Wang Hong-De, Zhang Jiahao, Li Yuwan, Li Zong, Yan Wenqiang, Ao Yingfang
Department of Sports Medicine, Beijing Key Laboratory of Sports Injuries, Institute of Sports Medicine, Peking University Third Hospital, Peking University, Beijing, China.
Orthop J Sports Med. 2023 Feb 16;11(2):23259671221144780. doi: 10.1177/23259671221144780. eCollection 2023 Feb.
Bone bruises are frequently found on magnetic resonance imaging (MRI) after an anterior cruciate ligament (ACL) tear in pediatric patients.
To establish a classification system for different bone bruise patterns to estimate the severity of a knee injury in pediatric patients with ACL tears.
Cross-sectional study; Level of evidence, 3.
A medical database was retrospectively reviewed to identify all cases of primary ACL tears in patients who were aged ≤17 years at the time of the injury and underwent MRI at our institution within 4 weeks of the injury between January 2011 and December 2020. A total of 188 patients were identified (67 male, 121 female; mean age, 15.1 ± 1.4 years). Bone bruises were classified according to their depth and location on MRI in the sagittal and coronal planes.
The new classification system identified 3 grades of depth: grade I, the bone bruise was located within the epiphysis but did not reach the epiphyseal plate (n = 54 [35.3%]); grade II, the bone bruise was within the epiphysis that reached the epiphyseal plate (n = 55 [35.9%]); and grade III, the bone bruise was in both the epiphysis and metaphysis (n = 44 [28.8%]). The bone bruise location was classified into 4 types: type a, the deepest bone bruise area was in the lateral tibial plateau (n = 66 [43.1%]); type b, the deepest bone bruise area was in the lateral femoral condyle, commonly occurring in the lateral one-third to two-thirds of the lateral femoral condyle (n = 22 [14.4%]); type c, the bone bruise area had a similar depth in both the lateral femoral condyle and lateral tibial plateau (n = 54 [35.3%]); and type d, the bone bruise area was in the lateral tibial plateau and lateral femoral condyle and extended to the fibular head (n = 11 [7.2%]). The prevalence of collateral ligament injuries increased from grade I to III. All patients with grade III type c bone bruises had meniscal lesions.
This new classification system provides a basis for estimating associated lesions of the knee before surgery.
小儿患者前交叉韧带（ACL）撕裂后，磁共振成像（MRI）检查经常发现骨挫伤。
建立不同骨挫伤模式的分类系统，以评估小儿ACL撕裂患者膝关节损伤的严重程度。
横断面研究；证据等级，3级。
回顾性分析医学数据库，以确定2011年1月至2020年12月期间受伤时年龄≤17岁且在我院受伤后4周内接受MRI检查的所有原发性ACL撕裂病例。共确定188例患者（男67例，女121例；平均年龄，15.1±1.4岁）。根据MRI矢状面和冠状面的深度及位置对骨挫伤进行分类。
新的分类系统确定了3个深度等级：I级，骨挫伤位于骨骺内但未到达骨骺板（n = 54 [35.3%]）；II级，骨挫伤位于到达骨骺板的骨骺内（n = 55 [35.9%]）；III级，骨挫伤位于骨骺和干骺端（n = 44 [28.8%]）。骨挫伤位置分为4种类型：a型，最深骨挫伤区域位于胫骨外侧平台（n = 66 [43.1%]）；b型，最深骨挫伤区域位于股骨外侧髁，常见于股骨外侧髁的外侧三分之一至三分之二处（n = 22 [14.4%]）；c型，股骨外侧髁和胫骨外侧平台的骨挫伤区域深度相似（n = 54 [35.3%]）；d型，骨挫伤区域位于胫骨外侧平台和股骨外侧髁并延伸至腓骨头（n = 11 [7.2%]）。侧副韧带损伤的发生率从I级到III级增加。所有III级c型骨挫伤患者均有半月板损伤。
这种新的分类系统为术前评估膝关节相关损伤提供了依据。
