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  • Royce Lewis Suffers A Bone Bruise In His Knee

    Lucas Seehafer

    By Lucas Seehafer

    The Minnesota Twins announced on Sunday evening that top prospect Royce Lewis suffered a bone bruise in his right knee after slamming into the wall while making an incredible catch during the team’s 7-3 win over the Kansas City Royals.

    Image courtesy of Jeffrey Becker, USA Today Network

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    While Lewis making a trip to the 10-day IL is less than ideal, in the grand scheme, the news he and the Twins received after the game is relatively good. Or, at least, as good as could be expected.

    Bone bruises fall on the fracture spectrum and are so named because of the dark spot they create on MRI. The ends of long bones—such as the femur of the thigh and the tibia and fibula of the lower leg—are comprised of cancellous bone, which is relatively porous and filled with blood. When a small portion of the spiderweb-like matrix inside the cancellous bone fractures, a dark image appears on MRI and is diagnosed as a bone bruise. 

    Like most fractures, bone bruises typically heal within a matter of weeks, and rarely do they progress to a more severe injury. As such, the primary factor when determining a return-to-play is the amount of pain the athlete is experiencing, as well as their ability to tolerate said pain. 

    According to Baseball Prospectus’s Recovery Dashboard, three MLB players have suffered a bone bruise in their knee since 2017, with the median number of days missed settling in at 27. The median days missed jumps to 28 when considering bone bruises in general, regardless of body region.

    The Twins will continue to assess Lewis’s knee in the coming days as the swelling decreases and the holiday weekend comes to a close. But for now, it would appear as if he—and the Twins—dodged a major bullet. 

    Share your thoughts in the COMMENTS. 

     

    Lucas Seehafer is a journalist and physical therapist living in southern Minnesota. In addition to Twins Daily, Lucas writes for a number of sites including Baseball Prospectus. He's currently working on a Ph.D. in Kinesiology.

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    Heezy1323

    Heezy1323 845

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    Good summary Lucas. I see bone bruises such as this fairly frequently, and they can be present for a number of different reasons. I tend to view them on the MRI images where fluid/edema shows up bright (T2 or PD FS), so I think of them as bright spots on MRI more than dark spots. 

    Most likely, this is a result of the femur slamming into the tibia, causing a bruise just like you might get on your thigh if you accidentally bump into the edge of a table or something like that. Your description of the bone in that area is spot on- I tend to describe it to patients as kind of like a puffy cheeto. It is softer bone than in the shaft of longbones, and as a result is more susceptible to injuries like this. 

    The timetable for recovery is dependent on a number of factors including the specific size and location of the bone bruise, the initial severity, whether it is present on both the femur AND tibia (called a kissing lesion) or on just one side, the alignment of the leg and probably several others. In my experience working with athletes, these always take longer than you think. If I had to guess, I would say 4 weeks would be the minimum for a full return (though I hope I'm wrong). 

    Of course, bone bruises can (and often do) occur with ACL tears, so it's good to hear that the ACL graft appears to be fine. That would be a relative disaster in this case, obviously. 

     

    image.png.e3d8d38eb7953dbe33f4cefbafa9fe60.png

    This image shows an MRI of a knee with the darker gray areas being normal bone, and the brighter areas being the area of the bone bruise in this particular case.

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