From the Guidelines
To treat soft tissue swelling in the knee, the most effective approach is to start with the RICE protocol and consider pharmacotherapy with acetaminophen or topical NSAIDs, as recommended by the 2021 VA/DoD Clinical Practice Guideline for the Non-Surgical Management of Hip and Knee Osteoarthritis 1.
Initial Treatment
The RICE protocol consists of:
- Resting the knee to prevent further injury
- Applying Ice for 15-20 minutes every 2-3 hours for the first 48-72 hours
- Using Compression with an elastic bandage wrapped snugly but not too tight
- Elevating the knee above heart level when possible
Pharmacotherapy
Over-the-counter NSAIDs like ibuprofen (400-800mg three times daily with food) or naproxen (220-440mg twice daily) can help reduce inflammation and pain, but acetaminophen (500-1000mg every 6 hours, not exceeding 4000mg daily) is recommended as the initial treatment 1.
Topical Treatments
Topical treatments like diclofenac gel applied 3-4 times daily may provide localized relief with fewer side effects 1.
Referral to Physical Therapy
Consider early referral to physical therapy based on pain severity, functional limitations, and adherence, as recommended by the 2021 VA/DoD Clinical Practice Guideline for the Non-Surgical Management of Hip and Knee Osteoarthritis 1.
Important Considerations
If swelling persists beyond 7-10 days, worsens significantly, is accompanied by severe pain, inability to bear weight, or fever, seek medical attention as these may indicate a more serious injury requiring professional evaluation. Soft tissue swelling occurs due to increased fluid in the tissues surrounding the knee joint, typically resulting from inflammation after injury or overuse, and proper treatment aims to reduce this inflammatory response and promote healing.
Key Points to Consider
- The treatment of knee OA should be tailored according to knee risk factors, general risk factors, level of pain intensity and disability, sign of inflammation, and location and degree of structural damage 1.
- Non-pharmacological treatment of knee OA should include regular education, exercise, appliances, and weight reduction 1.
- Opioid analgesics are not recommended for the management of OA pain due to the high risk of adverse effects 1.
From the Research
Soft Tissue Swelling Knee Treatment
- The treatment of soft tissue injuries, including those in the knee, is crucial to reduce complications, alleviate pain, and restore normal function promptly 2.
- The PRICE (protection, rest, ice, compression, and elevation) method is a widely accepted approach for treating uncomplicated soft tissue injuries to the upper or lower limbs, including the knee 2.
- Nurses should have a thorough understanding of the rationale and evidence base supporting PRICE treatment to provide accurate information to patients and carers about the management of soft tissue injuries and anticipated recovery time 2.
- While the RICE (rest, ice, compression, and elevation) method is an established combination to prevent swelling, it may not be sufficient to stimulate lymphatic resorption, and additional methods such as negative pressure therapy may be necessary 3.
- The treatment of perioperative swelling using RICE or RICE+ (with additional negative pressure therapy) can help reduce postoperative swelling and improve outcomes in patients with ankle fractures, and similar approaches may be applicable to knee injuries 3.
- Outcome measures for the treatment of soft tissue swelling include the relative amount and time course of postoperative swelling, demand for analgesic therapy, rate of complications, and mobility of the affected joint 3.