Articular and osseous lesions in recent ligament tears: arthroscopic changes compared with magnetic resonance imaging findings

The treatment of ligament injuries of the knee has undergone rapid progress, especially with the improvement of arthroscopic reconstruction of the anterior cruciate ligament (ACL). Since the advent of magnetic resonance imaging (MRI) after knee trauma with ligament injuries, interest has focussed on the clinical significance of concomitant articular and osseous lesions. In 48 of 141 MRIs, different types of these lesions were found; in 38 cases an arthroscopy was performed and 34 times the patients could clinically and radiologically be examined after at least 6 months. Bone bruise was found 26 times, in 16 cases associated with ACL-tears. Eleven patients had subchondral fractures, 7 osteochondral fractures, and in 4 patients, stress fractures were found. They were attributed to various mechanisms of trauma, in different percentages associated with ligament tears and in different dimensions visible or progressive on follow-up MRIs. Obviously some of the different lesions of subchondral and spongeous bone can indicate later degenerative arthritis, so that we find hints for a modification of rehabilitation, e.g., open versus closed kinetic chain or orthosis with relief of single compartments.