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

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

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

Outcome:
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.

References:
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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