ACL tear or ITBS. MRI results provided. Please guide.


Q: Hello. I have had pain on the outside of my patella on both of my legs for about a year and a half now. I do not remember having any injury. I have no problems walking, but if I try to run, severe pain starts at about 600 metres. The pain goes away completely after about 3 days of rest. Once the pain starts, I cannot climb down the stairs due to intense pain, while climbing up the stairs is manageable. The doctor advised an MRI scan and this is what the report says -
"Diffuse interstitial tear of ACL with intact attachments", " Diffuse swelling in lower patellar articular cartilage without focal loss".
I had suspected it to be ITBS, as the pain is on the outer side of the patella and is more severe climbing downstairs. But it looks like it is an ACL tear. Can you please answer the following queations.
1)Can the diagnosis be wrong? Can ITBS or something else be confused for ACL tear in an MRI scan?
2)What is a diffuse interstitial tear? Is it a full tear or partial tear?
3)I would like to avoid rexonstructive surgery. But I would like to maintain a healthy lifeatyle with running, trekking etc. Please guide me on how to proceed.

Symptoms:  Severe pain on the outer side of the patella triggered by running for about 600 metres. Difficulty climbing downstairs once the pain starts. Climbing upstairs is not a problem. No trouble doing deep knee bends. Clicking sound when bending knee.

A:   Hello,
Thanks for your query.
I have gone through your question in detail and understand your concern. Your clinical history suggests runners knee these include chondromalacia patella and iliotibial band syndrome. Treatment of it is rest and analgesic for few days whenever there are symptoms. Answer to your queries.
1. Yes, there is a possibility of the diagnosis to be wrong. As it is well known that MRI may show tear of ACL and actually it is intact sometimes. However it does not confuse with iliotibial band syndrome or similar other conditions on MRI. You can repeat MRI if confused.
2. Diffuse interstitial tear is tear of middle,not of attachment (Ends) ,it is a complete tear.
3, Quadriceps exercises are useful as muscle strengthening may compensate for ACL tear.
Hope your query get answered.
Wishing you good health
Take care

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