Review Question - QID 4454

Bone bruising occurs in more than half of all ACL tears and is seen most commonly on the posterolateral tibia and middle 1/3 of the lateral femoral condyle (sulcus terminalis).

ACL tears usually occur as a result of a non-contact pivoting injury. Bone bruise patterns correlate with the direction of the abnormal anterior translation and abutment of the posterolateral tibia against the middle 1/3 of the lateral femur during the injury.

Viskontas et al., in a prospective cohort study, looked at the correlation between the mechanism of ACL injury and presence of bone bruise patterns in 100 patients. They found that bone bruising was more frequent, deeper, and more intense in non-contact ACL injuries (P < .001).

Yoon et al. reviewed 81 patients with bone contusions and associated meniscal and medial collateral ligament (MCL) injuries in patients with anterior cruciate ligament ruptures. They found patients with more severe bone contusions tended to have more concomitant injuries of the menisci and the MCL.

Illustration A shows an example of the abnormal anterior translation and abutment of the posterolateral tibia against the middle 1/3 of the lateral femoral condyle during the injury. Illustration B shows a T2 sagittal MRI with characteristic bone bruising from an ACL injury.

Incorrect Answers:
Answer 1,4,5: These bone bruise patterns are not characteristic with ACL injury.
Answer 2: Is the characteristic bone bruise pattern for lateral patellar dislocation.