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The Effect of a Geographic Lateral Bone Bruise on Knee Inflammation After Acute Anterior Cruciate Ligament Rupture

Darren L. Johnson, MD, David P. Bealle, MD, Jefferson C. Brand, Jr, MD, John Nyland, EdD, PT, SCS, ATC and David N.M. Caborn, MD

Section of Sports Medicine, University of Kentucky School of Medicine, Lexington, Kentucky

Presented at the 66th annual meeting of the American Academy of Orthopaedic Surgeons, Anaheim, California, February 1999.

Address correspondence and reprint requests to Darren L. Johnson, MD, Section of Sports Medicine, Division of Orthopaedic Surgery, University of Kentucky School of Medicine, Kentucky Clinic, K-431, Lexington, KY 40536-0284

We prospectively evaluated 40 patients who had knee inflammation after isolated anterior cruciate ligament rupture with or without an associated "geographic" bone bruise/subchondral fracture of the lateral femoral condyle. All patients with acute ruptures documented by magnetic resonance imaging within 1 week of injury were evaluated for a geographic bone bruise/subchondral fracture of the lateral femoral condyle. Two groups of 20 patients each (bone bruise versus no bone bruise) were then enrolled. Variables measured at 1, 2, 3, and 4 weeks after injury included pain, range of motion, effusion, and number of days with an antalgic gait. Patients with a bone bruise had increased size and duration of effusion, increased number of days required to nonantalgic gait without external aids, increased days to achieve normal range of motion, and increased pain scores at measured time intervals. This study confirms results of previous clinical and histologic studies showing an associated articular cartilage lesion, otherwise known as bone bruise/subchondral fracture, is clinically significant. There appears to be an association between a geographic bone bruise and increased disability in patients with acute anterior cruciate ligament ruptures. Patients with a geographic bone bruise may require longer to reach normal homeostasis (range of motion, pain, neuromuscular control) before undergoing anterior cruciate ligament reconstruction.

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