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Bone Contusions of the Posterior Lip of the Medial Tibial Plateau (Contrecoup Injury) and Associated Internal Derangements of the Knee at MR Imaging¹

¹ From the Departments of Radiology (P.A.K., R.H.G., R.G.D., M.W.A.) and Orthopedics (P.A.K., R.G.D., D.R.D., M.W.A.), University of Virginia Health System, Lee St, Charlottesville, VA 22908. Received September 9, 1998; revision requested October 23; revision received January 18, 1999; accepted January 21. Address reprint requests to P.A.K.

View larger version (125K): [in a new window]   Figure 1a. Sagittal T1-weighted MR images (600/20) from two knees show typical (a) small and (b) large bone contusions (arrows) with different configurations of the posterior lip of the medial tibial plateau.

View larger version (129K): [in a new window]   Figure 1b. Sagittal T1-weighted MR images (600/20) from two knees show typical (a) small and (b) large bone contusions (arrows) with different configurations of the posterior lip of the medial tibial plateau.

View larger version (198K): [in a new window]   Figure 2a. (a–c) Coronal turbo STIR MR images (5,500/29/150) and (d) axial gradient-echo MR image (770/18, 30° flip angle) demonstrate typical locations of bone contusions. (a) Posterior in the knee, both medial (arrowhead) and lateral (arrow) tibial contusions are evident as areas with high signal intensity. The peripheral medial femoral condyle contusion is somewhat evident and is depicted better in b. (b) In a slightly more anterior image, the far peripheral medial femoral condyle contusion (arrow) is just posterior to the medial collateral ligament and the tibial contusions. (c) More anterior image than b depicts the lateral femoral condyle contusion (*). (d) Image of a left knee depicts both medial and lateral tibial plateau contusions (arrows).

View larger version (200K): [in a new window]   Figure 2b. (a–c) Coronal turbo STIR MR images (5,500/29/150) and (d) axial gradient-echo MR image (770/18, 30° flip angle) demonstrate typical locations of bone contusions. (a) Posterior in the knee, both medial (arrowhead) and lateral (arrow) tibial contusions are evident as areas with high signal intensity. The peripheral medial femoral condyle contusion is somewhat evident and is depicted better in b. (b) In a slightly more anterior image, the far peripheral medial femoral condyle contusion (arrow) is just posterior to the medial collateral ligament and the tibial contusions. (c) More anterior image than b depicts the lateral femoral condyle contusion (*). (d) Image of a left knee depicts both medial and lateral tibial plateau contusions (arrows).

View larger version (196K): [in a new window]   Figure 2c. (a–c) Coronal turbo STIR MR images (5,500/29/150) and (d) axial gradient-echo MR image (770/18, 30° flip angle) demonstrate typical locations of bone contusions. (a) Posterior in the knee, both medial (arrowhead) and lateral (arrow) tibial contusions are evident as areas with high signal intensity. The peripheral medial femoral condyle contusion is somewhat evident and is depicted better in b. (b) In a slightly more anterior image, the far peripheral medial femoral condyle contusion (arrow) is just posterior to the medial collateral ligament and the tibial contusions. (c) More anterior image than b depicts the lateral femoral condyle contusion (*). (d) Image of a left knee depicts both medial and lateral tibial plateau contusions (arrows).

View larger version (170K): [in a new window]   Figure 2d. (a–c) Coronal turbo STIR MR images (5,500/29/150) and (d) axial gradient-echo MR image (770/18, 30° flip angle) demonstrate typical locations of bone contusions. (a) Posterior in the knee, both medial (arrowhead) and lateral (arrow) tibial contusions are evident as areas with high signal intensity. The peripheral medial femoral condyle contusion is somewhat evident and is depicted better in b. (b) In a slightly more anterior image, the far peripheral medial femoral condyle contusion (arrow) is just posterior to the medial collateral ligament and the tibial contusions. (c) More anterior image than b depicts the lateral femoral condyle contusion (*). (d) Image of a left knee depicts both medial and lateral tibial plateau contusions (arrows).

View larger version (146K): [in a new window]   Figure 3a. Sagittal T1-weighted MR images (600/20) show (a) lateral compartment contusions (arrows) and (b) arthroscopically proved ACL tear (arrows) in a patient with a medial tibial plateau contusion.

View larger version (144K): [in a new window]   Figure 3b. Sagittal T1-weighted MR images (600/20) show (a) lateral compartment contusions (arrows) and (b) arthroscopically proved ACL tear (arrows) in a patient with a medial tibial plateau contusion.

View larger version (147K): [in a new window]   Figure 4a. Sagittal gradient-echo MR images (770/18, 30° flip angle) depict arthroscopically proved, typical far peripheral tears of the posterior horn of the medial meniscus in conjunction with medial tibial plateau contusions in two patients. Note the (a) subtle meniscal tear (arrow) near the meniscocapsular junction and (b) smaller, far peripheral meniscal tear (arrow).

View larger version (128K): [in a new window]   Figure 4b. Sagittal gradient-echo MR images (770/18, 30° flip angle) depict arthroscopically proved, typical far peripheral tears of the posterior horn of the medial meniscus in conjunction with medial tibial plateau contusions in two patients. Note the (a) subtle meniscal tear (arrow) near the meniscocapsular junction and (b) smaller, far peripheral meniscal tear (arrow).

View larger version (155K): [in a new window]   Figure 5a. Sagittal (a) T1-weighted (600/20) and (b) gradient-echo (770/18, 30° flip angle) MR images of arthroscopically proved meniscocapsular separations of the posterior horn of the medial meniscus that are common in patients with medial tibial bone contusions. Note the fluid (arrow) interposed abnormally between the meniscus and the capsule.

View larger version (162K): [in a new window]   Figure 5b. Sagittal (a) T1-weighted (600/20) and (b) gradient-echo (770/18, 30° flip angle) MR images of arthroscopically proved meniscocapsular separations of the posterior horn of the medial meniscus that are common in patients with medial tibial bone contusions. Note the fluid (arrow) interposed abnormally between the meniscus and the capsule.

View larger version (30K): [in a new window]   Figure 6. Diagram of the mechanism for developing bone contusions at the time of ACL rupture. Outlines of the distal femur (thin line) and of the proximal tibia (thick line) are superimposed A before; B, C during; and D after injury. A, Knee in normal position, without contusions. MCL = medial collateral ligament. B, Knee in valgus alignment after initial blow, or coup. The tibia (thick line) subluxates forward on the externally rotated femur (thin line), and lateral compartment contusions (lined areas in B–D) occur as the ACL ruptures and as the bones impact against one another. C, Contrecoup injury occurs medially, after dissipation of forces when there is compensatory varus alignment with internal rotation of the femur and persistent (although decreased) anterior subluxation of the tibia, which allows impaction with bone contusions at specific locations in the medial compartment (dotted areas). D, Knee is reduced, with normal relationship of the tibia relative to the femur after injury. Lateral (lined areas) and medial (dotted areas) compartment bone contusions are shown in their typical locations.