Keywords:
Musculoskeletal joint, Musculoskeletal bone, MR, Diagnostic procedure, Athletic injuries, Oedema
Authors:
B. Ciszkowska-Lyson, B. Dominik, U. Zdanowicz, R. Smigielski; Warsaw/PL
DOI:
10.1594/ecr2018/C-3210
Aims and objectives
Contusions of the posterior part the tibia frequently accompany anterior cruciate ligament (ACL) injuries.
The matter of compression in this cases tends,
however,
to be neglected.
“The terms bone bruise or bone contusion have been used synonymously and are thought to represent a spectrum of occult bone injuries,
including bleeding,
infarction and oedema due to microscopic compression fractures of cancellous bone” [Mandalia and Henson,
2008]
We noted that posterior tibial plateau’s fracture as a result of bone bruises can result in the reduction of the plateau’s surface supporting the lateral meniscus.
This observation is conducive to the fact that the lateral meniscus has its dedicated surface on the tibial plateau,
at posterior margin.
Lateral meniscus glides on that surface allowing proper knee biomechanics without damaging the meniscus.
However,
if that surface gets reduced,
due to for example compression fracture of the plateau,
it may eventually,
lead to both menisci tearing as well as the progression of osteoarthritis[Kim et al.,
2017].
While analyzing MRI results of the patients with ACL tears,
we have frequently observed bone bruising described in the literature.
What is more,
we have also noted the disruption of a posterior tibial plateau’s bony structure continuity within the area of bruising.
Our ultimate objective was to find the optimal assessment method allowing to precisely categorize the damage to the posterior margin of the tibia and its relation to the lateral meniscus’ positioning.
It is important to properly assess the degree of the damage as the more extensive impairment of the plateau can lead to the disruption of bony stability of the knee despite a properly executed reconstruction of the ligament.
A reliable classification system would allow to detect and assess the loss of support for the meniscus,
which plays a major role in the biomechanics of the knee.
It could serve as a simple diagnostic tool for orthopedic surgeons,
helping them to make decisions concerning the best course of treatment.