion Patterns of the Knee at MR Imaging: Footprint of the Mechanism of Injury

    Published Online:Oct 1 2000https://doi.org/10.1148/radiographics.20.suppl_1.g00oc19s135

    Abstract

    Bone marrow contusions are frequently identified at magnetic resonance imaging after an injury to the musculoskeletal system. These osseous injuries may result from a direct blow to the bone, from compressive forces of adjacent bones impacting one another, or from traction forces that occur during an avulsion injury. The distribution of bone marrow edema is like a footprint left behind at injury, providing valuable clues to the associated soft-tissue injuries. Five contusion patterns with associated soft-tissue injuries occur in the knee: pivot shift injury, dashboard injury, hyperextension injury, clip injury, and lateral patellar dislocation. The classic bone marrow edema pattern seen following the pivot shift injury involves the posterolateral tibial plateau and the midportion of the lateral femoral condyle. Edema occurs in the anterior aspect of the proximal tibia following the dashboard injury. Hyperextension results in the “kissing” contusion pattern involving the anterior aspect of the proximal tibia and distal femur. The clip injury results in a prominent area of edema involving the lateral femoral condyle and a smaller area of edema involving the medial femoral condyle. Finally, lateral patellar dislocation results in edema involving the inferomedial patella and anterior aspect of the lateral femoral condyle. In many instances, the mechanism of injury can be determined by studying the distribution of bone marrow edema, which then enables one to predict with accuracy the specific soft-tissue abnormalities that are likely to be present.

    References

    • 1 Mink JH, Deutsch AL. Occult cartilage and bone injuries of the knee: detection, classification, and assessment with MR imaging. Radiology 1989; 170:823-829. Link, Google Scholar
    • 2 Steiner RM, Mitchell DG, Rao VM, Schweitzer ME. Magnetic resonance imaging of diffuse bone marrow disease. Radiol Clin North Am 1993; 31:383-409. Medline, Google Scholar
    • 3 Kapelov SR, Teresi LM, Bradley WG, et al. Bone contusion of the knee: increased lesion detection with fast spin-echo MR imaging with spectroscopic fat saturation. Radiology 1993; 189:901-904. Link, Google Scholar
    • 4 Lynch TC, Crues JV, III, Morgan FW, et al. Bone abnormalities of the knee: prevalence and significance at MR imaging. Radiology 1989; 171:761-766. Link, Google Scholar
    • 5 Graf BK, Cook DA, De Smet AA, Keene JS. “Bone bruises” on magnetic resonance imaging evaluation of anterior cruciate ligament injuries. Am J Sports Med 1993; 21:220-223. Crossref, Medline, Google Scholar
    • 6 Tung GA, Davis LM, Wiggins ME, et al. Tears of the anterior cruciate ligament: primary and secondary signs at MR imaging. Radiology 1993; 188:661-667. Link, Google Scholar
    • 7 Remer EM, Fitzgerald SW, Friedman H, et al. Anterior cruciate ligament injury: MR imaging diagnosis and patterns of injury. RadioGraphics 1992; 12:901-915. Link, Google Scholar
    • 8 Murphy BJ, Smith RL, Uribe JW, Janecki CJ, Hetchman KS, Mangasarian RA. Bone signal abnormalities in the posterolateral tibia and lateral femoral condyle in complete tears of the anterior cruciate ligament: a specific sign? Radiology 1992; 182:221-224. Link, Google Scholar
    • 9 Rosen MA, Jackson DW, Berger PE. Occult osseous lesions documented by magnetic resonance imaging associated with anterior cruciate ligament ruptures. Arthroscopy 1991; 7:45-51. Crossref, Medline, Google Scholar
    • 10 Stallenberg B, Genevois PA, Sintzoff SA, Jr, Matos C, Andrianne Y, Struyven J. Fracture of the posterior aspect of the lateral tibial plateau: radiographic sign of anterior cruciate ligament tear. Radiology 1993; 187:821-825. Link, Google Scholar
    • 11 Cobby MJ, Schweitzer ME, Resnick D. The deep lateral femoral notch: an indirect sign of a torn anterior cruciate ligament. Radiology 1992; 184:855-858. Link, Google Scholar
    • 12 Kaplan PA, Gehl RH, Dussault RG, Anderson MW, Diduch DR. Bone contusion of the posterior lip of the medial tibial plateau (contrecoup injury) and associated internal derangements of the knee at MR imaging. Radiology 1999; 211:747-753. Link, Google Scholar
    • 13 Sonin AH, Fitzgerald SW, Hoff FL, et al. MR imaging of the posterior cruciate ligament: normal, abnormal, and associated injury patterns. RadioGraphics 1995; 15:551-561. Link, Google Scholar
    • 14 Sonin AH, Fitzgerald SW, Friedman H, et al. Posterior cruciate ligament injury: MR imaging diagnosis and patterns of injury. Radiology 1994; 190:455-458. Link, Google Scholar
    • 15 DeLee JC, Bergfeld JA, Drez D, Jr, et al. The posterior cruciate ligament. In: DeLee JC, Drez D, Jr, eds. Orthopaedic sports medicine: principles and practice. Philadelphia, Pa: Saunders, 1994; 1374-1443. Google Scholar
    • 16 Yu JS, Goodwin D, Salonen D, et al. Complete dislocation of the knee: spectrum of associated soft-tissue injuries depicted by MR imaging. AJR Am J Roentgenol 1995; 164:135-139. Crossref, Medline, Google Scholar
    • 17 Bassett LW, Grover JS, Seeger LL. Magnetic resonance imaging of knee trauma. Skeletal Radiol 1990; 19:401-405. Medline, Google Scholar
    • 18 Twaddle BC, Hunter JC, Chapman JR, Simoniah PT, Escobedo EM. MRI in acute knee dislocation: a prospective study of clinical, MRI, and surgical findings. J Bone Joint Surg Br 1996; 78:573-579. Medline, Google Scholar
    • 19 Hoover NW. Injuries of the popliteal artery associated with fractures and dislocations. Surg Clin North Am 1961; 41:1099-1112. Crossref, Medline, Google Scholar
    • 20 Miller TT, Gladden P, Staron RB, Henry JH, Feldman F. Posterolateral stabilizers of the knee: anatomy and injuries assessed with MR imaging. AJR Am J Roentgenol 1997; 169:1641-1647. Crossref, Medline, Google Scholar
    • 21 Derscheid GL, Garrick JG. Medial collateral ligament injuries in football: non-operative management of grade I and grade II sprains. Am J Sports Med 1981; 9:365-368. Crossref, Medline, Google Scholar
    • 22 Fetto JF, Marshall JL. Medial collateral ligament injuries of the knee: a rationale for treatment. Clin Orthop 1978; 132:206-218. Medline, Google Scholar
    • 23 Holden DL, Eggert AW, Butler JE. The non-operative treatment of grade I and II medial collateral ligament injuries to the knee. Am J Sports Med 1983; 11:340-344. Crossref, Medline, Google Scholar
    • 24 Ellsasser JC, Reynolds FC, Omohundro JR. The non-operative treatment of collateral ligament injuries of the knee in professional football players: an analysis of seventy-four injuries treated non-operatively and twenty-four injuries treated surgically. J Bone Joint Surg Am 1974; 56:1185-1190. Crossref, Medline, Google Scholar
    • 25 Schweitzer ME, Tran D, Deely DM, Hume EL. Medial collateral ligament injuries: evaluation of multiple signs, prevalence and location of associated bone bruises, and assessment with MR imaging. Radiology 1995; 194:825-829. Link, Google Scholar
    • 26 Garvin GJ, Munk PL, Vellet AD. Tears of the medial collateral ligament: magnetic resonance imaging findings and associated injuries. Can Assoc Radiol J 1993; 44:199-204. Medline, Google Scholar
    • 27 Kirsch MD, Fitzgerald SW, Friedman H, Rogers LF. Transient lateral patellar dislocation: diagnosis with MR imaging. AJR Am J Roentgenol 1993; 161:109-113. Crossref, Medline, Google Scholar
    • 28 Sanders TG, Morrison WB, Cornum KG, Miller MD. Acute dislocation of the patella: MR findings and surgical correlation of specific medial soft tissue injuries (abstr). Radiology 1999; 213(P):115. Google Scholar
    • 29 Sallay PI, Poggi J, Speer KP, Garrett WE. Acute dislocation of the patella: a correlative pathoanatomic study. Am J Sports Med 1996; 24:52-60. Crossref, Medline, Google Scholar
    • 30 Feller JA, Feagin JA, Jr, Garrett WE. The medial patellofemoral ligament revisited: an anatomical study. Arthroscopy 1993; 1:184-186. Google Scholar
    • 31 Spritzer CE, Courneya DL, Burk DL, Jr, Garrett WE, Strong JA. Medial retinacular complex injury in acute patellar dislocation: MR findings and surgical implications. AJR Am J Roentgenol 1997; 168:117-122. Crossref, Medline, Google Scholar
    • 32 Starok M, Lenchikl L, Trudell D, Resnick D. Normal patellar retinaculum: MR and sonographic imaging with cadaveric correlation. AJR Am J Roentgenol 1997; 168:1493-1499. Crossref, Medline, Google Scholar
    • 33 Hautamaa PV, Fithian DC, Kaufman KR, Daniel DM, Pohlmeyer AM. Medial soft tissue restraints in lateral patellar instability and repair. Clin Orthop 1998; 349:174-182. Crossref, Medline, Google Scholar
    • 34 Rorabeck CH, Bobechko WP. Acute dislocation of the patella with osteochondral fracture: a review of eighteen cases. J Bone Joint Surg Br 1976; 58:237-240. Medline, Google Scholar
    • 35 Hunter SC, Marascalco R, Hughston JC. Disruption of the vastus medialis obliquus with medial knee ligament injuries. Am J Sports Med 1983; 11:427-431. Crossref, Medline, Google Scholar
    • 36 Conlan T, Garth WP, Jr, Lemons JE. Evaluation of the medial soft-tissue restraints of the extensor mechanism of the knee. J Bone Joint Surg Am 1993; 75:682-693. Crossref, Medline, Google Scholar

    Article History

    Published in print: Oct 2000