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Bone bruise and anterior cruciate ligament rupture: A systematic literature review on prevalence, progression, impact on the knee, and prognosis
Author(s):
Filardo G. (Italy)
,
Filardo G. (Italy)
Affiliations:
Andriolo L.
,
Andriolo L.
Affiliations:
Di Laura Frattura G.
,
Di Laura Frattura G.
Affiliations:
Napoli Francesca
,
Napoli Francesca
Affiliations:
Zaffagnini S.
,
Zaffagnini S.
Affiliations:
Candrian C.
Candrian C.
Affiliations:
ESSKA Academy. Filardo G. 05/09/18; 209356; P04-599 Topic: Sports Related Injuries
Giuseppe Filardo
Giuseppe Filardo
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Abstract
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Objectives: During anterior cruciate ligament (ACL) injury, the large external forces responsible for ligament rupture also cause a violent impact between the tibial and femoral articular cartilage which is transferred to the bone, and result in bone bruises. Several aspects remain controversial and await evidence to understand the role and how this MRI finding should be managed while addressing the ligament lesion. Thus, aim is to document the evidence of the available literature on the role of bone bruise associated to ACL lesions.

Methods: A systematic review of the literature was performed on bone bruise associated to ACL injury up to September 2017 on three medical electronic databases: PubMed, Web of Science, and the Cochrane Collaboration. The Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines were used. The relevant articles were studied to investigate three main aspects: the prevalence and progression of bone bruise associated with ACL lesions, their impact on the knee in terms of lesion severity and joint degeneration progression over time, and the influence of bone bruise on patient prognosis in terms of clinical outcome.

Results: The search identified 415 records, after screening according to the inclusion/exclusion criteria 83 papers were used for the analysis, involving a total of 10047 patients. Bone bruise has a high prevalence (78% in the most recent papers), with distinct patterns related to the mechanism of injury. This MRI finding is detectable only in a minority of cases after the first few months after trauma, but its presence and persistence have been correlated to a more severe joint damage which may affect the degenerative progression of the entire joint, with recent evidence suggesting possible effects on the clinical outcome over time.

Conclusions: The systematic review of the literature documented a growing interest on bone bruise associated to ACL injury. However, prospective long-term studies are needed to better understand the natural history of bone bruise, identifying prognostic factors and targets of specific treatments, to be developed in light of the overall joint derangements accompanying ACL lesions.

Keywords:
Bone bruise; bone contusion; ACL; knee
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