HomeAnswersRadiologyacl injuryI have an ACL sprain with an intrasubstance tear. What to do?

What is the best possible treatment for low-grade sprain of the ACL with an intrasubstance tear?

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The following is an actual conversation between an iCliniq user and a doctor that has been reviewed and published as a Premium Q&A.

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Published At January 27, 2023
Reviewed AtOctober 10, 2023

Patient's Query

Hi doctor,

I had an MRI on my left knee after experiencing pain, swelling, and instability after playing soccer one evening. I am a 25-year-old female.

The MRI impressions state that mild to moderately increased intrasubstance signal with fraying and expansion of the ACL and probable low-grade partial-thickness intrasubstance tear at the proximal to mid-ACL, with small partially septated fluid signal structure within the posterior intercondylar notch and sagittal image measures 9 mm. It says I have a low-grade sprain of the ACL with probable low-grade partial-thickness intrasubstance tear and either a small ACL ganglion or small loculated effusion and synovial stranding within the posterior intercondylar notch. No meniscal tear or osteochondral injury. Quadriceps and patellar tendon, PCL, and medial and lateral collateral ligament complexes all appear intact. There is mild synovial thickening and edema at the anterior medial tibial margin tracking deep to the infrapatellar fat pad.

I have now received conflicting diagnoses from three different orthopedic surgeons. I have instability in my knee and pain and swelling, I have now undergone six weeks of physical therapy with no relief. One surgeon thinks I have patellar tendonitis which is causing the instability and I do not need surgery because the ACL tear is not bad. One surgeon thinks it is my ACL that is causing the instability and it needs to be reconstructed. I am not sure what to do or who is correct.

Hi,

Welcome to icliniq.com.

The MRI (magnetic resonance imaging) findings in your case indicate acute on chronic ACL (anterior cruciate ligament) injury with associated inflammatory changes. In my belief, it is the ACL injury that is causing the instability and not the patellar tendinosis.

In literature also patellar tendinosis is not a known cause of instability in the knee and your case clearly shows ACL (anterior cruciate ligament) pathology with lots of inflammation which is a common cause of sports injury-induced instability. I had a discussion with an orthopedic surgeon also about your case and he also agrees with me on the same.

I hope this sorts your query, if you have any more doubts please feel free to discuss.

Same symptoms don't mean you have the same problem. Consult a doctor now!

Dr. Chitrangada Jitendra
Dr. Chitrangada Jitendra

Radiology

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