Posterior tibial bone bruising associated with posterior‐medial meniscal tear in patients with acute anterior cruciate ligament injury

Abstract Purpose To evaluate whether medial‐sided bone bruising was associated with postero‐medial meniscal tears in patients with an acute rupture of their anterior cruciate ligament (ACL). Methods A retrospective analysis of 150 consecutive patients who had an MRI scan within 8 weeks of their ACL rupture that underwent an ACL reconstruction was performed. Based on the intra‐operative findings, two groups were identified: Group A ( N = 75) had no postero‐medial meniscal tear associated with the acute ACL rupture and Group B ( N = 75) had a postero‐medial meniscal tear found at time of reconstruction. All patients’ pre‐operative MRI scans were reviewed for bone bruising in the following anatomic sites: lateral femoral condyle (LFC), lateral tibial plateau (LTP), medial femoral condyle (MFC), and medial tibial plateau (MTP). Results MTP bone bruising was found to be more prevalent in cases that had a postero‐medial meniscal tear in the setting of an acute ACL injury ( p = 0.046). MTP Grade 2 or 3 bone bruising was more common in patients that had a postero‐medial meniscal tear ( p = 0.046). There was a slightly higher incidence of grade 2 or 3 MTP bone bruising in cases with a postero‐medial meniscal tear, although this did not reach statistical significance (n.s.) There was no difference in LFC, LTP or MFC bone bruising in patients with or without a postero‐medial meniscal tear (n.s) for all. Conclusions Medial‐sided bone bruising; especially present on the posterior tibial plateau may result from a higher injury force during the injury to the ACL. The identification of medial bone bruising on pre‐operative MRI imaging following an acute ACL rupture should raise the suspicion of an associated postero‐medial meniscal tear. Level of evidence III.