Summary: This is a retrospective cohort study that demonstrates amongst that pediatric patients with an open femoral physis have a 10-fold increased likelihood of having an intact ACL despite the presence of bipolar lateral femoral condyle and posterior lateral tibial plateau bone contusions after an acute injury compared to patients with a closed femoral physis.

Background

Bone contusion patterns following anterior cruciate ligament (ACL) tears have been extensively studied in adult patients. A recent study has shown pediatric patients with ACL injuries to have the same bone contusion pattern as adults and occurred at similar rates. However, the incidence of ACL tears in skeletally immature patients who have an ACL pattern of bone contusion has not be previously investigated.

Purpose

To radiographically determine the incidence of ACL tears in skeletally immature patients with the classic lateral femoral condyle (LFC) and lateral tibial plateau (LTP) bone bruise pattern that is seen in adults with ACL tears.

Methods

This retrospective cohort study was performed by performing a query for “contusion” within the MRI read for all patients between the ages of 6 and 22 years of age, with MRIs performed from 1/1/2015 to 6/30/2019. MRI images were reviewed to denote the presence of ACL, PCL, MCL, or LCL tears, meniscus tears, cartilage lesions, bone bruise pattern, and physeal status of femoral and tibial physes. MRIs were reviewed by two fellowship-trained orthopedic surgeons. The specific locations of bone contusions were recorded using zones described by the Whole-Organ Magnetic Resonance Imaging Score (WORMS) for bone contusion. The primary outcome variable was the incidence of ACL tears in patients with the presence of both central lateral femoral condyle and posterior lateral tibial plateau bone contusions. We analyzed differences in the primary outcome variable based upon physeal status using Fischer's Exact testing.

Results

A total of 691 patients who met inclusion criteria were identified. There were 192 patients excluded (151 patellar instability, 23 history of prior ACL reconstruction, 7 with no bony contusions, 3 with fibular head contusion only, 2 with patellar fracture, 2 with tibial plateau fracture, and 2 with no viewable MRI). Of the 499 remaining patients, a total of 269 patients had the presence of both central lateral femoral condylar and posterior lateral tibial plateau bone contusions. Of these 269 patients, 259 (96.3%) had an ACL tear identified on MRI. Patients with an open femoral physis had a higher likelihood of having an intact ACL despite the presence of central LFC and posterior LTP contusions than patients with a closed femoral physis (8/74 (10.8%) vs. 2/195 (1.0%), chi-square value 14.4, p < 0.001). Patients with an intact ACL tear despite presence of central LFC and posterior LTP contusions were younger than patients with ACL tear with this contusion pattern (14.6 vs. 16.4, p = .017).

Conclusion

Patients who have an open femoral physis have a higher likelihood to have an intact ACL despite the presence of central LFC and posterior LTP bone contusions compared to patients who have a closed femoral physis. An ACL tear should not be assumed to be present despite the presence of typical ACL bone bruise in pediatric patients, particularly those with open physes.

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Inter- and Intra-Rater Reliability of Measurenebt of ACL TUnnels with Radiographs, CT, and MRI Abstract Presentation 4 minutes Robert A Magnussen, MD, MPH, UNITED STATES Alexander Sparks, BS, UNITED STATES Jacy Leon, BS, UNITED STATES Matthew Colatruglio, BS, UNITED STATES Joshua Bowler, MD James Oosten, BS, UNITED STATES Alex C. Dibartola, MD, MPH, UNITED STATES Joshua Scott Everhart, MD, MPH, UNITED STATES Robert A. Duerr, MD, UNITED STATES Christopher C. Kaeding, MD, UNITED STATES David C. Flanigan, MD, UNITED STATES
Changes In Muscle Strength And Hop Performance After ACL Reconstruction. A Randomized Controlled Trial Comparing Patellar Tendon And Hamstring Tendon Autografts With Standard Or Accelerated Rehabilitation Abstract Presentation 6 minutes Riccardo Cristiani, MD, PhD, SWEDEN Christina Mikkelsen, PT, SWEDEN Peter Olov Wange, MD, SWEDEN Daniel Olsson, PhD, SWEDEN Anders Stalman, MD, PhD, Associate Professor, SWEDEN Bjorn Engstrom, MD, PhD, Assoc. Prof., SWEDEN
Combined Reconstruction Of The Medial Collateral Ligament And Anterior Cruciate Ligament Using Ipsilateral Semitendinosus Tendon And Opposite Semitendinosus With Ipsilateral Gracilis Tendon: A Minimum One-Year Follow-Up Study In NITOR.Dhaka,Bnagladesh Abstract Presentation 4 minutes Dibakar Sarkar, MS(Orthopaedic surgery),FACS(USA),AO fellow(Bangko, BANGLADESH
Early ROM exercise after ACLR with hamstring autograft does not cause joint laxity : A Prospective Randomized Controlled Trial, 2 years follow up ePoster Presentation Jeong-Ku Ha, MD, phD, Prof, KOREA, REPUBLIC OF Kyu Sung Chung, MD, PhD, Prof., KOREA, REPUBLIC OF
Concurrent Treatment Of A Displaced Bucket Handle And Anterior Cruciate Ligament Reconstruction: A Higher Risk Of Stiffness? Abstract Presentation 5 minutes Etienne Deroche, MD, FRANCE Cécile Batailler, MD, PhD, FRANCE John Swan, MBBS, FRANCE Sebastien Lustig, MD, PhD, Prof., FRANCE Elvire Servien, MD, PhD, Prof., FRANCE
Effect Of Graft Choice On 6-Year Outcomes Of Revision Anterior Cruciate Ligament Reconstruction In The Multicenter ACL Revision Study (Mars) Cohort Abstract Presentation 6 minutes Rick W. Wright, MD, UNITED STATES
Clinical Outcomes Of Primary Acl Reconstruction With Tibial Attachment Preserving Quadrupled Hamstring Graft: Does Graft Size Matter? - A Prospective Study With Review Of Literature Abstract Presentation 5 minutes Shaival Dalal, M.S.MRCS(Edinburgh), UNITED KINGDOM Ghislain N. Aminake, MBBS, MMed(Ortho),MRCPS(Glasg), CAMEROON Randy Guro, BSc, UNITED KINGDOM Amit Pramod Chandratreya, FRCS(Tr&Orth), MS(Orth), MCh(Orth), UNITED KINGDOM Rahul Kotwal, FRCS(Ortho), UNITED KINGDOM
Factors associated with anterior cruciate ligament (ACL) reconstruction among ACL injuries in Alberta, Canada ePoster Presentation Yuba Raj Paudel, MPH, CANADA Mark F. Sommerfeldt, MD, CANADA Donald C. Voaklander, PhD, CANADA
In Vivo Measurement of Anterior Cruciate Ligament Elongation and Strain Rate during Increasingly Demanding Activities ePoster Presentation Kyohei Nishida , MD, PhD, JAPAN Caiqi Xu, MD, CHINA Tom Gale, MS, UNITED STATES William Anderst, PhD, UNITED STATES Freddie H. Fu, MD, UNITED STATES
The Effect Of Lateral Extraarticular Tenodesis On In Vivo Cartilage Contact In Combined Anterior Cruciate Ligament Reconstruction ePoster Presentation Kyohei Nishida , MD, PhD, JAPAN Tom Gale, MS, UNITED STATES Daisuke Chiba, MD, PhD, JAPAN Felipe Martin Suntaxi, MS, UNITED STATES Bryson P. Lesniak, MD, UNITED STATES Freddie H. Fu, MD, UNITED STATES William Anderst, PhD, UNITED STATES Volker Musahl, MD, Prof., UNITED STATES
Lower Socioeconomic Status Adversely Affects Access To Care And The Rate Of Instability Events And Bucket Handle Meniscus Tears Following Anterior Cruciate Ligament Tears Abstract Presentation 6 minutes Edward S. Chang, MD, UNITED STATES Blake M. Bodendorfer, MD, UNITED STATES Andrew Curley, MD, UNITED STATES David X. Wang, MD, UNITED STATES Christine Conroy, MD, UNITED STATES Mark Hopkins, MD, UNITED STATES Brian McCormick, MD, UNITED STATES Caroline Fryar, MD, UNITED STATES

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Skeletally Immature Patients with Classic Anterior Cruciate Ligament Bone Bruise Patterns Have a Higher Chance of Having an Intact Anterior Cruciate Ligament than Skeletally Mature Patients

Skeletally Immature Patients with Classic Anterior Cruciate Ligament Bone Bruise Patterns Have a Higher Chance of Having an Intact Anterior Cruciate Ligament than Skeletally Mature Patients

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Purpose

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Skeletally Immature Patients with Classic Anterior Cruciate Ligament Bone Bruise Patterns Have a Higher Chance of Having an Intact Anterior Cruciate Ligament than Skeletally Mature Patients

Skeletally Immature Patients with Classic Anterior Cruciate Ligament Bone Bruise Patterns Have a Higher Chance of Having an Intact Anterior Cruciate Ligament than Skeletally Mature Patients

Background

Purpose

Methods

Results

Conclusion

More ISAKOS 2021: Global Content