Treatment for Knee Contusion
The optimal treatment for a knee contusion should begin with the RICE protocol (Rest, Ice, Compression, Elevation) for the first 24-72 hours, followed by a progressive rehabilitation program including gentle range of motion exercises and gradual return to activity. 1, 2, 3
Initial Management (First 24-72 hours)
RICE Protocol
- Rest: Avoid weight-bearing activities that cause pain; use crutches if necessary
- Ice: Apply cold packs for 15-20 minutes every 2-3 hours
- Compression: Use an elastic bandage to reduce swelling
- Elevation: Keep the knee elevated above heart level when possible
Medication
- Topical NSAIDs: First-line treatment for pain relief with fewer systemic effects 4, 1
- Oral NSAIDs: Consider naproxen 500mg twice daily when not contraindicated 1
- Acetaminophen: Up to 4g/day as a safe alternative if NSAIDs are contraindicated 1
Rehabilitation Phase (After 72 hours)
Exercise Therapy
- Begin gentle range of motion exercises as soon as tolerated
- Progress to strengthening exercises for quadriceps and hamstrings
- Continue for 2-3 weeks until normal strength and range of motion are restored 1
Activity Modification
- Gradually return to normal activities as pain and swelling decrease
- Consider low-impact exercises (swimming, cycling) before returning to high-impact activities
Warning Signs Requiring Further Evaluation
- Significant decrease in knee range of motion
- Sympathetic knee effusion (swelling)
- Signs of infection (increased warmth, redness, fever)
- Persistent pain beyond 2-3 weeks 1, 5
Advanced Imaging
- X-rays: Usually not necessary for simple contusions unless fracture is suspected
- MRI: Consider if symptoms persist beyond 2-3 weeks or if there is concern for associated injuries (ligament tears, meniscal damage) 4, 6
Special Considerations
- Kissing contusions: These involve both surfaces of the joint and may indicate more serious underlying injuries requiring more careful management and possibly MRI evaluation 6
- Risk of myositis ossificans: Early range of motion exercises can help prevent this complication 5
Prevention of Complications
- Reassess after 1-2 weeks of initial treatment
- Immediately reevaluate if symptoms worsen 1
- Avoid prolonged immobilization which can lead to stiffness and muscle atrophy
Return to Activity Criteria
- Full or near-full pain-free range of motion
- Restored muscle strength (at least 90% compared to uninjured side)
- Ability to perform sport-specific movements without pain
Most knee contusions resolve completely with appropriate conservative management. The key to successful treatment is early implementation of the RICE protocol followed by progressive rehabilitation to restore normal function and prevent complications.