The Predicted Position of the Knee Near the Time of ACL Rupture Is Similar Between 2 Commonly Observed Patterns of Bone Bruising on MRI

Am J Sports Med. 2023 Jan;51(1):58-65. doi: 10.1177/03635465221131551. Epub 2022 Nov 28.


Background: Bone bruises observed on magnetic resonance imaging (MRI) can provide insight into the mechanisms of noncontact anterior cruciate ligament (ACL) injury. However, it remains unclear whether the position of the knee near the time of injury differs between patients evaluated with different patterns of bone bruising, particularly with regard to valgus angles.

Hypothesis: The position of the knee near the time of injury is similar between patients evaluated with 2 commonly occurring patterns of bone bruising.

Study design: Descriptive laboratory study.

Methods: Clinical T2- and T1-weighted MRI scans obtained within 6 weeks of noncontact ACL rupture were reviewed. Patients had either 3 (n = 20) or 4 (n = 30) bone bruises. Patients in the 4-bone bruise group had bruising of the medial and lateral compartments of the femur and tibia, whereas patients in the 3-bone bruise group did not have a bruise on the medial femoral condyle. The outer contours of the bones and associated bruises were segmented from the MRI scans and used to create 3-dimensional surface models. For each patient, the position of the knee near the time of injury was predicted by moving the tibial model relative to the femoral model to maximize the overlap of the tibiofemoral bone bruises. Logistic regressions (adjusted for sex, age, and presence of medial collateral ligament injury) were used to assess relationships between predicted injury position (quantified in terms of knee flexion angle, valgus angle, internal rotation angle, and anterior tibial translation) and bone bruise group.

Results: The predicted injury position for patients in both groups involved a flexion angle <20°, anterior translation >20 mm, valgus angle <10°, and internal rotation angle <10°. The injury position for the 3-bone bruise group involved less flexion (odds ratio [OR], 0.914; 95% CI, 0.846-0.987; P = .02) and internal rotation (OR, 0.832; 95% CI, 0.739-0.937; P = .002) as compared with patients with 4 bone bruises.

Conclusion: The predicted position of injury for patients displaying both 3 and 4 bone bruises involved substantial anterior tibial translation (>20 mm), with the knee in a straight position in both the sagittal (<20°) and the coronal (<10°) planes.

Clinical relevance: Landing on a straight knee with subsequent anterior tibial translation is a potential mechanism of noncontact ACL injury.

Keywords: MRI; anterior cruciate ligament injury; bone contusion; kinematics.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Anterior Cruciate Ligament Injuries* / diagnostic imaging
  • Anterior Cruciate Ligament Injuries* / pathology
  • Biomechanical Phenomena
  • Contusions* / diagnostic imaging
  • Contusions* / pathology
  • Epiphyses / pathology
  • Femur / pathology
  • Hematoma / pathology
  • Humans
  • Knee Injuries* / diagnostic imaging
  • Knee Injuries* / pathology
  • Knee Joint / diagnostic imaging
  • Knee Joint / pathology
  • Magnetic Resonance Imaging / methods
  • Tibia / pathology