Table 2.
Clinical studies
| Study | Year | Aim | Materials and subjects | Intervention | Results | Conclusion | Clinical relevance |
|---|---|---|---|---|---|---|---|
| Nishimori et al16 | 2008 | Correlate cartilage defects of the PLTP with BB | 39 patients underwent ACLR (35 BB-positive; four BB-negative) | MRI evaluation of the presence of BB in the lateral compartment; arthroscopic evaluation of cartilage defect | BB was observed in 89.7% of patients; at overall arthroscopic examination, 84.6% had lateral meniscal tears, 87.2% had cartilage defects in LFC, and 74.3% had cartilage defects in PLTP. Of the BB-positive group, 91.4% had lateral meniscal tears (P=0.008), 94.3% had cartilage defects in LFC (P=0.004), and 80% had cartilage defects in PLTP (P=0.04) | BB correlates with articular cartilage defects in ACL injuries | Arthroscopic examination of the associated lesions |
| Johnson et al35 | 2000 | Assessing the effect of geographic BB lesions on clinical outcomes | 40 patients with ACL tears (20 BB-positive and 20 BB-negative) | One week to 4 weeks assessment of: pain; ROM; effusion; and days to nonantalgic gait | BB-positive patients showed: larger effusion (4.6 cm versus 3.9 cm); longer time for effusion dissipation (4 weeks versus 2.4 weeks); longer time to achieve nonantalgic gait without aids (4 weeks versus 2.8 weeks); longer time to achieve symmetric and equal ROM (3.8 weeks versus 2.7 weeks) (P<0.001); and higher pain scores (6.1 versus 2.9) | Statistically significant association between BB and increased disability | Patients with BB geographic lesions postoperative recovery and pain evaluation |
| Hanypsiak et al20 | 2008 | Assessing the natural history and healing of BB and cartilage defects at a 12-year follow-up | 44 subjects underwent ACLR | Patients called for at least a 10-year follow-up; MRI, radiographic assessment, clinical features, and IKDC score were evaluated | IKDC was 70.6 in BB-negative patients (n=36) and 70.0 in BB-positive patients (n=8) (P>0.05). No correlation found between cartilage lesions before surgery and at follow-up. IKDC was 72.8 in patients with cartilage defects and 69.0 in those without (P>0.05). At an average of 12.7 years of follow-up, 100% of lesions were absent at MRI | BB resolves over a long time period; its evaluation and presence at baseline did not affect IKDC score after surgery | Functional knee examination and correlation with the BB |
| Bisson et al33 | 2013 | To determine a possible association between bone bruises and demographic factors and articular injuries in ACL injured patients | 171 patients with ACL injury | MRI BB detection and localization, multivariate analysis for the correlation of BB and its predisposing factors | BB was detected in: 85% of LTP; 77% of LFC; 26% of MTP; and 6% of MFC. Age >18 years predicted less LFC BB (OR =0.27, for ages 18–28; and OR =0.18, for ages >29 years); male sex predicted mild, moderate, and severe LFC BB (OR =6.16; OR =8.98; and OR =15.66, respectively) and mild LTP BB (OR =0.19); contact injuries predicted severe LTP BB (OR =5.1). LFC and LTP BB were associated with meniscal tears (OR =2.57 and OR =3.13, respectively) | BB is most common in young males and is associated with meniscal tears | Several risk factors for the prediction of BB development in the lateral compartment are evaluated |
| Dunn et al34 | 2010 | Evaluate the correlation between BB and other preoperative features with prolonged knee pain and dysfunction | 525 patients underwent ACLR | The administration of the KOOS symptom and pain scales and SF-36 bodily pain scale. BB assessment (presence [yes/no] and location) at MRI | BB presence was 80% among subjects. Higher pain was associated with high BMI (P<0.0001), female sex (P=0.001), lateral collateral ligament injury (P=0.012), and older age (P=0.038). More symptoms were associated with lateral collateral ligament injury (P=0.014), higher BMI (P<0.0001), and female sex (P<0.0001). BB was not associated with either pain or symptoms, while younger age and nonjumping mechanism were associated with BB (P=0.034 and P=0.006, respectively) | Younger age and not jumping at the time of injury are risk factors for BB development | Clinical and social factors are correlated with the BB |
| Szkopek et al29 | 2012 | Evaluate the association between BB, pain, and dysfunction with a 2-month follow-up | 17 patients with ACL tears | MRI evaluation and KOOS after injury and at 2 weeks, 1 month, and 2 months. Subjective pain evaluated daily | Pain reduction was about 50% in 2 weeks. BB volume was larger in the lateral compartment than in the medial compartment. Volume increased in 2 weeks and began to decrease at 1 month. BB volume was correlated with K2 in the medial tibial compartment, and with K5 in the LFC. BB intensity was related with K1 and K5 | No strong correlation between disability and lateral BB | Functional assessment of the knee correlated with the BB natural history |
| Westermann et al31 | 2013 | Assess the correlation between lateral compartment geometry and BB patterns | Two cases of ACL injury | MRI evaluation 7 days and 10 days after injury; radiological measurement of tibial plateau curvature | Case 1: LTP curvature radius was 53.5 mm; BB was severe/extended. Case 2: LTP curvature radius was 32.1 mm; BB was mild/superficial | Highly convex joint surface (unstable knee) is associated with milder BB because of the lower amount of force needed for dislocation | In BB, evaluation of the knee geometry can also help to determine the cause and mechanism |
Abbreviations: PLTP, posterolateral tibial plateau; BB, bone bruise; ACLR, anterior cruciate ligament reconstruction; MRI, magnetic resonance imaging; LFC, lateral femoral condyle; ROM, range of motion; IKDC, International Knee Documentation Committee; n, number; OR, odds ratio; LTP, lateral tibial plateau; MTP, medial tibial plateau; MFC, medial femoral condyle; KOOS, Knee Injury and Osteoarthritis Outcome Score; SF-36, Short Form-36; BMI, body mass index; ACL, anterior cruciate ligament; K1, module I of the KOOS score; K2, module II of the KOOS score; K3, module III of the KOOS score.