Misdiagnosed bone bruise?

[Savanna]

I fell off my bike two weeks ago and twisted my left knee rather badly in the fall. I did not slam my knee into the ground. I just twisted it sharply while my weight was on my left foot. I had no external injuries--no scrapes, no bruises.

My whole knee hurt the first day or two, but by the third day it was clear that most of my pain was on the medial side, inside, of my knee. I can neither flex the knee all the way nor extend it all the way. It is a little swollen, but not severely, and it hurts sharply on the medial side if I twist or overextend it while walking. The medial side of my knee, in addition to be painful when palpated (especially along the joint line) is warm to the touch.

All of these symptoms indicate a torn meniscus, which is what my orthopedist thought, as well, until he got my MRI results. My MRI shows that my meniscus is fine, that I probably sprained my medial collatoral ligament (makes sense), and that I have a significant bone bruise on the top, outside of my tibia as well as bottom outside of my femur. The thing is, I have NO pain whatsoever on the outside or backside of my knee and everything I've read says that bone bruises are really painful, and painful to the touch. I can press as hard as I like on those parts of my leg and feel no discomfort. Here are my questions:

1) Is there such a thing as a painless bone bruise that still limits movement due to inflammation?

2) Does it seem likely that I actually do have a torn meniscus and the MRI just missed it?

3) Can an MRI falsely indicate a bruised bone? I'd believe it for sure if the MRI showed that the medial side of my tibia and femur were bruised, but that's not the case.

I am just perplexed by the bone bruise thing . . . Thanks for any help you can provide!

[Vinman]

no test is every 100% accurate. It is well known that MRI is not perfect. I have worked with many that have had negative MRIs but end up getting scoped and they find what the clinical exam suggested as a meniscus tear.

[mtnbikerskierchick]

I've always been told that meniscus damage can be missed on the MRI.... fairly often. But, if I'm remembering correctly, it tends to miss the lateral side more than the medial. It is probably possible that you have a torn meniscus, but take the time to reduce the swelling and maybe go to PT before going under the knife.

Every bone bruise I've ever had has been really painful... limiting activity for up to 3-4 months.

[Savanna]

Thanks very much, both of you, for your advice. I do think I am going to give it some more time to heal on its own.

Vinman, I've noticed a lot of really helpful advice you've given to other posters, and I am wondering whether you have any thoughts on the bone bruise not actually hurting. Thanks again!

[Mofro261]

I have had significant bone bruising on the ends of the femur and tibia on several rounds on knee injuries ( 2x torn acl's, meniscus). At no time do I remember the bone bruising painful to the touch, but always upon movement/walking weight bearing, and each time the pain persisted for 3-4 months. Also the bone bruising contributed to persistant swelling and did effect the ROM of the knee. If you escaped a knee injury with only bone bruising, congrats on not needing surgery.

[Vinman]

I guess it is possible for the bone bruise to not hurt. The location of your bone bruise makes sense if you have an MCL tear.

I have examined other knees that have identifiable bone bruises on MRI but don't have tenderness. The swelling inside your knee from the bone bruise could limit motion if there is enough of it.

Do you have a lot of swelling around the knee?

[Savanna]

Thanks for your replies. I do not have a lot of swelling around my knee, but I don't know whether that is any indicator of the amount of swelling inside my knee. My doctor prescribed Voltaren, which looks like a pretty heavy-duty anti-inflammatory. I suppose that if after taking the Voltaren for a few days my range of motion increases, it would indicate that the swelling is the problem and not a torn meniscus, right? I do hope I can get through this without surgery!