Patterns of bone bruise in knee injury
The pattern of bone bruise in knee injuries can give clues for the mechanism and associated injuries.
Radiographic features
Five classic bone contusion patterns have been described :
- pivot-shift injury
- valgus stress to flexed and externally rotated knee
- contusion pattern: posterolateral tibial plateau and mid part of lateral femoral condyle
- associated with anterior cruciate ligament (ACL) tears
- see also: contrecoup injury of the knee, O'Donoghue unhappy triad
- dashboard injury
- anterior force to tibia in a flexed knee (e.g. knees against dashboard in motor vehicle collision, or fall onto flexed knee)
- contusion pattern: anterior tibia +/- posterior patella
- associated with posterior cruciate ligament (PCL) tear
- clip injury
- valgus stress to flexed knee
- contusion pattern: lateral femoral condyle and lateral tibial plateau +/- medial femoral condyle from medial collateral ligament (MCL) avulsive stress
- associated with MCL injuries
- hyperextension injury
- direct force to anterior tibia with foot planted
- contusion pattern: "kissing contusions" of anterior tibial plateau and anterior femoral condyle
- associated with ACL, PCL, meniscal injuries, and in severe cases knee dislocation
- lateral patellar dislocation
- twisting injury to flexed knee
- anterolateral lateral femoral condyle and inferomedial patella
- associated with medial patellar retinaculum +/- medial patellofemoral ligament injury +/- medial patellotibial ligament injuries
