Background:In adults with anterior cruciate ligament (ACL) tears, bone bruises on magnetic resonance imaging (MRI) scans provide insight into the underlying mechanism of injury. There is a paucity of literature that has investigated these relationships in children with ACL tears.Purpose:To examine and compare the number and location of bone bruises between contact and noncontact ACL tears in pediatric patients.Study Design:Cohort study; Level of evidence, 3.Methods:Boys ≤14 years and girls ≤12 years of age who underwent primary ACL reconstruction surgery between 2018 and 2022 were identified at 3 separate institutions. Eligibility criteria required detailed documentation of the mechanism of injury and MRI performed within 30 days of the initial ACL tear. Patients with congenital lower extremity abnormalities, concomitant fractures, injuries to the posterolateral corner and/or posterior cruciate ligament, previous ipsilateral knee injuries or surgeries, or closed physes evident on MRI scans were excluded. Patients were stratified into 2 groups based on a contact or noncontact mechanism of injury. Preoperative MRI scans were retrospectively reviewed for the presence of bone bruises in the coronal and sagittal planes using fat-suppressed T2-weighted images and a grid-based mapping technique of the tibiofemoral joint.Results:A total of 109 patients were included, with 76 (69.7%) patients sustaining noncontact injuries and 33 (30.3%) patients sustaining contact injuries. There were no significant differences between the contact and noncontact groups in terms of age (11.8 ± 2.0 vs 12.4 ± 1.3 years; P = .12), male sex (90.9% vs 88.2%; P > .99), time from initial injury to MRI (10.3 ± 8.1 vs 10.4 ± 8.9 days; P = .84), the presence of a concomitant medial meniscus tear (18.2% vs 14.5%; P = .62) or lateral meniscus tear (69.7% vs 52.6%; P = .097), and sport-related injuries (82.9% vs 81.8%; P = .89). No significant differences were observed in the frequency of combined lateral tibiofemoral (lateral femoral condyle + lateral tibial plateau) bone bruises (87.9% contact vs 78.9% noncontact; P = .41) or combined medial tibiofemoral (medial femoral condyle [MFC] + medial tibial plateau) bone bruises (54.5% contact vs 35.5% noncontact; P = .064). Patients with contact ACL tears were significantly more likely to have centrally located MFC bruising (odds ratio, 4.3; 95% CI, 1.6-11; P = .0038) and less likely to have bruising on the anterior aspect of the lateral tibial plateau (odds ratio, 0.27; 95% CI, 0.097-0.76; P = .013).Conclusion:Children with contact ACL tears were 4 times more likely to present with centrally located MFC bone bruises on preoperative MRI scans compared with children who sustained noncontact ACL tears. Future studies should investigate the relationship between these bone bruise patterns and the potential risk of articular cartilage damage in pediatric patients with contact ACL tears.

中文翻译：

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调查接触性和非接触性急性前十字韧带撕裂儿科患者的骨挫伤模式：一项多中心研究


背景：在患有前十字韧带 (ACL) 撕裂的成年人中，磁共振成像 (MRI) 扫描中的骨挫伤可以帮助我们了解潜在的损伤机制。很少有文献调查 ACL 撕裂儿童中这些关系。目的：检查和比较儿科患者接触性和非接触性 ACL 撕裂之间骨挫伤的数量和位置。研究设计：队列研究；证据级别，3。方法：在 3 个不同的机构中确定了 2018 年至 2022 年期间接受初次 ACL 重建手术的 ≤14 岁男孩和 ≤12 岁女孩。资格标准要求详细记录损伤机制，并在初次 ACL 撕裂后 30 天内进行 MRI 检查。排除先天性下肢畸形、合并骨折、后外侧角和/或后十字韧带损伤、既往同侧膝关节损伤或手术、或 MRI 扫描显示的闭合骺板的患者。根据接触性或非接触性损伤机制将患者分为两组。使用脂肪抑制 T2 加权图像和基于网格的胫股关节测绘技术，回顾性检查术前 MRI 扫描，以确定冠状面和矢状面是否存在骨挫伤。结果：总共纳入 109 名患者，其中 76 名患者被纳入研究。 (69.7%) 名患者遭受非接触性损伤，33 名患者 (30.3%) 遭受接触性损伤。接触组和非接触组在年龄（11.8 ± 2.0 vs 12.4 ± 1.3 岁；P = .12）、男性（90.9% vs 88.2%；P > .99）、初次受伤时间方面没有显着差异MRI（10.3 ± 8.1 vs 10.4 ± 8.9 天；P = .84），存在伴随的内侧半月板撕裂（18.2% vs 14.5%； P = .62）或外侧半月板撕裂（69.7% vs 52.6%；P = .097），以及运动相关损伤（82.9% vs 81.8%；P = .89）。合并外侧胫骨股骨（外侧股骨髁 + 外侧胫骨平台）骨挫伤（87.9% 接触 vs 78.9% 非接触；P = 0.41）或合并内侧胫股骨（内侧股骨髁 [MFC] + 内侧股骨挫伤）的频率没有观察到显着差异。胫骨平台）骨挫伤（54.5% 接触性 vs 35.5% 非接触性；P = .064）。接触性 ACL 撕裂的患者明显更有可能出现位于中央的 MFC 瘀伤（比值比，4.3；95% CI，1.6-11；P = 0.0038），并且外侧胫骨平台前部出现瘀伤的可能性较小（比值比，0.27；95% CI，0.097-0.76）。结论：与非接触性 ACL 的儿童相比，术前 MRI 扫描中出现接触性 ACL 撕裂的儿童出现中央 MFC 骨挫伤的可能性是非接触性 ACL 的儿童的 4 倍。眼泪。未来的研究应该调查这些骨挫伤模式与接触性 ACL 撕裂的儿科患者关节软骨损伤的潜在风险之间的关系。