Hemarthrosis of the knee joint in adults

An unpleasant disease – hemarthrosis of the knee joint most often occurs against the background of leg injuries, which can occur at any age. Today, it is increasingly diagnosed in people from 25 to 40 years old, since during this period of life the main physical activity is observed. For the same reason, hemarthrosis is more often detected in men than in women.

What is hemarthrosis

Hemarthrosis of the knee joint is called hemorrhage into the joint. Blood fills the joint capsule, as a result of which blood clots form, tissues are compressed, blood circulation is disturbed, and the joint itself is deformed. Traumatic hemarthrosis occurs when menisci, ligaments are torn, as well as fractures inside the joint or knee bruises. Left untreated, the disease can lead to irreversible consequences.

– When the knee hits a hard surface, intra-articular blood vessels often rupture, and blood enters the articular synovial sac. This is the shell that surrounds the joint, explains traumatologist, orthopedist Aslan Imamov. – The knee is one of the largest joints of the lower extremities, it accounts for most of the dynamic and physical loads. Injuries to this area can have very serious consequences, so it is important to diagnose and treat hemarthrosis in a timely manner.

Causes of hemarthrosis of the knee joint in adults

Traumatic hemarthrosis always accompanies intra-articular fractures and can be observed with ruptures and tears of ligaments, menisci, severe bruises and dislocations.

“The most common cause of knee hemarthrosis is a mechanical injury to the joint or periarticular tissues,” says Dr. Imamov. – The knee joints, like the ankle, are most susceptible to injury, so diagnosing hemarthrosis of the ankle joint is also often necessary.

When falling on the right or left knee, or hitting the knee, the following may occur:

• fracture of the knee joint or patella;
• dislocations or subluxations of the joints;
• meniscus tears;
• sprains and ruptures of the knee ligaments and nearby muscles and tissues.

Any of these injuries can lead to joint bleeding.

Hemarthrosis can also occur in the absence of serious injuries, for example, in violation of blood clotting and fragility of the walls of blood vessels. Non-traumatic hemarthrosis is often diagnosed in diseases such as hemophilia, severe hemorrhagic diathesis, scurvy, vasculitis, vessel aneurysm, its dissection, or congenital weakness. Against the background of these diseases, even a minor injury will burn to cause bleeding and lead to hemarthrosis.

Formed during the breakdown of hemoglobin and in violation of the structure of the molecule, a special pigment, hemosyridin, negatively affects the structure of the knee joint, which leads to a loss of its mobility and flexibility. With repeated hemorrhages, tissue and joint destruction occurs. Hemarthrosis can occur at any age and have different symptoms and severity.

And yet, the most common cause of hemarthrosis is torn ligaments or meniscal injuries due to sports injuries. The most dangerous in this regard are football, hockey, basketball, figure skating and power martial arts.

Intra-articular bleeding in intra-articular fractures most often occurs in road accidents or falls from a height. Hemarthrosis can occur in older people, due to the weakening of the muscular skeleton and bone frame.

In very rare cases, the disease can develop due to complications during surgery on the knee joint, if the surgeon touches large vessels.

Symptoms of knee hemarthrosis in adults

Symptoms of hemarthrosis of the knee joint depend on the degree of hemorrhage, but there are common signs:

• knee pain;
• swelling, sometimes on the whole leg;
• when pressed, the patella is movable;
• when trying to stand up or lean on the injured leg, the pain becomes stronger.

There are 3 degrees of hemarthrosis:

• Mild hemarthrosis. No more than 15 milliliters of blood enters the joint cavity. At the same time, patients complain about the symptoms of the main injury – local pain and slight swelling.
• Medium hemarthrosis. The volume of blood in the joint is up to 100 milliliters, it itself increases and takes on a spherical shape. Patients complain of arching pain inside the joint and painful movements of the knee. On palpation, fluid is palpable in a closed cavity and bulges noticeably on the sides of the patella.
• Severe hemarthrosis. The hemorrhage continues, as a result, more than 100 milliliters of blood accumulates in the joint cavity. Cyanotic skin color and tissue tension are added to the symptoms of the II degree. The patient cannot move his knee.

Treatment of hemarthrosis of the knee joint in adults

If you suspect hemarthrosis of the knee joint, first of all, the patient needs to be kept calm and it is advisable to put a small pillow or roller under the knee.

With mild hemarthrosis, the blood liquefies itself, so no special treatment is required. A fixing bandage is applied to the joint, and patients are also recommended to apply cold compresses to the damaged area for several days. It is important to provide the patient with peace and limit his physical activity. To accelerate the resorption of hematomas inside the joint, UHF is sometimes prescribed.

If the blood volume exceeds 30 milliliters, a puncture is made with blood suction and washing of the articular cavity. At the end of the manipulation, drugs are injected into the joint cavity and the injured knee is immobilized. If necessary, repeat the procedure.

In severe hemarthrosis, patients receive combined treatment along with the main injury in the hospital. Punctures are carried out as blood accumulates in the joint. In the event that hemarthrosis is difficult to treat and its recurrence, additional examinations are required to establish the cause of bleeding.

In case of severe damage to the joint, it is restored with the help of joint implants. In the future, patients are prescribed a course of painkillers and anti-inflammatory drugs, and in some cases chondroprotectors for the prevention and treatment of diseases that deform the joints.

If hemarthrosis has developed against the background of hemophilia, then medical care is provided to the patient in the hematology department.

Diagnostics

Diagnosing hemarthrosis of the knee joint is usually easy. The pathological condition can be detected by visual examination. Usually, patients complain of pain and limited movement in the knee. Even with a visual examination, it is easy to suspect bursitis, but this disease can be similar in symptoms to other ailments: rheumatoid or septic arthritis, gout, even with an injury, such as a fracture.

It is important to correctly diagnose hemarthrosis, as the disease is often mistaken for a normal sprain and do not go to the doctors. An inflammatory process that is not healed in time can lead to the destruction of cartilage tissue. You can determine the formation of chronic pathology by sharp pains, bruises in the knee area and general discomfort in this area. Therefore, after bruises, dislocations and sprains of the legs, it is recommended to contact a traumatologist to establish the correct diagnosis.

The diagnosis of “hemarthrosis of the knee” is made on the basis of characteristic clinical signs, anamnesis and the results of instrumental studies. Patients are prescribed x-rays of the knee joint in 2 projections, which helps to identify possible bone damage. If there is suspicion of cartilage damage or ligament rupture, arthroscopy, CT or MRI of the knee joint is done.

• Puncture. A mandatory diagnostic method for suspected hemarthrosis is to pump out the fluid and is performed with local anesthesia. Using a thick needle, the doctor sucks out the contents of the joint and checks its condition. This method allows you to determine the features of the inflammatory process and its duration.
• Radiography. X-ray allows you to determine the condition of the bones of the joint, which is especially important after falls and accidents. A snapshot in 2 projections makes it possible to identify abdominal fractures inside the joint.
• Arthroscopy. The surgical method refers to operations with minimal intervention. The process consists in examining the joint cavity from the inside. The artoscope is inserted through a small incision and the image is displayed on a screen. If necessary, the injured segments are removed through another incision. Such a low-traumatic intervention does not harm neighboring healthy tissues.
• MRI. The most informative of all instrumental studies allows you to assess the degree of damage to the tissues of the knee, its localization and the extent of distribution. As an exception, when an MRI is not possible, it can be replaced by an ultrasound.

Hemarthrosis of the knee joint with a mild injury suggests that the patient has a bleeding disorder. In this case, the patient is sent to a hematologist and tests are prescribed to assess the state of the blood coagulation system.

Modern treatments

Traditional treatment of hemarthrosis includes both conservative therapy and surgical intervention, if necessary. Medical treatment is complemented by proper nutrition. To restore the joint, it is important to do a set of exercises that will be prescribed by the attending physician. The duration of therapy depends on the severity of the injury.

The standard treatment regimen for hemarthrosis:

• puncture;
• removal of accumulated fluid from the cavity;
• washing the joint with an antiseptic;
• imposition of a plaster splint for immobility for 2 weeks;
• limitation of physical activity for 30 days;
• antiseptic treatment for external skin lesions;
• pain relief for severe pain;
• treatment of internal injuries, if any;
• physiotherapy;
• course of physiotherapy.

With inflammation of the synovial membrane of the joint, patients are prescribed antibiotic therapy. Antibiotics are injected into the affected joint during punctures. If during the diagnosis free fragments of bones or cartilage are found, as well as in case of serious injuries of the ligamentous apparatus or ruptures of the meniscus, the treatment is supplemented with arthroscopy.

In cases where hemarthrosis of the knee joint develops against the background of blood diseases, standard treatment is supplemented with the introduction of antihemophilic globulin, transfusion of fresh frozen plasma.

Prevention of hemarthrosis of the knee joint in adults at home

There are no special measures for the prevention of hemarthrosis for healthy people. People who have suffered knee injuries in the past should avoid re-injury. In their diet should be dishes with gelatin of animal origin to strengthen the joints and increase their elasticity.

In addition, you must follow the basic rules of first aid before the ambulance arrives in order to avoid subsequent complications.

Popular questions and answers