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Author Topic: Why is my (small) bone bruise taking so long to heal?  (Read 31871 times)

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Offline runner7

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Why is my (small) bone bruise taking so long to heal?
« on: July 30, 2011, 06:02:40 PM »
I just got my second MRI for my knee injury:



It doesn't look much different than the first time I got my MRI in February (I got injured in December).

The thing that is confusing me is why my injury is taking SO long to heal.  It's a very small bone bruise as you can see in the MRI, but it still hurts to walk (I try to move as little as I can).  I am (was) a 21 years old college runner, so I don't understand why this isn't healing more quickly.

I've looked up plenty of studies on bone bruises, and I'll often find a HUGE bone bruise covering the whole femoral condyle on like a 65 year old woman, and it's gone at a 9 week follow-up!

Has anyone else had this problem?
« Last Edit: July 30, 2011, 06:06:16 PM by runner7 »

Offline Lottiefox

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Re: Why is my (small) bone bruise taking so long to heal?
« Reply #1 on: July 30, 2011, 10:20:45 PM »
What has your doctor said? Is it just a bone bruise or is the cartilage over the bruise involved? It certainly looks a bit uneven over the flare of the bruise indicating you might have some edema still going on or possible cartilage involvement?. You really need a doc to fully discuss what the MRI means though. Bone bruises take a long time to heal - and if they are on a weight bearing section (looks like yours is) then they never really get chance to rest much.....hang in there.......if you only have a bruise then just be patient....but ask your doctor what he thinks...

Lottie
Bilateral patella OA since 2009, no surgeries.
Euflexxa working well x3 to current
Right forefoot CRPS post fusion surgery 2011
Refusing to let the ailing parts stop me....

Offline Vickster

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Re: Why is my (small) bone bruise taking so long to heal?
« Reply #2 on: July 30, 2011, 11:56:21 PM »
As Lottie says, are you sure it's a bone bruise and not a cartilage / bone defect? 

I had both with my injury - that type of small abnormality and also the extensive femoral condyle bone bruising, clear on the first MRI.  On the second one, no more oedema obvious but still the jaggedy bit in the subchondral bone - I had sugery between the two MRIs and know that there is fibrocartilage, so scar tisssue, over the bone defect (in a very similar spot to yours).

I was told that bone bruises take 3-6 monthd to heal in most cases but sometimes 12 months or more.

Hope you get some answers from your doctor.

Good luck :)
Came off bike onto concrete 9/9/09
LK arthroscopy 8/2/10
2nd scope on 16/12/10
RK arthroscopy on 5/2/15
Lateral meniscus trim, excision of hoffa's fat pad, chondral stabilisation
LK scope 10.1.19 medial menisectomy, trochlea microfracture, general tidy up

Offline runner7

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Re: Why is my (small) bone bruise taking so long to heal?
« Reply #3 on: July 31, 2011, 02:05:25 AM »
Thanks for the replies!  After my first MRI in February, the doctor told me that it was a bone bruise with osteophytes.  Here is my first MRI.  Look only at the bottom-right image:



You can clearly see the bone bruise and (black) ostephyte embedded in the cartilage.  It *appears* to me that the osteophyte has faded with time but the bruise still kind of remains.  Does it look like this to you all?

Anyway, I'm supposed to hear from my doctor on Monday.  He's one of the best in Atlanta, so I hope his diagnosis is positive.

Vickster, how long did it take for your pain to go away?  I've read that there are no nerves within cartilage or within bone -- there are only nerves in a thin layer on the edge of the bone.  So I'm hoping that even though I'm not feeling an improvement this is only because the surface of the bone hasn't healed yet, but everything else is healing.

Thanks!

Offline Vickster

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Re: Why is my (small) bone bruise taking so long to heal?
« Reply #4 on: August 01, 2011, 07:42:35 PM »
My knee is far far better but I wouldn't say it is healed and I don't think it will ever be 100%.  In addition to the defect on the femoral condyle, I also have extensive softening on the tibia opposite - I am knock kneed and also missing a bit of meniscus now on that side, so I fear that the cartilage damage will probably get worse over time - my OS said that a distal femoral osteotomy was my best option should the issues continue to unload the lateral compartment. 

I am sticking with lots of cycling and stretching and it seems to be working  :)  My defect was a deep one, but I spontaneously developed scar tissue to fill it.  Not the best surface as is still tender to touch and I cannot kneel, but while the fibro holds, no more surgery for me!
Came off bike onto concrete 9/9/09
LK arthroscopy 8/2/10
2nd scope on 16/12/10
RK arthroscopy on 5/2/15
Lateral meniscus trim, excision of hoffa's fat pad, chondral stabilisation
LK scope 10.1.19 medial menisectomy, trochlea microfracture, general tidy up

Offline Dizzy

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Re: Why is my (small) bone bruise taking so long to heal?
« Reply #5 on: August 01, 2011, 09:07:44 PM »
I had to do a double take, I thought you might have stolen my MRI.

Although mine is better than a year ago (the last MRI said "resolving:), I am still struggling with it. On my second MRI the reviewer made a comment that mine was probably the result of a "tiny, focal full thickness chondramalacia". The Kneeguru was good enough to point out to me that does not mean a hole rather a full thickness softening.

My 2 cents (and thats all this is), the problem may be with the cartilage which is why the bone bruise is healing so slow (basically what everyone else above is saying).
4/10 running overuse injury/PFS diagnosis
6/10, 9/10, 1/11 PT
12/10 Euflexxa
12/10, 2/11, 7/11 Stem cell injections
5/11 to date - ART

Offline Vickster

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Re: Why is my (small) bone bruise taking so long to heal?
« Reply #6 on: August 01, 2011, 09:23:56 PM »
Here's my 2nd MRI - about 11 months post injury and 2 months before the 2nd scope - can see the damage to the subchondral bone but not (to my untrained eye) the extensive softened cartilage on the tibia (grade 1-2) and the one a month post injury with all the bone bruising in the femoral condyle

« Last Edit: August 01, 2011, 09:29:01 PM by Vickster »
Came off bike onto concrete 9/9/09
LK arthroscopy 8/2/10
2nd scope on 16/12/10
RK arthroscopy on 5/2/15
Lateral meniscus trim, excision of hoffa's fat pad, chondral stabilisation
LK scope 10.1.19 medial menisectomy, trochlea microfracture, general tidy up

Offline runner7

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Re: Why is my (small) bone bruise taking so long to heal?
« Reply #7 on: August 04, 2011, 05:58:40 AM »
I got my diagnosis for the new MRI today.  My OS said it is a medial femoral osteochondral defect, which is pretty much what I thought.  I think the "bone bruising" has faded away.

He said my options at this point are microfracture or giving it more time.  I'll meet with him in a week to discuss.

However...

I've been doing a lot of research on my own on this, and I finally found a study that seems applicable to my injury.  The title of the study is "MRI-Demonstrated Outcome of Subchondral Stress Fractures of the Knee After Treatment with Iloprost or Tramadol: Observations in 14 Patients".  The study isn't free (you'll have to purchase a copy), but it is a retrospective analysis of another study that is free called "Short-term outcome of painful bone marrow oedema of the knee following oral treatment with iloprost or tramadol: results of an exploratory phase II study of 41 patients". (And a link: http://rheumatology.oxfordjournals.org/content/46/9/1460.full).

Basically, the first study concerns the effect of two drugs called Iloprost and Tramadol on bone marrow edema.  The second study takes the data from the original study and analyzes it from a subchondral stress fracture point of view -- the same issue that it appears Vickster and I have.

Here's some info from the study:

Results: After three months, the SSF volumes had decreased by a median of 42.2% in group 1 and increased by a median of 2.2% in group 2 (P = 0.008). After 1 year, the median decrease in SSF volumes was 100.0% in group 1 and 65.7% in group 2 (P = 0.017).

Conclusion: This small case series suggests that healing of SSF is more pronounced after Iloprost treatment.

So I'm going to ask my OS if I can try this before getting surgery.

(I assume quoting small parts from the study falls under fair use, but if not then let me know).
« Last Edit: August 10, 2011, 03:33:18 PM by runner7 »

Offline Lottiefox

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Re: Why is my (small) bone bruise taking so long to heal?
« Reply #8 on: August 04, 2011, 09:29:06 AM »
Your defect is pretty much where mine is. Mine is full thickness, the result of general thinning before my time then 90 sprint shuttle runs one afternoon on a bumpy park and I felt something happen. I had nasty horrible pain for a fortnight when I tried to jog or even step down a stair. I avoided surgery like the plague as I wasn't convinced the rest of my failing cartilage would cope with anything like MFX. Mine has calmed down a lot but I know if I ran it would create massive problems and pain for me - I can live without running and do other stuff so I manage! I think your choice depends on what you want to do, how far you want to see if conservative measures help and your expectations afterwards. I think at 21 you probably have a far better chance of a good MFX outcome than me at 42 with genetically **** knees! But certainly trying other routes is a good plan, keep us posted,

I have never heard of that drug?! Iloprost? What is it?

Good luck

Lottie  :)
Bilateral patella OA since 2009, no surgeries.
Euflexxa working well x3 to current
Right forefoot CRPS post fusion surgery 2011
Refusing to let the ailing parts stop me....

Offline Vickster

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Re: Why is my (small) bone bruise taking so long to heal?
« Reply #9 on: August 04, 2011, 10:14:25 AM »
Good news that you have a clear diagnosis :)  My defect is lateral on left knee but in the same sort of area.  It was full thickness at time of injury but had filled with fibrocartilage when the knee was scoped after 5 months to sort the meniscus so didn't need microfracture as my body had done a DIY job in response to the trauma (not everyone generates fibro like this apparently) and the scar tissue was still in tact at the second scope (15 months post trauma).

If it doesn't settle, then do consider some sort of fix as you do have age on your side, but mfx on a condyle comes with a period on crutches and a fairly lengthy rehab. Mfx is reasonably successful for a small isolated defect (did the doc give you an estimate of the size?)

I cannot run to this day (starts to hurt after about 6 strides) but it's not my thing anyhow, cycling more my bag, quicker way to get from A-B  ;D

Good luck with what you decide :)
Came off bike onto concrete 9/9/09
LK arthroscopy 8/2/10
2nd scope on 16/12/10
RK arthroscopy on 5/2/15
Lateral meniscus trim, excision of hoffa's fat pad, chondral stabilisation
LK scope 10.1.19 medial menisectomy, trochlea microfracture, general tidy up