INJURIES
IN SPORTS
BONE
BRUISE AND KISSING
CONTUSION IN THE ACUTELY INJURED KNEE
Terzidis
Ioannis
Orthopaedic
Surgeon,
President of the Sports Medicine Association of Greece
The bone bruise and bone
contusion is a finding substantiated by MRI studies. This entity is
recognized as focal signal abnormality in the subchondral bone marrow
and the appearances are thought to represent microtrabecular fractures,
haemorrhage and oedema of the marrow without disruption of the adjacent
cortices or overlying articular cartilage. Unlike a fracture, the bone
contusion rarely involves both cancellous and compact cortical bone.
These osseous injuries may result from a direct blow to the bone, or
compression forces of adjacent bones impacting one another, or traction
forces that occur during an avulsion injury. In the literature the
terms “bone contusion”, “bone
bruise” and “bone marrow oedema” have
been known for at least a decade and seem to be used
synonymously. The MRI sensitivity and specificity for bone
contusion is reported to be 91-96% and 86-96% respectively.
Regarding
the frequency of bone contusion Binfield and Williams reported 4% in
the immature knee, Bretlau et al reported 65% in the acutely injured
knee and Perrin et al reported 58% associated with more serious
injuries (meniscal tears, ligaments tears). Bone contusions in both
surfaces of the knee (kissing contusion) are rather rare complex
injuries of the knee and their importance has not been well
established. These characteristic lesions that occur both on the
femoral and tibial condyle are of great importance, not only
in that they are frequently a sign of more serious associated injury,
but also because they may account for clinical lengthy symptoms.
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