Patterns of bone bruise in knee injury

Last revised by Andrew Murphy on 18 Nov 2021

The pattern of bone bruise in knee injuries (a.k.a. bone contusion) can give clues for the mechanism and associated injuries. 

Radiographic features

Five classic bone contusion patterns have been described 1-4:

  • pivot-shift injury
  • dashboard injury
    • anterior force to tibia in a flexed knee (e.g. knees against dashboard in motor vehicle collision, or fall onto flexed knee)
    • contusion pattern: anterior tibia +/- posterior patella
    • associated with posterior cruciate ligament (PCL) tear
  • clip injury
    • valgus stress to flexed knee
    • contusion pattern: lateral femoral condyle and lateral tibial plateau +/- medial femoral condyle from medial collateral ligament (MCL) avulsive stress
    • associated with MCL injuries
  • hyperextension injury
    • direct force to anterior tibia with foot planted
    • contusion pattern: "kissing contusions" of anterior tibial plateau and anterior femoral condyle
    • associated with ACL, PCL, meniscal injuries, and in severe cases knee dislocation
  • lateral patellar dislocation
    • twisting injury to flexed knee
    • contusion pattern: anterolateral lateral femoral condyle and inferomedial patella
    • associated with medial patellar retinaculum +/- medial patellofemoral ligament injury +/- medial patellotibial ligament injuries

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Cases and figures

  • Figure 1: pivot-shift
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  • Figure 2: hyperextension
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  • Figure 3: clip injury
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  • Figure 4: dashboard injury
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  • Case 1: pivot-shift injury
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  • Case 2: lateral patellar dislocation
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  • Case 3: hyperextension injury
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  • Case 4: pivot shift with impacted tibial plateau fracture
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  • Case 5: pivot shift edema with ACL and meniscal tears
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  • Case 6: hyperextension knee injury
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  • Case 7: pivot shift knee injury
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