ACL tears and bone bruises

Knee 0

Lenny Macrina

Physical Therapist United States

Research Review

Not sure if you saw my recent post on social media about bone bruises after an ACL tear so I wanted to discuss it further here.

In this study, the authors looked at the incidence of radiographic chondral changes (without correlation with clinical and functional outcomes) on MRI 5 years after the ACL tear.

Bone bruises often coincide with an acute ACL tear and can be seen on an MRI. Basically, a larger bone bruise was shown to have a significant influence on chondral changes 5 years post-surgery.

In most of the cases, the lateral side of the knee (both the tibia and the femur) were involved. Whereas the medial side had fewer incidences of a bone bruise after the injury.


Outline of a bone bruise on the distal femur and proximal tibia after an ACL injury

This is very typical after an ACL injury and previously cited by numerous authors.

I’ve always said that these bone bruises need to be communicated throughout the rehab team. These bone bruises should influence the progression back to sport.


Delay impact activities after ACL surgery

It is for this reason that I have delayed most of my athletes’ return to impact activities until 4-5 months after the surgery. I often don’t initiate running and plyometrics until 4-5 months after the surgery.

We need to respect the bone bruise healing times (which are still not truly known). They seem to take months to achieve homeostasis, which means no pain or swelling.

Only another MRI would truly confirm full healing so we need to rely on symptoms, most of the time.

I think this may allow the athlete to achieve better long-term success. But we need to understand these bruises more before we can fully determine the correct rehab process.

I think the long term life of the athlete’s knee can be influenced by our rate of rehab progressions. To me, slower seems to be better in these situations.

Gone are the days of trying to return our athletes back to their sport as quickly as possible.

Take the time to get their motion back, especially knee extension.

We are beginning to better understand the implications of these bone bruises on the long-term health of the athlete’s knee.

Educate the patient fully and build confidence! Rehab after an ACL surgery is never easy so don’t take anything for granted!

This was originally posted on Lenny Macrina’s website. You can click here to read more blogs from him.

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About the Author


Lenny Macrina

Physical Therapist United States

Lenny Macrina has been a practicing physical therapist since 2003 and currently serves as the Director of Physical Therapy at Champion Physical Therapy and Performance in Waltham, MA. His interests include research and rehabilitation of the shoulder, elbow and knee joints. He has successfully treated many orthopaedic and sports medicine related injuries that are both post-operative and non-operative in nature, in recreational athletes to the high-level professional athletes. Lenny is a board certified sports physical therapist by the APTA and a certified strength and conditioning specialist by the National Strength and Conditioning Association. In 2010, he was nominated by his peers to be included in the prestigious American Sports Medicine Fellowship Society which includes top fellowship-trained orthopaedic surgeons and physical therapists. Along with maintaining a full clinic schedule, he has co-authored various current concept papers, book chapters, research papers and a home study course for the APTA’s Orthopaedic section. He is a peer reviewer for the esteemed JOSPT and has reviewed rehabilitation textbooks and research papers for that journal. Through this research, he has been involved in numerous published articles in journals including: AJSM, JOSPT, Journal of Sports Health, Journal of Athletic Training, CORR, Operative Techniques in Sports Medicine, and many others. He has presented at various national conferences including APTA’s Combines Sections Meeting, ASMI’s “Injuries in Baseball Course”. Lenny received his Bachelor’s degree in Biotechnology from Worcester Polytechnic Institute and his Master’s degree in physical therapy from Boston University.

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