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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Tranexamic Acid Has No Effect On Post-Operative Hemarthrosis Or Pain Control Following Acl Reconstruction Using Bone Patella Tendon Bone Autograft: A Double-Blinded Randomized Control Trial Abstract Presentation 5 minutes Jordan W Fried, BM, UNITED STATES David Bloom, BA, UNITED STATES Eoghan T. Hurley, MB, BCh, MCh, IRELAND Samuel Baron, MD, UNITED STATES Kirk Anthony Campbell, MD, UNITED STATES Eric Jason Strauss, MD Laith M. Jazrawi, MD, UNITED STATES Michael J Alaia, MD, UNITED STATES
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Quadriceps Tendon Vs. Hamstring Tendon Autograft In Primary Anterior Cruciate Ligament Reconstruction: A Matched-Pairs Study With A Mean Follow-Up Of 6.5 Years Award Winner 5 minutes Armin Runer, PD MD, GERMANY Aline Suter, MD, AUSTRIA Tommaso Roberti di Sarsina, MD, ITALY Caroline Hepperger, PhD, AUSTRIA Peter Gföller, MD, AUSTRIA Christian Hoser, MD, AUSTRIA Robert Csapo, PhD, AUSTRIA Christian Fink, MD, Prof., AUSTRIA
Impingement Due to Graft Buckling Is More Prevalent after ACL Reconstructions with an Adjustable-Loop Compared to a Fixed-Loop Abstract Presentation 5 minutes Julian De Rover, NETHERLANDS Inge Van Den Akker-Scheek, PhD, NETHERLANDS Hugo Christiaan van der Veen, MD, PhD, NETHERLANDS
Creating A Crosswalk For Knee Outcomes After ACLR From The KOOS(5) To The IKDC-SKF Abstract Presentation 6 minutes Jessica L. Johnson, DPT, PhD, UNITED STATES Aaron Boulton, PhD, UNITED STATES Kurt Paul Spindler, MD, UNITED STATES Laura J. Huston, MS, UNITED STATES Tim Spalding, FRCS(Orth), UNITED KINGDOM Laura Asplin, UNITED KINGDOM May Arna Risberg, PT, PhD, NORWAY Lynn Snyder-Mackler, PT, ScD, FAPTA, UNITED STATES
Coach Education Improves Implementation Of ACL Injury Prevention Programs: A Cluster-Randomized Controlled Trial Abstract Presentation 5 minutes Daphne Ling, PhD, MPH, TAIWAN Caroline Boyle, UNITED STATES Brandon Schneider, MS, UNITED STATES Joseph Janosky, DrPHc, MS, PT, ATC, UNITED STATES James Kinderknecht, UNITED STATES Robert G. Marx, 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
Early Return To Sport After Quadriceps Tendon Autograft ACL Reconstruction: Comparison To Bone-Patellar Tendon-Bone Autograft At A Minimum 1-Year Follow-Up ePoster Presentation Evan W. James, MD, UNITED STATES Dakota Adamec , BS , UNITED STATES Spencer Sullivan, BS, UNITED STATES Per-Henrik Randsborg, MD, PhD, NORWAY Brandon Schneider, MS, UNITED STATES Robert G. Marx, MD, UNITED STATES Answorth A. Allen, MD, UNITED STATES Frank A. Cordasco, MD, MS, UNITED STATES Benedict U. Nwachukwu, MD, MBA, UNITED STATES Danyal H. Nawabi, MD, FRCS(Orth), UNITED STATES
Full-Thickness Peroneus Longus Tendon Autograft For Anterior Cruciate Ligament Reconstruction: Outcomes And Donor Site Morbidity ePoster Presentation Tarun Goyal, MBBS, MS, DNB, MCh, FRCS (Edin), INDIA Souvik Paul, MBBS, MS Orthopedics (AIIMS), DNB, MCh, Dip SICOT, INDIA Lakshmana Das Sekar, MS, DNB Orthopaedics, INDIA Arghya Kundu Choudhury, MS, MCh Joint replacement and reconstruction, INDIA
Dynamic Radiostereometry Evaluation Of Two Different Anterior Cruciate Ligament Reconstruction Techniques: Does Single Bundle Reconstruction Plus Lateral Plasty Cause Knee Over-Constraint? Abstract Presentation 4 minutes Alberto Grassi, PhD, ITALY Stefano Di Paolo, Eng, PhD, ITALY Piero Agostinone, MD, QATAR Gian Andrea Lucidi, MD, ITALY Erika Pinelly, MsC, ITALY Marco Bontempi, PhD, ITALY Laura Bragonzoni, Prof., ITALY Stefano Zaffagnini, MD, Prof., ITALY
PSM: Pivot Shift Meter Cellphone Application for Classifying ACL Injuries Abstract Presentation 5 minutes Edmundo Berumen Nafarrate, PhD, Prof., MEXICO Carlos Alejandro Vega Najera, MD, MEXICO Joel Alejandro Cabral, MD, MEXICO Luis Sigala Gonzalez, Eng, MEXICO Ivan Ramos Moctezuma, Eng, MEXICO Carlos Leal, MD, Prof., COLOMBIA Jesus Javier Tonche, MD, MEXICO Avril Pérez Fontes, MD, MEXICO Fatima Quintana Trejo, Eng, MEXICO
Risk Factor Analysis for Graft Failure after Anterior Cruciate Ligament Reconstruction with or without mLET Abstract Presentation 7 minutes Filip R Hendrikx, MD, BELGIUM Koen Lagae, MD, BELGIUM Annemieke Van Haver, PhD, MSc, BELGIUM Peter Verdonk, MD, PhD, BELGIUM

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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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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