patella sublux with MCL sprain of hyperlax 16 yr old - or ACL tear?

[BayBells]

My 16 yr old daughter had MRI with report that read, "wavy, discontinous acl - suggestive of tear..." and lateral meniscus tear...bone bruise, no problems in any other part of knee...." She had the MRI 24 hours after falling to the floor in a basketball game.  She felt her knee cap slide out and then back in, which was painful and then she fell. She had just landed from a jump and was pivoting to pass the ball when this happened...no popping sound, no pain after 5-10 minutes. Minimal swelling but sore and stiff for the next day or two.  Doctor saw some laxity in the joint so thought we should rule out an ACL tear but his only finding when he saw her was sprained MCL and maybe a bone bruise.   

PT and his partner both found no signs of ACL tear -- they did two exams to judge that and they think her only symptoms are of the MCL sprain...no problem with meniscus. They think she'll back and running in no time, without surgery. 

I read that for teenagers an MRI is much less accurate than for adults, especially for meniscal damage, but this MRI seems to be so opposite what appears to be wrong with her knee...we'll know more soon I hope.

My daughter is loose jointed and has subluxed her shoulder 7 or 8 times over the past 5 five years of basketball but shoulder specialist says she will outgrow this as her joint naturally tighten up...this might help explain the knee??

It's been almost three weeks since the accident and after 3x a week of PT she feels great and has been running...she's a very strong, fast athlete so maybe she's able to stabilize her knee even though the acl is torn...or maybe it's not torn at all? She's very hopeful that she'll be playing lacrosse this season and would do so with a brace if she has to...We're SO confused...any ideas or thoughts on this?  Thanks!!!

[Elly]

Hi,
I'm a 22 yr old girl in England (where it is very grey by the way and we'd like some sun from the states! - guessing you're in America cos unless you went private in the UK you'd never get a routine MRI that quick!).

I had a similar accident about 3 years ago and thought it was just a bad spain and left it , though couldn't weight bare fully for 3 days. I had very recurrent re-injury of the knee like a lesser version of the original injury (about once or twice a fortnight it would re-sprain).

I have been having it looked at by various very experienced physio's over the past 6 months while I've been on a waiting list to see an orthopaedic consultant, and the original thought was a classic ACL rupture and meniscus tear, as the laxity tests were positive.

However, I saw the ortho consultant and after much pushing and pulling (he really pushed my patellar across laterally at which point everyone went "ah..") it looks more like I've been getting patella subluxation/dislocation, and the laxity felt in my knee before was due to a lot of hypermobility (hyperlaxity - runs in families, benign condition).

It really confuses diagnosis and they want to check out my ligaments too so now i'm in the MRI queue! (waiting list here for routine MRI where I live is 2 months but that's pretty good really - I thought it would be more like 6 months).

Anyway, as a total guess i reckon if the ACL was completely torn they'd see it on the MRI even if it isn't so clear in teenagers, as it's usually pretty obvious (as far as i'm aware!) If it was her patella clicking out of place the main thing they do is loads of physio to get the muscles strong and make it run back on track. The physio can also advise as to whether she should wear a knee support for sport, and what type to get.

Hope that helps or something, feel free to get in touch if you want!

Elly