16 Year Old Female With Knee Pain And Swelling - Page #4

Working Diagnosis:
Pivot shift bone bruise with intact ACL, transient patellar dislocation

Crutches for touch weightbearing initially and then as tolerated. Physical therapy for quadriceps strengthening.

Patient did well and progressed nicely. She did have some pain after doing a lot of walking on vacation about 2 months after initial injury. Patient returned to dancing in about three months.

Author's Comments:
The interesting aspect of this case was the pivot shift bone bruises with intact ACL. Gentili et al reported 100 % specificity of lateral compartment bone contusion for ACL tears. On the other hand, Snearly et al reported bone bruises with intact ACL in almost 30 % of adolescents. The patient's ligamentous laxity could have been secondary to age. One could also consider genetic testing for disorders such as Marfan's or Ehlers-Danlos if indicated. We did not think it was in this patient.

Gentili A et al. Anterior cruciate ligament tear: indirect signs at MR Imaging. Radiology 1994(193)835-40.
Snearly WN et al. Lateral compartment bone contusions in adolescents with intact anteror cruciate ligments. Radiology 1996 (198)205-208.

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