Haemarthrosis of Knee Joint after Injury

• Rapid swelling of the knee after an injury   > a significant injury.
• Causes of Traumatic Haemarthrosis of Knee :- alone or any combination
  -ACL/PCL injury
  -Osteochondral fracture
  -Meniscal injury/tear
  -Joint Capsule tear
  -Patella fracture/dislocation
  -Intra-articular fractures
• Diagnosis:- H/O trauma plus a thorough examination gives an accurate diagnosis in most patients.
  –Clinical Examination: Local Swelling with joint effusion, Tenderness, Painful movement, Examination/Tests for ligament laxity if possible (e.g. Drawer tests, Lachmann Test, Valgus/Varus stress test, Mc-Murray’s test, Pivot shift test etc)
  –Examination under anaesthesia if clinical evaluation difficult due to pain
  –Arthroscopic examination: invaluable in looking for the existence of other injuries with/without an associated ACL tear
  –X-ray:- to diagnose fracture(s)
  

  Lipohaemarthrosis (blood & fat in the joint space) in a person with a subtle tibial plateau fracture. The white arrow shows a fluid level between the upper fat component and the lower blood component

  –MRI Examination:– beneficial to help diagnosing ligament/meniscus tears, osteochondral fractures, local soft tissue oedema etc.
  -Aspiration of the fluid→ to help in reaching a diagnosis & to decrease pain.

• Initial Treatment:-Aspiration & Splinting of the knee, along with re-evaluation
• Adjuvant tests- including x-ray, & MRIs is beneficial.
• Although arthroscopic evaluation of the knee is not needed in every patient with an acute hemarthrosis, most of these patients eventually undergo arthroscopy to complete the diagnosis or as a means of early surgical intervention.
• Surgical Treatment:-  to repair an injured structure   > depending on the patient’s age, activity level, amount of instability, & associated lesions.
• Routine arthroscopy:- indicated as a means to determine the correct treatment & not merely for diagnosis.