Background The presence of bone bruises (BB), especially in the lateral compartment of the knee, is a common finding in the context of anterior cruciate ligament (ACL) injury. However, different patterns have been described and a precise correlation with mechanism of ACL injury has never been determined.
Objective To correlate the MRI features of ACL injuries with the exact injury mechanism obtained from video-analysis. Such investigation, which has never been performed up to now, provides relevant insights in the understanding ACL injury mechanism and in the genesis of intra-articular lesions such as bone bruises.
Design Fifteen professional football players sustaining an ACL injury (while playing during an official match of First League Championship) were included in the study. The video of injury was obtained from the Television broadcast. Knee Magnetic Resonance Imaging (MRI) was obtained within 7 days from the injury. BB and meniscal/cartilage lesions were analyzed on MRI, while a video analysis of mechanisms of ACL injury and injury dynamics were assessed from the videos.
Results The most common pattern of BB present in 8 cases (53%) was a femoral BB >5 mm in the central portion of the lateral femoral condyle and in the posterior portion of the lateral tibial plateau. In all these cases, the injury occurred with single-leg load during a pivoting maneuver while changing direction during pressing (33%), dribbling (7%), goalkeeping (7%) or in response of being being tackled on the upper body (7%). All these injuries occurred without direct contact, high horizontal speed and with an abducted hip.
Other patterns included BB only in tibia (20%), tibia and femur BB <5 mm (7%) or no BB (20%). In these cases, injury occurred due to direct contact (20%), recovery balance after kicking (13%) or jumping (7%), and while tackling (7%).
Conclusions A characteristic and well-defined BB pattern, with BB in both tibia and femur, was identified in ACL injuries without direct contact and while the football players had single-leg loading while pivoting trying to perform a sudden change of direction.
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