Hemorrhage into the knee joint is called hemarthrosis. It manifests itself as pain, swelling, decreased mobility and changes in the contours of the joint. Blood from the knee must be evacuated, and this requires a puncture of the joint. Subsequently, the underlying disease that caused the hemorrhage is treated.

Causes of hemorrhage into the joint cavity

Depending on the cause of occurrence, knee hemorrhages are divided into three groups:

• Traumatic.
• Non-traumatic.
• Postoperative.

The most common type of bleeding into the joint cavity is traumatic hemarthrosis. For blood to leak into the joint in significant quantities, serious tissue damage must occur: cartilage, bones or ligaments. Therefore, bleeding into the joint is a sign of severe trauma that may require surgical intervention:

• Up to 70% of all knee bleeds in adults are due to anterior cruciate ligament (ACL) rupture.
• In 10% of cases, the cause of hemorrhage is a meniscus tear.
• In 2-5%, hemorrhage is caused by a torn cartilage fragment or an intra-articular bone fracture.
• In 5% of cases, the cause is a rupture of the posterior cruciate ligament or knee joint capsule.
• In children, the leading cause is lateral patellar dislocation.

Non-traumatic hemorrhage is usually associated with a blood clotting disorder, such as hemophilia, vitamin K deficiency, liver cirrhosis, and anticoagulant use. Rare causes of non-traumatic hemorrhage in the knee joint include diabetic arthropathy, vitamin C deficiency, septic arthritis, tumors in the knee area, hemangiomas, as well as ruptures of the arteries of the knee joint due to osteoarthrosis and degenerative changes in the posterior horn of the medial meniscus.

Postoperative hemorrhages are most often associated with endoprosthetics. Less often, it develops as a complication of other knee surgeries.

Symptoms

After an injury, the joint swells over several hours. Mobility is significantly reduced, but the pain is not always severe. The pain can range from mild to severe, depending on the nature of the injury, and usually increases as blood accumulates inside the joint due to the pressure it exerts.

All other symptoms depend on the type of injury. For example, when the meniscus is torn, the knee joint is blocked: a person cannot straighten, or less often bend, the leg. When the anterior cruciate ligament is torn, a feeling of instability appears in the knee, and during a clinical examination, the doctor can determine a positive anterior drawer symptom: the shin is excessively displaced forward during passive movement, since the tibia is no longer held by the torn ligament.

Diagnostics

Using ultrasound, you can see fluid in the knee, but you cannot reliably determine that it is blood and not inflammatory exudate.

The most accurate method is considered to be MRI. With this procedure, it is possible to distinguish blood from other fluids, as well as to establish the cause of the hemorrhage, for example, to visualize torn ligaments or menisci.

When intra-articular bone fractures are suspected, which account for only a small proportion of knee hemorrhage cases, radiography and CT scanning are the preferred diagnostic options.

Treatment of hemorrhage in the knee joint

Patients with hemarthrosis require a puncture of the knee joint. The doctor performs this procedure under local anesthesia. The doctor inserts a needle into the joint cavity to evacuate the accumulated fluid and inject medications into the knee. This procedure quickly reduces pain and improves knee mobility by reducing intra-articular pressure.

The color of the fluid that the doctor obtains from the knee can help the doctor guess the cause of the hemorrhage. It can be pink, red, or brown, and in severe trauma it may contain fatty droplets.

Other methods of conservative treatment:

• ice;
• anti-inflammatory drugs;
• immobilization;
• compression bandages.

During the recovery period, massage, exercise therapy, and physical therapy are used.
Some patients will need surgery to partially remove the meniscus or reconstruct the anterior cruciate ligament. At Dr. Waqas Javed’s Clinic, all knee interventions are performed using a minimally invasive arthroscopic method.

Possible complications

Severe or recurrent hemarthrosis can lead to destruction of intra-articular cartilage and osteoarthritis.

The toxic effect of blood on the articular membrane causes its hypertrophy (proliferation) and fibrosis (scarring).

Most often, complications develop with bleeding into a joint against the background of hemophilia, but this is a rare cause, accounting for no more than 1% of cases, and is mainly diagnosed at the age of 2-3 years. Repeated episodes of bleeding into the joint cavity can cause arthropathy with impaired joint mobility and patient disability. This complication develops in 20% of patients with hemophilia. In addition to the knee, other joints are also affected.

Rehabilitation and exercise therapy

After surgery or a period of immobilization, patients require rehabilitation. How long it will take depends on the nature of the injury. If after meniscus resection recovery takes only one and a half months, then after a rupture of the anterior cruciate ligament and its reconstruction, recovery takes six months. The main means of rehabilitation is considered to be therapeutic exercise, but other procedures are additionally used, such as massage, physiotherapy, mechanotherapy, electromyostimulation.

Forecast

After a knee puncture, the pain goes away in a few days, and most other symptoms disappear completely in a few weeks, unless there are gross anatomical defects in the knee. If there are such defects, then without treatment, a person will suffer from joint instability or recurrent blockades. Inflammatory processes (reactive synovitis) will worsen, and in the long term, the risk of osteoarthritis increases. Surgical treatment may be required to prevent these consequences.

Prevention

Prevention of knee hemorrhages is identical to injury prevention. It is necessary to warm up before training, exercise in good shoes, and avoid running on slippery surfaces. Unfortunately, there are no measures that will protect against knee injury with a 100% guarantee.

If you notice that your knee is swollen, painful, and difficult to move as a result of an injury, contact Dr. Waqas Javed’s Clinic in Lahore. We will conduct diagnostics and find out whether there is blood in the joint or not. If there is, we will perform a puncture to evacuate the hemorrhagic contents, as it has a negative effect on the condition of the cartilage and synovial membrane. Then we will find out the cause of the hemorrhage and conduct treatment that will relieve you of pain and help restore knee function