Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2025 May 16;145(1):300.
doi: 10.1007/s00402-025-05858-0.

Bone bruise assessment in knees with ACL lesions: semi-quantitative scores outperform quantitative evaluation

Giorgio Di Laura Frattura  1 , Alessandro Sangiorgio  2 , Alberto Poggi  3 , Maurizio Busacca  4 , Filippo Del Grande  5   6 , Gabriele Vincenzo  5 , Vittorio Bordoni  7 , Giuseppe Filardo  1   6
Affiliations

Bone bruise assessment in knees with ACL lesions: semi-quantitative scores outperform quantitative evaluation

Giorgio Di Laura Frattura et al. Arch Orthop Trauma Surg. .

Abstract

Purpose: Bone bruise is a common consequence of trauma. Its presence, size, and shape correlate with articular damage and symptoms evolution. Purpose of this study was to identify, among the most used quantitative and semi-quantitative evaluation strategies, the most reliable method to evaluate bone bruise in knees with anterior cruciate ligament (ACL) injury.

Methods: Knee Magnetic Resonance Imaging (MRI) of 100 ACL-injured patients were selected. Bone bruise characteristics were assessed by five different evaluators applying Whole Organ Magnetic Resonance Scoring (WORMS) and MRI Osteoarthritis Knee Score (MOAKS). Bone bruise area was measured freehand using Intellispace® PACS Enterprise. A topographic assessment in the coronal view was performed to evaluate reproducibility between different operators. Inter and intra-rater agreement were calculated with Fleiss-k for WORMS, MOAKS, and topographic evaluation, and with intra-class correlation (ICC) for area measurement.

Results: Bone bruise presence was reported in 63-65% of cases in the lateral femoral condyle, 42-48% in the medial femoral condyle, 80-82% in the lateral tibial plateau, 53-61% in the tibial sulcus, and 40-42% in the medial tibial plateau, with a substantial to almost perfect agreement (Fleiss-k 0.67-0.89). Inter-rater agreement was classified as moderate for WORMS and MOAKS (Fleiss-k = 0.46 and 0.45, respectively), while the area measurement resulted in a poor agreement (ICC = 0.44). Intra-rater agreement was classified as almost perfect for WORMS and MOAKS (Fleiss-k = 0.91 and 0.90, respectively), while the area measurement resulted in a good agreement (ICC = 0.79).

Conclusions: Semi-quantitative scores outperformed the quantitative evaluation of bone bruise. WORMS and MOAKS both resulted in a moderate inter-rater agreement, while bone bruise area assessment showed poor reliability. Intra-rater reliability confirmed the advantages of the semi-quantitative approach versus the quantitative one, being good for the area measurement while almost perfect when both WORMS and MOAKS scores were used to assess bone bruise in ACL-injured knees.

Keywords: ACL; Anterior cruciate ligament; Bone bruise; MOAKS; WORMS.

PubMed Disclaimer

Conflict of interest statement

Declarations. Ethical approval: Not applicable. Informed consent: Not applicable. Conflict of interest: None.

Similar articles

See all similar articles

References

    1. Bordoni V, di Laura Frattura G, Previtali D, Tamborini S, Candrian C, Cristallo Lacalamita M et al (2019) Bone bruise and anterior cruciate ligament tears: presence, distribution pattern, and associated lesions in the pediatric population. Am J Sports Med 47:3181–3186 - DOI - PubMed
    1. Bretlau T, Tuxøe J, Larsen L, Jørgensen U, Thomsen HS, Lausten GS (2002) Bone bruise in the acutely injured knee. Knee Surg Sports Traumatol Arthrosc 10:96–101 - DOI - PubMed
    1. Compagnoni R, Lesman J, Ferrua P, Menon A, Minoli C, Gallazzi M et al (2021) Validation of a new topographic classification of bone marrow lesions in the knee: the six-letter system. Knee Surg Sports Traumatol Arthrosc 29:333–341 - DOI - PubMed
    1. Dube B, Bowes MA, Hensor EMA, Barr A, Kingsbury SR, Conaghan PG (2018) The relationship between two different measures of osteoarthritis bone pathology, bone marrow lesions and 3D bone shape: data from the osteoarthritis initiative. Osteoarthritis Cartilage 26:1333–1337 - DOI - PubMed - PMC
    1. Faggioni L, Neri E, Castellana C, Caramella D, Bartolozzi C (2011) The future of PACS in healthcare enterprises. Eur J Radiol 78:253–258 - DOI - PubMed

LinkOut - more resources