Bone bruises associated with acute ankle ligament injury: do they need treatment?

PURPOSE: The aim of this systematic review is to analyse the current knowledge, incidence, relevance, and need for treatment of bone bruises associated with acute ankle ligament injury. METHODS: A search was made of PubMed, OVID/Medline, Cochrane databases using the keyword "bone bruises" in combination with "ankle", "sprain", "management", "surgery", and "conservative treatment". RESULTS: No randomized controlled trials or prospective cohort studies were found. Only case series were retrieved. A critical appraisal for validity and usefulness of the studies revealed that the best level of evidence on this topic is represented by retrospective comparative studies. Nine studies evaluating the management of bone bruises associated with acute ankle ligament injuries were found. CONCLUSION: The clinical prognosis of bone bruises is generally good, with a normalization of MRI appearance usually within 6-12 months after trauma. Currently, there is no evidence that these lesions need specific treatment. Thus, the management of the concomitant ligament lesions is sufficient. Further research is necessary to successfully address the management of bone bruises, and more evidence is required to decide if these lesions need to be treated at all.