Bone Bruises Associated with Anterior Cruciate Ligament Injury as Indicators of Injury Mechanism: A Systematic Review.

BACKGROUND: Anterior cruciate ligament (ACL) injury is one of the most common injuries in sports, and the injury mechanisms are not completely clear. Bone bruises seen on magnetic resonance imaging (MRI) following ACL injuries may provide significant information for determining ACL injury mechanisms. OBJECTIVE: The aim was to determine ACL injury mechanisms through an evaluation of locations of bone bruises associated with ACL injury. METHODS: A search for related articles in PubMed and the EBSCO Sport Database was performed using selected search strings from inception to August 6, 2018. Original studies with specified bone bruise locations identified using MRI technology were reviewed. RESULTS: A total of 12 studies with 589 patients were selected for review. A total of 471 bone bruises in the lateral tibial plateau were reported. Of these bone bruises, 409 (87%) occurred in the posterior section. A total of 242 bone bruises in the medial tibial plateau were reported. Of these bone bruises, 208 (86%) occurred in the posterior section. A total of 266 bone bruises in the lateral femoral condyle were reported. Of these bone bruises, 65 (25%) and 184 (69%) occurred in the anterior and central sections, respectively. A total of 105 bone bruises in the medial femoral condyle were reported. Of these bone bruises, 49 (47%) and 41 (39%) occurred in the anterior and central sections, respectively. CONCLUSIONS: Bone bruise location patterns indicate that tibial anterior translation relative to the femur was a primary injury mechanism in the majority of ACL injuries selected in this review, and that the maximal knee valgus apparently occurred after tibial anterior translation sufficient to injure the ACL. Bone bruise location patterns also indicate knee hyper-extension as another mechanism of non-contact ACL injury.

Clinician Recommendations and Perceptions of Factors Associated With Ankle Brace Use.

BACKGROUND: Little information is available regarding the ankle braces orthopaedic sports medicine clinicians recommend or clinicians' concerns that may influence their decisions to recommend use of an ankle brace. HYPOTHESES: (1) Clinicians most frequently recommend lace-up braces with straps. (2) Clinicians who are concerned about potential adverse side effects from ankle brace use are less likely to recommend an ankle brace to prevent ankle sprain injuries. STUDY DESIGN: Descriptive survey study. LEVEL OF EVIDENCE: Level 3. METHODS: Surveys were sent via e-mail to 1000 randomly selected members of the Orthopaedic Section of the American Physical Therapy Association (APTA) and 1000 randomly selected members of the National Athletic Trainers' Association (NATA). A total of 377 individuals responded to the survey. RESULTS: Lace-up braces, specifically lace-up braces with straps, were the most frequently recommended type of ankle brace. Regression analyses indicated that the only perceived adverse side effect significantly related to frequency of ankle brace recommendation was a potential negative influence on ankle strength. CONCLUSION: Based on our sample, clinicians recommend lace-up ankle braces with straps most frequently to prevent ankle sprain injuries. Clinicians who are concerned about weakness of ankle musculature may be less likely to recommend use of an ankle brace. CLINICAL RELEVANCE: Clinicians may effectively reduce the number of ankle sprain injuries by recommending an ankle brace use after an initial ankle sprain injury.