MANUAL MINORS
Knee hemarthrosis is the accumulation of blood within the joint cavity of the knee, typically caused by trauma or intra-articular injury, such as ligament tears (especially the anterior cruciate ligament, ACL), fractures, or meniscal damage.
It can also occur spontaneously in individuals with bleeding disorders, such as haemophilia, or as a result of anticoagulant use. The presence of blood in the joint causes inflammation, pain, and stiffness, limiting knee movement.
Diagnosis
Patients with knee hemarthrosis typically present with rapid onset of swelling, intense pain, and limited range of motion in the knee, usually following an injury or direct blow. Joint effusion often develops within hours of the trauma. Initial diagnosis is based on clinical evaluation, with observation of a swollen, warm, and tender knee.
Arthrocentesis (joint aspiration) can be performed to confirm the presence of blood in the joint and rule out other causes of joint effusion, such as infection or arthritis. In cases of trauma, X-rays should be ordered to rule out fractures, and an MRI is useful for assessing ligament or meniscal injuries.
Differential Diagnosis
Condition | Key Differentiation |
|---|---|
Joint Effusion due to Arthritis | Usually associated with chronic conditions, such as rheumatoid arthritis; no blood in aspirated fluid. |
Joint Infection (Septic Arthritis) | Fever, severe pain, swelling, purulent fluid in the joint. |
Bursitis | Localised swelling over the patella or lateral knee without intra-articular involvement. |
Soft Tissue Contusion | Swelling without joint fluid or significant intra-articular injury. |
Traumatic Synovitis | Inflammation of the synovial membrane with effusion, but no blood in the joint. |
Emergency Management
Management in the emergency setting includes:
Arthrocentesis: This is performed to evacuate the accumulated blood, relieve pain, and confirm the diagnosis. The aspirated fluid can be sent for analysis, especially if septic arthritis or haemophilia is suspected.
Immobilisation: Temporarily immobilising the knee with a splint is recommended to reduce pain and allow soft tissue healing.
Analgesics and Anti-Inflammatories: NSAIDs are administered to control pain and reduce inflammation.
Evaluation of Associated Injuries: If severe intra-articular damage (such as an ACL tear or fracture) is suspected, an MRI is performed to plan definitive treatment.
For patients with bleeding disorders, coagulation abnormalities must be corrected through infusion of clotting factors or adjustment of anticoagulant therapy.
Definitive Treatment
Definitive treatment depends on the underlying cause of the hemarthrosis:
Ligament or Meniscal Injuries: If ligament tears (such as the ACL) or meniscal damage is confirmed, surgical intervention such as arthroscopic repair or reconstruction may be required.
Intra-Articular Fractures: Fractures affecting the knee joint require surgical stabilisation, typically with internal fixation using plates or screws.
Treatment of Underlying Causes: For patients with bleeding disorders (such as haemophilia), treatment focuses on replacing deficient clotting factors to prevent recurrent episodes of hemarthrosis.
Rehabilitation
Rehabilitation following treatment includes muscle-strengthening exercises, stretching, and physiotherapy to restore knee range of motion and prevent stiffness. The recovery period varies depending on the severity of the underlying injury and the type of intervention performed.
For significant traumatic injuries, recovery may take between 6 weeks to several months. Regular follow-up is important to prevent complications such as post-traumatic osteoarthritis or joint stiffness, particularly in cases of recurrent hemarthrosis.
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