Vol.:(0123456789) 1 3 Knee Surgery, Sports Traumatology, Arthroscopy https://doi.org/10.1007/s00167-019-05490-7 KNEE Posterior tibial bone bruising associated with posterior-medial meniscal tear in patients with acute anterior cruciate ligament injury Manuel Calvo‑Gurry 1  · Eoghan T. Hurley 1  · Daniel Withers 1  · Mihai Vioreanu 1  · Ray Moran 1 Received: 23 July 2018 / Accepted: 18 March 2019 © European Society of Sports Traumatology, Knee Surgery, Arthroscopy (ESSKA) 2019 Abstract Purpose To evaluate whether medial-sided bone bruising was associated with postero-medial meniscal tears in patients with an acute rupture of their anterior cruciate ligament (ACL). Methods A retrospective analysis of 150 consecutive patients who had an MRI scan within 8 weeks of their ACL rupture that underwent an ACL reconstruction was performed. Based on the intra-operative findings, two groups were identified: Group A (N = 75) had no postero-medial meniscal tear associated with the acute ACL rupture and Group B (N = 75) had a postero-medial meniscal tear found at time of reconstruction. All patients’ pre-operative MRI scans were reviewed for bone bruising in the following anatomic sites: lateral femoral condyle (LFC), lateral tibial plateau (LTP), medial femoral condyle (MFC), and medial tibial plateau (MTP). Results MTP bone bruising was found to be more prevalent in cases that had a postero-medial meniscal tear in the setting of an acute ACL injury (p = 0.046). MTP Grade 2 or 3 bone bruising was more common in patients that had a postero-medial meniscal tear (p = 0.046). There was a slightly higher incidence of grade 2 or 3 MTP bone bruising in cases with a postero- medial meniscal tear, although this did not reach statistical significance (n.s.) There was no difference in LFC, LTP or MFC bone bruising in patients with or without a postero-medial meniscal tear (n.s) for all. Conclusions Medial-sided bone bruising; especially present on the posterior tibial plateau may result from a higher injury force during the injury to the ACL. The identification of medial bone bruising on pre-operative MRI imaging following an acute ACL ruptureshould raise the suspicion of an associated postero-medial meniscal tear. Level of evidence III. Keywords Anterior cruciate ligament · Bone bruise · Meniscal tear Introduction Anterior cruciate ligament (ACL) ruptures are a common, sports-related, musculoskeletal injury, with an incidence of up to 68.6 per 100,000 person years [1]. They are often associated with other injuries including multi-ligamentous injury, cartilage damage and meniscal tears, many of which are diagnosed intra-operatively during arthroscopic recon- struction [2]. Previous studies have reported that 43% of patients with ACL tears have concomitant lateral or medial meniscal tears [3]. The most common pathology found alongside acute ACL ruptures are medial meniscal tears, which have been found in up to 72.7% of arthroscopies dur- ing ACL reconstruction [4]. ACL injuries are most commonly diagnosed with mag- netic resonance imaging (MRI) alongside clinical evalu- ation [5]. Utilisation of MRI following ACL injuries can identify specific patterns of bone bruising related to the mechanism of injury involved [5, 6] The bone bruises manifest as increased signal intensity on T2-weighted MRI and are believed to result from trabecular damage due to impact between articular surfaces near the time of the injury [2, 7–11]. The association between acute ACL injury and lateral femoral condyle (LFC) and posterior lateral tibial plateau (LTP) bruising has been well described in the lit- erature [6, 7]. Medial compartment bone bruising has also been reported with Kaplan et al. [6] attributing bone bruis- ing involving the posterior lip of the medial tibial plateau to * Mihai Vioreanu mihai@mihaivioreanu.com 1 Sports Surgery Clinic, Dublin, Ireland