Osseous lesions associated with anterior cruciate ligament injuries. Assessment by magnetic resonance imaging at various periods after injuries

Abstract

In 56 patients with anterior cruciate ligament (ACL) rupture, we retrospectively examined osseous lesions secondary to the rupture using magnetic resonance imaging (MRI). Depending on the time from their ligamentous injury to the performance of MRI, the patients were divided into three groups: the acute group (less than 1 month, n = 20), the subacute group (between 1 and 12 months, n = 16), and the chronic group (12 months or more, n = 20). Occult osseous lesions which were not detected by roentgenography were revealed by MRI in 14 patients in the acute group (70.0%), 5 in the subacute group (31.3%), and 1 in the chronic group (5%). The detection rate of osseous lesions by MRI was significantly higher in the acute group than in the other groups (P < 0.001). Osseous lesions were always detected in the same locations of the lateral compartment of the knee joint. When examined by arthroscopy, these lesions were often found to be accompanied by articular cartilage injuries. In the acute group, osseous lesions were visible in the high signal intensity area of T2-weighted images and in the low signal intensity area of proton density images. They were interpreted as representing hemorrhage and edema within the bone marrow. In the subacute and chronic groups, the osseous lesions were smaller, and their signal intensity on T2-weighted images was lower than that in the acute group, probably reflecting the ongoing resorption of the hemorrhage and healing of the lesions. These results suggest that osseous lesions develop following injury to the ACL.