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Injured Knee. MRI Revealed Partial Tear To ACL And Bone Bruising. New Indication Is ACL Fully Torn. Remedy?

Posted on Wed, 24 Jul 2013

Question: Hello Doctor - My daughter, 14 year old highly competitive soccer player, injured her right knee on May 4, MRI done May 9, indicated partial tear to ACL, bone bruising , no other damage observed (PCL, LCL, MCL & meniscus in tact) - referred to ortho surgeon who did not feel surgery required, we have completed 8 weeks of intense physio, made tremendous recovery, running , lunches , weighted squats swelling dissipated, no pain .......just reassessed - original MRI re-read by separate Radiologist, and referral to sports ortho. They now indicate that ACL is fully torn, MCL partial tear and meniscus damage, require surgery ASAP. ???? we are at a loss as to how to proceed - any guidance would be appreciated -we would like to have a new MRI completed and 3rd opinion given her progress and dramatic difference of first two opinions – I am attaching initial MRI report
thanks

Answered by Dr. Dr. Praveen Tayal (34 minutes later)

Hello,
Thanks for posting your query.
The tremendous recovery that you daughter has achieved after 8 weeks of intensive physiotherapy is suggestive of a partial ACL tear. In case of a complete tear, a pain and swelling with knee instability is likely to persist until the repair is undertaken.
The best way is to get a fresh MRI scan done and get it evaluated for present position of the knee joint. Since your daughter is clinically better and is symptom free, there is nothing much to worry. Till then she can continue with her daily exercise regimen.
I hope this answers your query.
In case you have additional questions or doubts, you can forward them to me, and I shall be glad to help you out.
Please accept my answer in case you do not have further queries.
Wishing you good health.
Regards.
Dr. Praveen Tayal.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Dr. Praveen Tayal (10 hours later)

Hello Dr. Tayal - thanks for information - very helpful

It is important to note that physical examination does show some "play" in the R knee joint versus the uninjured L knee, however, not significant.

We will pursue another MRI.

WIll a partial tear heal itself over time ? WOuld it be possible for her to return to normal and play again at high level without surgery ?

Answered by Dr. Dr. Praveen Tayal (2 hours later)

Hello.
Thanks for writing again.
The partial tear heals on itself if the tear involves less than half of thickness of the ligament. Since she is symptomatically better, she is likely to resume her normal routine soon. Surgery may not be required. The exact decision can only be made after a repeat MRI scan.
Hope my answer is helpful.
Do accept my answer in case there are no further queries.
Regards

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Dr. Praveen Tayal (15 minutes later)

thank you doctor XXXXXXX

Answered by Dr. Dr. Praveen Tayal (6 minutes later)

Hi,
Thank you.
I am glad I could help.
You can consult me again directly through my profile URL http://bit.ly/Dr-Praveen-Tayal
Please accept my answer in case there are no further queries and recommend our services to your friends too if you have found it helpful.
I wish you the very best in whatever you do.
Warm regards

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Dr. Praveen Tayal (49 minutes later)

Dr. XXXXXXX - I will take advantage of my additional follow-up with you and ask about your experience, I hope you do not mind. How long have you practiced as an orthopedic surgeon, and have you had experience with athletes returning to full performance after a partial ACL tear without surgery ?

thanks again

Answered by Dr. Dr. Praveen Tayal (6 hours later)

I am practicing as an orthopedician since 1995. I do see such kind of patients in my OPD routinely and in case of a partial thickness tear at a young age, a complete recovery is seen with conservative treatment.
Your daughter might not need any surgery if the tear involves less than half of the thickness of the ligament. Let us hope for the best and wait for the MRI results.
Best Regards.

Note: For further queries, consult a joint and bone specialist, an Orthopaedic surgeon. Book a Call now.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar