A bruised knee does require treatment

Posted on 18 May 2017

A bruised knee will usually heal itself – but it can take a frustratingly long time. Here’s advice from a Mediclinic orthopaedic surgeon on how proper knee care can help nature along.

Bone bruising usually results in a deep ache in the knee, and while not as serious as a fracture it can cause problems for months. Dr Cecil Reid, an orthopaedic surgeon at Mediclinic Constantiaberg with a special interest in hip and knee surgery, offers insider advice for retaining range of motion and strengthening the muscles that provide dynamic stability.

What is a bruised knee?

‘A bruise usually describes injury to skin or underlying soft tissue,’ Dr Reid explains, ‘but a bruised knee implies injury to the bone as well, although without a break in the bone cortex [the outer, denser part of the bone], which would be a fracture.’

Bruising to the knee can happen as a result of accidental direct impact, such as in contact sports and activities. ‘Someone with healthy bone can take a significant impact directly to the knee, which can result in bruising of the skin and soft tissue, bone and cartilage, but without a fracture resulting,’ says Dr Reid.

This kind of injury is less likely in the elderly or frail, who often have decreased bone density and are more likely to sustain a fracture of the patella (knee cap) as a result of direct trauma. Similarly, indirect injury – such as a twisting injury – is more likely to result in injury to ligaments or meniscus (the rubbery, C-shaped disc that cushions the knee), while high-energy injuries such as those sustained in a car accident can result in fractures around the knee or multi-ligament injury with knee dislocation.

How is a bruised knee diagnosed?

Diagnosis involves excluding other injuries to the knee such as damage to the bone cortex, meniscus, ligaments or cartilage.

‘X-rays may exclude a fracture but won’t be of much value for assessment of knee bruising,’ says Dr Reid. An MRI will show the extent of any bruising, but he adds that this is ‘an expensive investigation’.

What does initial treatment entail?

Dr Reid’s initial management involves the RICE principles: rest, ice, compression and elevation.

  • Rest: How long the rest period should be depends on the severity of the injury. ‘The knee is usually immediately painful and it might be obvious that the injured person should not continue with further activity. However, sometimes while the body is warmed up during sporting activity, the pain might be less severe initially and the extent of the injury may only become apparent that evening or the next day,’ says Dr Reid.
  • Ice: Ice packs reduce pain and swelling. The sooner they’re applied, the better.
  • Compression: Use an evenly applied bandage, stocking or soft knee brace for pain relief. It shouldn’t be too tight and it should include the calf.
  • Elevation: ‘It’s not always practical to elevate the knee to the level of the chest for prolonged periods, but it’s advisable to keep the injured knee on a bench or footstool while sitting, and on a pillow while lying down, until the pain and swelling have subsided,’ says Dr Reid.

What if the pain and swelling don’t subside within 48 hours?

If there’s still pain 48 hours after the injury and the swelling hasn’t subsided, and if in addition you can’t put weight on the knee or do an unassisted straight leg lift while lying down, you need to get medical attention.

‘The medical practitioner will do a clinical assessment of the knee ligaments and stability of the patella, and assess for a knee effusion [fluid in the joint], which could develop in the days following the injury. This could be an indication of a fracture, a tear of the anterior cruciate ligament (ACL) or a significant meniscal tear,’ Dr Reid explains.

What does follow-up treatment entail?

  • Pain management: ‘Combination analgesia could include simple analgesia such as paracetamol and a non-steroidal anti-inflammatory (NSAID) such as ibuprofen,’ says Dr Reid.
  • Movement: ‘I would usually involve a physiotherapist to assist with rehabilitation of the knee and start early active and passive motion exercises,’ says Dr Reid. ‘Moving the knee might be uncomfortable initially, but it’s unlikely to be unbearably painful. Worsening pain with movement could signify a missed injury and warrants orthopaedic assessment and possibly an MRI scan.’
  • Non-invasive and alternative treatment: Ultrasound, transcutaneous electrical nerve stimulation or acupuncture might provide pain relief in cases of prolonged symptoms.

If the pain gets steadily worse over time, if the knee remains unstable or gives way, if there’s persistent fluid on the knee, or if there’s painful clicking or locking of the knee, further assessment is required.

Published in Orthopaedics

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