and Treating Persistent Knee Hematoma After Motorcycle Accident

Sustained a left knee contusion with a hematoma that has not resolved after a bicycle fall?

Hello, doctor.
On May 10, I fell while riding my motorcycle on an oily road, resulting in a bruise on my left knee that gradually hardened.
After late May, I began receiving X-ray and ultrasound examinations and treatments at orthopedic, traditional Chinese medicine, and rehabilitation clinics, all of which indicated a hematoma with a diameter of about 4 cm.
It is possible that fibrous tissue has developed within the hematoma, and I need to wait for it to resolve and absorb on its own.
Two months later, the size and swelling remain relatively unchanged, but there is almost no pain and it does not affect my daily activities.
After massage, the original lump softens like edema, and there is also a harder protruding mass of proliferative tissue near the tibia.
After acupuncture, there is a light yellow fluid that drains out, and after squeezing it out, the fluid and swelling return the next day.
Based on your experience, doctor: 1.
Is it appropriate to consider surgical removal at this stage, or should I continue with conservative treatment and wait for it to resolve? 2.
If I attempt surgical removal, are there any other proliferative side effects? Will I need to rely on crutches for walking in the short term?
Here are the images: Image 1 and Image 2 show the current state of the hematoma, and Image 3 shows an ultrasound comparison with the left knee hematoma on the left and the normal right knee on the right.
Thank you for your time and guidance.

Pin Ding, 20~29 year old female. Ask Date: 2022/07/15

Dr. Li Zhonghuai reply Surgery

Hello! The ultrasound shows that the hematoma is still present.
It has been over two months since May, and the blood clot has dissolved.
The fluid can be drained out with a fine needle.
Take care! Changhua Hospital is concerned about you!

Reply Date: 2022/07/15

More Info

After a motorcycle accident, persistent knee hematoma can be a concerning issue, especially when it remains unchanged for an extended period. Based on your description, it seems that you have been dealing with a hematoma that has not significantly decreased in size over the past two months. The fact that it has become hard and has fibrous tissue developing within it suggests that it may be transitioning from a simple hematoma to a more complex situation involving scar tissue formation.

Understanding the Current Situation
1. Hematoma Characteristics: A hematoma is essentially a localized collection of blood outside of blood vessels, usually due to trauma. In your case, the hematoma is approximately 4 cm in diameter and has shown signs of fibrous tissue development. This can happen as the body attempts to heal the injury, but it can also lead to complications if the hematoma does not resolve properly.

2. Symptoms and Impact: You mentioned that the hematoma is not causing significant pain and does not affect your daily activities. This is a positive sign, as it indicates that the injury may not be severely impacting the knee's function. However, the presence of a hard mass and the ability to express yellow fluid upon massage suggests that there may still be underlying issues that need to be addressed.

Treatment Options
1. Conservative Management: Given that the hematoma is not causing pain or functional impairment, conservative management is often the first line of treatment. This includes monitoring the hematoma, applying gentle compression, and possibly continuing physical therapy or rehabilitation exercises to maintain knee mobility and strength. The body can sometimes absorb the hematoma on its own, especially if it is not causing significant issues.

2. Surgical Intervention: If the hematoma persists without improvement, or if it begins to cause discomfort or functional limitations, surgical intervention may be considered. The decision to surgically remove the hematoma should be based on several factors:
- Size and Symptoms: If the hematoma remains large and begins to cause pain or restrict movement, surgery may be warranted.

- Risk of Complications: Surgical removal can lead to complications such as infection, additional bleeding, or the formation of scar tissue. These risks should be weighed against the potential benefits of removing the hematoma.

Post-Surgical Considerations
If surgery is performed, you may need to use crutches for a short period to avoid putting weight on the knee while it heals. The recovery process can vary depending on the extent of the surgery and the individual’s overall health. Physical therapy may be necessary to regain strength and mobility in the knee after surgery.

Conclusion
In summary, while your current situation with the knee hematoma may not require immediate surgical intervention, it is essential to continue monitoring it. If you notice any changes in symptoms, such as increased pain, swelling, or functional limitations, it would be prudent to consult with an orthopedic surgeon for a thorough evaluation. They can provide personalized recommendations based on the latest imaging studies and your overall health status. Always prioritize open communication with your healthcare providers to ensure the best possible outcome for your recovery.

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