Knee Hemarthrosis: Symptoms, Treatment, and Recovery

Knee hematoma and swelling?

I felt a sensation of my knee dislocating when I turned around after flipping a switch.
It quickly returned to its normal position, but I fell due to severe pain.
I sat down until the pain subsided before walking back to my chair to rest.
When I tried to go to bed, I suddenly experienced pain and was unable to walk.
I felt something in my knee (like a bone) that I could move, but when I sat down to check again, it was gone.
The next morning, 11 hours after the injury, my knee was swollen, and I felt instability when standing and applying weight.
I went to see a doctor, who drained 50cc of blood from the joint but did not specify where the injury was.
He only prescribed medication and said I didn't need to return for a follow-up in two weeks.

Twelve hours after seeing the doctor, my knee became slightly swollen again (not as much as in the morning), and I could only bend it to 90 degrees.
It felt a bit stiff, and I had to find a point of support while walking.
Is this blood accumulation? Do I need to have it drained again? Does the presence of blood indicate a ligament injury? I read online that ACL tears may not show obvious symptoms in the short term, and I'm worried about potential long-term effects.
How long should treatment be pursued to minimize the risk of complications?

Chen, 40~49 year old female. Ask Date: 2023/07/21

Dr. Wang Zhaomin reply Rehabilitation

Injuries to the tendons and ligaments associated with the knee joint often accompany bleeding or joint effusion, leading to joint swelling or limited range of motion.
It is recommended to seek early consultation with an orthopedic or rehabilitation specialist for accurate diagnosis and appropriate treatment options.

Reply Date: 2023/07/21

More Info

Knee hemarthrosis, or bleeding into the knee joint, is a condition that can occur after trauma, such as a fall or a twisting injury. Your description of the incident, where you felt a dislocation sensation followed by severe pain and swelling, is consistent with this condition. The immediate symptoms you experienced, including the inability to bear weight and the sensation of instability in the knee, are common indicators of potential ligament injuries, such as an anterior cruciate ligament (ACL) tear.

Symptoms of Knee Hemarthrosis
The primary symptoms of knee hemarthrosis include:
1. Swelling: This is often the most noticeable symptom and can occur rapidly after the injury due to bleeding into the joint.

2. Pain: Severe pain is common, especially when attempting to move the knee or bear weight.

3. Instability: A feeling of the knee giving way or being unstable can indicate ligament damage.

4. Limited Range of Motion: The knee may become stiff, making it difficult to bend or straighten fully.

5. Tenderness: The area around the knee may be tender to the touch.

Diagnosis and Treatment
Diagnosis typically involves a physical examination and imaging studies, such as an MRI, to assess for ligament injuries, cartilage damage, or other structural issues. In your case, the doctor performed a knee aspiration (arthrocentesis) to remove excess blood, which can relieve pressure and pain.

Treatment Options may include:
1. Rest and Ice: Resting the knee and applying ice can help reduce swelling and pain.

2. Compression and Elevation: Using a compression bandage and elevating the leg can further help manage swelling.

3. Medications: Non-steroidal anti-inflammatory drugs (NSAIDs) can be prescribed to alleviate pain and inflammation.

4. Physical Therapy: Once the acute phase has passed, physical therapy can help restore strength and stability to the knee.

5. Surgery: If there is significant ligament damage or if conservative treatments fail, surgical intervention may be necessary.

Recovery and Prognosis
The recovery time for knee hemarthrosis can vary depending on the severity of the injury and whether there are associated ligament tears. Generally, if the bleeding is managed and there are no significant structural injuries, recovery can take a few weeks. However, if there is an ACL tear or other serious injury, recovery may take several months, and rehabilitation will be crucial to regain full function.

Concerns About Long-term Effects
You mentioned concerns about potential long-term effects and the risk of residual instability or pain. It is essential to follow up with your healthcare provider if symptoms persist or worsen. An MRI can provide more detailed information about any ligament injuries that may not be immediately apparent. Early intervention and appropriate rehabilitation are key to minimizing the risk of long-term complications.

In summary, knee hemarthrosis is a serious condition that requires careful evaluation and management. While some cases may resolve with conservative treatment, others may require more extensive intervention. It’s crucial to monitor your symptoms and seek further medical advice if you experience persistent pain, swelling, or instability in your knee.

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