Royce Lewis Suffers A Bone Bruise In His Knee

Good summary Lucas. I see bone bruises such as this fairly frequently, and they can be present for a number of different reasons. I tend to view them on the MRI images where fluid/edema shows up bright (T2 or PD FS), so I think of them as bright spots on MRI more than dark spots. 

Most likely, this is a result of the femur slamming into the tibia, causing a bruise just like you might get on your thigh if you accidentally bump into the edge of a table or something like that. Your description of the bone in that area is spot on- I tend to describe it to patients as kind of like a puffy cheeto. It is softer bone than in the shaft of longbones, and as a result is more susceptible to injuries like this. 

The timetable for recovery is dependent on a number of factors including the specific size and location of the bone bruise, the initial severity, whether it is present on both the femur AND tibia (called a kissing lesion) or on just one side, the alignment of the leg and probably several others. In my experience working with athletes, these always take longer than you think. If I had to guess, I would say 4 weeks would be the minimum for a full return (though I hope I'm wrong). 

Of course, bone bruises can (and often do) occur with ACL tears, so it's good to hear that the ACL graft appears to be fine. That would be a relative disaster in this case, obviously. 

This image shows an MRI of a knee with the darker gray areas being normal bone, and the brighter areas being the area of the bone bruise in this particular case.