Driban Jeffrey B, Lohmander Stefan, Frobell Richard B
Division of Rheumatology, Tufts Medical Center, Boston, MA.
Department of Clinical Sciences, Lund University, Sweden.
J Athl Train. 2017 Jun 2;52(6):575-580. doi: 10.4085/1062-6050-52.1.09.
After an anterior cruciate ligament (ACL) injury, a majority of patients have a traumatic bone marrow lesion (BML, or bone bruise). The clinical relevance of posttraumatic lesions remains unclear.
To explore the cross-sectional associations between traumatic BML volume and self-reported knee pain and symptoms among individuals within 4 weeks of ACL injury.
Cross-sectional exploratory analysis of a randomized clinical trial.
Orthopaedic departments at 2 hospitals in Sweden.
As part of a randomized trial (knee anterior cruciate ligament nonoperative versus operative treatment [KANON] study), 121 young active adults (74% men, age = 26 ± 5 years, height = 1.8 ± 0.1 m, weight = 76 ± 13 kg) with an ACL tear were studied.
MAIN OUTCOME MEASURE(S): The BML volume in the proximal tibia and distal femur was segmented using magnetic resonance images obtained within 4 weeks of injury. A radiologist evaluated the presence of depression fractures on the images. Pain and symptoms of the injured knee (Knee Injury and Osteoarthritis Outcome Score [KOOS] pain and symptoms subscales) were obtained the same day as imaging. We used linear regression models to assess the associations.
Most knees had at least 1 BML (96%), and the majority (57%) had a depression fracture. Whole-knee BML volume was not related to knee pain for the entire cohort (β = -0.09, P = .25). Among those without a depression fracture, larger whole-knee BML volume was associated with increased knee pain (β = -0.46, P = .02), whereas no association was found for those with a depression fracture (β = 0.0, P = .96). Larger medial (β = -0.48, P = .02) but not lateral (β = -0.03, P = .77) tibiofemoral BML volume was associated with greater pain. We found no association between BML volume and knee symptoms.
We confirmed the absence of relationships between whole-knee BML volume and pain and symptoms within 4 weeks of ACL injury. Our findings extend previous reports in identifying weak associations between larger BML volume in the medial compartment and greater pain and between BML volume and greater pain among those without a depression fracture.
前交叉韧带（ACL）损伤后，大多数患者会出现创伤性骨髓损伤（BML，即骨挫伤）。创伤后损伤的临床相关性仍不明确。
探讨ACL损伤后4周内个体创伤性BML体积与自我报告的膝关节疼痛及症状之间的横断面关联。
一项随机临床试验的横断面探索性分析。
瑞典2家医院的骨科。
作为一项随机试验（膝关节前交叉韧带非手术与手术治疗[KANON]研究）的一部分，对121名年轻活跃的成年人（74%为男性，年龄=26±5岁，身高=1.8±0.1米，体重=76±13千克）进行了ACL撕裂研究。
使用损伤后4周内获得的磁共振图像对胫骨近端和股骨远端的BML体积进行分割。一名放射科医生评估图像上是否存在凹陷性骨折。在成像当天获取受伤膝关节的疼痛和症状（膝关节损伤和骨关节炎结果评分[KOOS]疼痛和症状子量表）。我们使用线性回归模型来评估关联。
大多数膝关节至少有1处BML（96%），且大多数（57%）有凹陷性骨折。全膝关节BML体积与整个队列的膝关节疼痛无关（β=-0.09，P=0.25）。在没有凹陷性骨折的患者中，全膝关节BML体积越大，膝关节疼痛越明显（β=-0.46，P=0.02），而在有凹陷性骨折的患者中未发现关联（β=0.0，P=0.96）。较大的内侧胫股BML体积（β=-0.48，P=0.02）而非外侧（β=-0.03，P=0.77）与更严重的疼痛相关。我们未发现BML体积与膝关节症状之间存在关联。
我们证实了在ACL损伤后4周内，全膝关节BML体积与疼痛和症状之间不存在关联。我们的研究结果扩展了先前的报告，即在内侧间室较大的BML体积与更严重的疼痛之间以及在没有凹陷性骨折的患者中BML体积与更严重的疼痛之间存在微弱关联。
