Systematic BME pattern analysis into routine MRI reporting may enhance diagnostic accuracy, improve clinical decision-making, and contribute to more individualized patient management strategies following ACL injury.
Abstract
Background: Bone marrow edema (BME) is one of the common magnetic resonance imaging (MRI) findings in anterior cruciate ligament injuries. The prevalence and clinical relevance of BME vary depending on injury mechanism and timing of imaging. This study aimed to evaluate the prevalence and patterns of BME in patients with ACL tears and to correlate these patterns with mechanism of injury.
Methods: In this hospital based observational study, a total of 136 patients with MRI confirmed ACL injuries were included. MRI of the affected knee was performed using standardized hospital protocols. BME patterns were categorized into pivot-shift, hyperextension, varus or valgus stress and mixed patterns. MRI findings were correlated with patient reported mechanism of injury.
Results: Bone marrow edema was detected in 63 (46.3%) patients. Among 63 patients with bone marrow edema, pivot-shift pattern of bone marrow edema was the most frequently observed MRI findings seen in 29 (46.0%) patients, followed by hyperextension pattern identified in 14 (22.2%) patients. Pivot-shift pattern was predominantly associated with sports injuries seen in 21 (29.2%) patients, while hyperextension were more commonly observed followed by road traffic accidents seen in 7 (21.9%) patients. Varus, valgus and mixed patterns were frequently seen in fall and twisting injuries. A statistically significant association was observed between bone marrow edema ptterns and reported mechanism of injury (x2 = 28.4, p = 0.003).
Conclusion: Systematic BME pattern analysis into routine MRI reporting may enhance diagnostic accuracy, improve clinical decision-making, and contribute to more individualized patient management strategies following ACL injury.
The strong association with ACL injury and having a potentially important role in knee stabilisation, their injuries need to be given due importance by radiologists and should not be underreported.
Meniscal ramp lesions were frequently detected on MRI in patients undergoing ACL reconstruction, although less commonly observed at the time of surgery, although less commonly observed at the time of surgery.
Erik Lerjefors, Riccardo Cristiani, Christoffer von Essen et al.· Arthroscopy: The Journal of...· 0 citations
MRI provides a detailed evaluation of knee injuries, aiding diagnosis and management, and MRI detection of associated abnormalities helps guide treatment and improve patient outcomes.
Abhishek Mishra, A. Singh· International Journal of Pha...· 0 citations
Background/Objectives: Posterolateral meniscocapsular detachment represents a potentially underrecognized component of knee trauma in patients with anterior cruciate ligament (ACL) injury. Altered rotational kinematics in ACL-deficient knees may increase stress on posterolateral corner structures. Although an association between ACL tears and posterolateral abnormalities has been reported, the true diagnostic performance of magnetic resonance imaging (MRI) for these lesions remains incompletely defined. This study aimed to evaluate the diagnostic accuracy of MRI for posterolateral meniscocapsular detachment in patients with confirmed ACL injury, to describe associated meniscal tears, and to assess the association between lateral tibial plateau bone marrow edema, age, and sex with the presence of detachment. Methods: In this retrospective study, 117 knee MRI examinations (1.5 T and 3 T) of patients with native ACL rupture or ACL graft failure were reviewed. Two readers independently assessed posterolateral meniscocapsular detachment. Ramp lesions, other meniscal tears and lateral compartment bone marrow edema were evaluated in consensus. Arthroscopy served as the reference standard. Diagnostic performance and inter-observer agreement were calculated. Detachment was considered present only when both readers independently identified the lesion. Results: MRI demonstrated high specificity (90.8%; 95% CI: 83.7–95.5%) for posterolateral meniscocapsular detachment, and promising sensitivity (87.5%; 95% CI: 47.3–99.7%) based on a small number of confirmed cases (n = 8); this estimate should be interpreted with caution given the wide confidence interval. One arthroscopically confirmed lesion was missed, and false-positive findings were limited. MRI also showed good diagnostic performance for ramp lesions and other associated meniscal tears, assessed as secondary endpoints. Lateral tibial plateau bone marrow edema, age, and sex were not significantly associated with detachment. Conclusions: Routine MRI shows high specificity and promising, although preliminary, sensitivity for detecting posterolateral meniscocapsular detachment in ACL-injured knees; given the small number of confirmed cases, this estimate warrants confirmation in larger cohorts. Careful multiplanar assessment and detailed anatomical knowledge are essential to optimize detection. Accurate preoperative MRI characterization may help guide surgical planning and reduce the risk of missed posterolateral meniscocapsular pathology at arthroscopy.
T. Bonanzinga, Elena Tosi, A. Favaro et al.· Diagnostics· 0 citations
A
BSTRACT
Anterior Cruciate Ligament (ACL) injuries are prevalent in the physically active population. Anatomical risk factors such as the Notch Width Index (NWI), the ratio of intercondylar notch width to bicondylar width, have been associated with ACL injury susceptibility. However, limited evidence exists on the predictive role of NWI in bilateral ACL injuries, which may reflect a distinct high-risk profile.
A retrospective cross-sectional study was conducted on 141 individuals who underwent knee MRI. 70 had no ACL injuries (controls), while 71 had complete ACL tears. NWI was measured on MRI at the level of the popliteal groove. Two blinded radiologists calculated NWI. Multinomial logistic regression assessed the association between NWI and ACL injury type, using controls as reference.
The mean age was 33.96 ± 12.12 years, with 83 males. Mean NWI was 0.259 ± 0.037. Lower NWI values were significantly associated with unilateral (
P
= 0.001; OR = 1.342 × 10²²) and bilateral ACL injuries (
P
= 0.001; OR = 3.384 × 10
32
). The model showed good fit (
P
= 0.985) with moderate explanatory power (Nagelkerke
R
² =0.321). Stem-and-leaf plots demonstrated a progressive narrowing of NWI across groups.
MRI-based NWI is a strong predictor of both unilateral and bilateral ACL injuries. Bilateral ACL injury cases may represent a distinct high-risk anatomical phenotype. NWI could serve as a valuable screening tool to identify at-risk individuals for targeted preventive interventions.
L. Arun, Rajiv Dubey, Amit Bajpayee et al.· Medical Journal of Dr. D.Y....· 0 citations
INTRODUCTION
Ankle sprains are among the most common musculoskeletal injuries, yet their clinical complexity is often underestimated. The relationship between ankle sprains and bone bruises in both the ankle joint and midfoot remains underexplored. At our institution, patients with moderate to severe ankle sprains routinely undergo magnetic resonance imaging (MRI) and receive conservative treatment with a short leg posterior cast splint. This study specifically focused on bone involvement assessed by MRI, rather than soft tissue or functional parameters.
METHODS
We retrospectively reviewed MRI scans of 70 patients with acute moderate (Grade 2) to severe (Grade 3) ankle sprains who presented consecutively between November 2014 and December 2019. Patients with mild sprains (Grade 1) were excluded. Bone bruises were assessed, and all patients were treated with a short leg posterior cast splint extending from the lower leg to the forefoot. Crutches were prescribed when pain persisted during weight-bearing after splint application. Multivariable logistic regression analysis was performed to evaluate the associations between MRI-detected bone bruises and crutch use following fixation.
RESULTS
The fixation period, available in 63 patients, ranged from 8 to 72 days (mean: 29.5 days). Walking pain requiring crutches, used as a proxy indicator of persistent weight-bearing pain rather than a validated clinical outcome, was observed in 32 /70 (45.7%) of patients. All patients experienced resolution of ankle joint pain following treatment. MRI revealed bone bruises in the ankle and midfoot in 57/70 (81.4%) of cases. Midfoot involvement, including the tarsal bones and Chopart joint, was present in 24/70 (34.3%) of cases. The talus was the most frequently affected bone 42/70 (60.0%), followed by the tibia 31/70 (44.3%), tarsal bones 18/70 (25.7%), and calcaneus 15/70 (21.4%). Bone bruises on the talocrural joint surface of the talus were significantly associated with crutch use after fixation (P = 0.041). Multivariable logistic regression analysis identified both younger age (odds ratio [OR] 0.957, 95% confidence Interval [CI] 0.930-0.985, P = 0.003) and bone bruises on the talocrural joint surface of the talus (OR 4.012, 95% CI 1.174-13.713, P = 0.027) as independent predictors of crutch use after fixation. All patients reported resolution of ankle joint pain by the final follow-up, with no persistent or recurrent symptoms documented during the observation period.
CONCLUSION
Bone bruises in the ankle and midfoot are frequently associated with moderate to severe ankle sprains. MRI findings indicate a multifaceted pathophysiology, underscoring the importance of individualized treatment strategies. In cases where bone bruises are present on the talocrural joint surface, midfoot immobilization and a temporary period of non-weight-bearing may be appropriate considerations.
H. Koiwai, M. Kamimura, Akira Taguchi et al.· BMC Musculoskeletal Disorder...· 0 citations
