Sage Journals: Discover world-class research

Abstract

Background:

Symptomatic pediatric patients referred for magnetic resonance imaging (MRI) commonly present with traumatic bone marrow edema (BME) patterns.

Purpose:

We sought to associate discrete MRI patterns of BME with specific injury mechanisms in pediatric knee injuries to classify injury patterns by anatomical location of the BME. We aimed to group these into 6 patterns: patellar dislocation, extensor mechanism overload, hyperextension, single compartment impaction, ligament avulsion/translation, and direct contusion.

Methods:

We retrospectively reviewed 314 MRIs performed with a standard protocol on symptomatic patients aged 3 to 18 years at 1 institution. Our analysis included images, reports, and traumatic BME patterns. A musculoskeletal radiologist and orthopedic surgeon independently assigned 1 of the 6 injury patterns to each scan.

Results:

After exclusion criteria were applied to the 314 MRIs, 62 (19.7%) remained, 40 boys and 22 girls. The average age was of 12.2 years. The most frequent injury patterns were patellar dislocation (n = 22, 35%) and extensor mechanism overload (n = 14, 22%). κ value associated with pattern determination was .766, indicating substantial concordance. Bone marrow edema signal intensity on fat-suppressed sequences was classified as severe in 92% of cases.

Conclusions:

The strength of pediatric knee ligaments and tendons relative to epiphyseal bone may contribute to a high rate of BME injury patterns seen on MRI in symptomatic pediatric patients. We found that pediatric BME could be classified into 6 specific injury patterns, which might be useful to clinicians in recognizing mechanisms of injury. Further clinical studies are needed to assess the clinical differences in both short-term and long-term outcomes of the BME patterns described.

Keywords

knee pediatrics bone bruise injury pattern lower extremity MRI sports

Get full access to this article

View all access options for this article.

References

Bassett

Grover

Seeger

LI.

Magnetic resonance imaging of knee trauma. Skeletal Radiol. 1990;19(6):401–405.

Delee

Bergfeld

Drez

DJ.

The posterior cruciate ligament. In: Mark D. Miller and Stephen R. Thompson (eds)Orthopaedic Sports Medicine: Principles and Practice. Philadelphia, PA: Elsevier, 1994:1374–1443.

Diederichs

Issever

Scheffler

MR imaging of patellar instability: injury patterns and assessment of risk factors. Radiographics. 2010;30(4):961–981.

Graf

Cook

de Smet

Keene

JS.

“Bone bruises” on magnetic resonance imaging evaluation of anterior cruciate ligament injuries. Am J Sports Med. 1993;21(2):220–223.

Hayes

Brigido

Jamadar

Propeck

Mechanism-based pattern approach to classification of complex injuries of the knee depicted at MR imaging. Radiographics. 2000;20:S121–S134.

Kapelov

Teresi

Bradley

, et al. Bone contusions of the knee: increased lesion detection with fast spin- echo MR imaging with spectroscopic fat saturation. Radiology. 1993;189(3):901–904.

Landis

Koch

GG.

An application of hierarchical kappa-type statistics in the assessment of majority agreement among multiple observers. Biometrics. 1977;33(2):363–374.

Meyers

McKeever

FM.

Fracture of the intercondylar eminence of the tibia. J Bone Joint Surg Am. 1959;41-A(2):209–220.

Meyers

McKeever

FM.

Fracture of the intercondylar eminence of the tibia. J Bone Joint Surg Am. 1970;52(8):1677–1684.

10.

Miller

Gladden

Staron

Henry

Feldman

Posterolateral stabilizers of the knee: anatomy and injuries assessed with MR imaging. AJR Am J Roentgenol. 1997;169(6):1641–1647.

11.

Mink

Deutsch

AL.

Occult cartilage and bone injuries of the knee: detection, classification, and assessment with MR imaging. Radiology. 1989;170(3, pt 1):823–829.

12.

Neubert

Steinbruck

Patellar dislocation in athletes. Arthroscopic diagnosis and therapy. Unfallchirurg. 1991;94(2):73–76.

13.

Oeppen

Connolly

Bencardino

Jaramillo

Acute injury of the articular cartilage and subchondral bone: a common but unrecognized lesion in the immature knee. AJR Am J Roentgenol. 2004;182(1):111–117.

14.

Sanders

Medynski

Feller

Lawhorn

KW.

Bone contusion patterns of the knee at MR imaging: footprint of the mechanism of injury. Radiographics. 2000;20:S135–S151.

15.

Sperner

Benedetto

Glötzer

The value of arthroscopy following traumatic patellar dislocation. Sportverletz Sportschaden. 1988;2(1):20–23.

16.

Steiner

Mitchell

Rao

Schweitzer

ME.

Magnetic resonance imaging of diffuse bone marrow disease. Radiol Clin North Am. 1993;31(2):383–409.

17.

Terzidis

Christodoulou

Ploumis

Metsovitis

Koimtzis

Givissis

The appearance of kissing contusion in the acutely injured knee in the athletes. Br J Sports Med. 2004;38(5):592–596.

18.

Twaddle

Hunter

Chapman

Simonian

Escobedo

EM.

MRI in acute knee dislocation. A prospective study of clinical, MRI, and surgical findings. J Bone Joint Surg Br. 1996;78(4):573–579.

19.

Viskontas

Giuffre

Duggal

Graham

Parker

Coolican

Bone bruises associated with ACL rupture: correlation with injury mechanism. Am J Sports Med. 2008;36(5):927–933.

20.

Goodwin

Salonen

, et al. Complete dislocation of the knee: spectrum of associated soft-tissue injuries depicted by MR imaging. AJR Am J Roentgenol. 1995;164(1):135–139.

Supplementary Material

Please find the following supplemental material available below.

For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.

For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.

0.00 MB

0.05 MB