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Figure A
88%
2916/3325
Figure B
3%
89/3325
Figure C
5%
155/3325
Figure D
2%
75/3325
Figure E
74/3325
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This patient has most likely sustained an ACL tear. This is supported by the history and positive Pivot Shift Test on physical exam. The most common bone bruise pattern resulting from an acute tear of the ACL is the central third of the lateral femoral condyle and posterior third of the lateral tibial plateau (shown in Figure A). The article by Graf et al found that 43% of ACL tears had an associated bone bruise on MRI if the image was taken within 6 weeks of injury. There was no correlation between the presence of a bone bruise and articular alterations or meniscal tears observed at surgery. In a prospective study (MOON Database) Dunn et al found that 418 of 525 (80%) patients with an ACL tear had bone bruising. They found that bone bruising is not associated with symptoms/pain at the time of index anterior cruciate ligament reconstruction. Yoon et al found that 84% of patients with ACL tears had bone bruises. The lateral femoral condyle was the most common location (68%). They found injuries of the menisci and the MCL tended to increase with the progression of bone contusion. Illustration A is a link to a video demonstrating the Pivot Shift Test. Incorrect Answers: Answer 2: Figure B shows an anterior tibia contusion. Answer 3: Figure C shows a bone contusion pattern consistent with a patellar dislocation. Answer 4: Figure D shows an anterior femoral condyle contusion. Answer 5: Figure E (meniscotibial ligament avulsion) show bone contustion patterns are consistent with a hyperextension injury (an example would be a PCL tear).
4.6
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