What is the best management approach for knee inflammation and pain after an acute fall?

Management of Knee Inflammation After Acute Fall

For a 49-year-old patient with knee inflammation following an acute fall, intra-articular corticosteroid injection is indicated for flares of knee pain, especially with effusion, providing rapid relief of inflammatory symptoms. 1

Initial Assessment and Management

• Evaluate for severity of inflammation and pain:

  • Presence of effusion
  • Focal tenderness
  • Ability to bear weight
  • Range of motion limitations

• Implement PRICE protocol for first 72 hours 2:

  • Protection: Protect the knee from further injury
  • Rest: Limit weight-bearing for up to 72 hours
  • Ice: Apply cold therapy to reduce swelling
  • Compression: Use compressive bandage or sleeve
  • Elevation: Keep the knee elevated when possible

Pharmacological Management

First-line options:

1. NSAIDs (e.g., naproxen):

   • Start with 500mg twice daily 3
   • Provides improved pain control, decreased swelling, and more rapid return to activity 2
   • Monitor for gastrointestinal, cardiovascular, and renal side effects 1

2. Acetaminophen:

   • Up to 4g daily in divided doses for mild to moderate pain 1
   • Less effective than NSAIDs but safer profile for some patients

3. Topical NSAIDs:

   • Apply 3-4 times daily 1
   • Good safety profile, especially for patients >75 years

For persistent inflammation:

1. Intra-articular corticosteroid injection:
   • Particularly effective for knee pain with effusion 1
   • Provides rapid relief of inflammatory symptoms
   • Consider once inflammation has been present for >1 week and not responding to oral medications

Physical Therapy Progression

1. Initial phase (once inflammation is more controlled):

   • Gentle range of motion exercises
   • Isometric quadriceps strengthening
   • Non-weight bearing exercises

2. Progressive phase:

   • Land-based aerobic exercises
   • Quadriceps strengthening exercises
   • Range of motion exercises 1
   • Functional treatment has been shown to be superior to immobilization 2

3. Advanced phase:

   • Sport-specific drills
   • Balance training
   • Endurance training 2

Supportive Measures

• Bracing:

  • Soft braces or knee sleeves can improve pain and self-reported physical function 1
  • Lace-up or semi-rigid supports are more effective than tape or elastic bandages 2

• Activity modification:

  • Avoid aggravating movements 1
  • Consider appropriate footwear

When to Consider Corticosteroid Injection

Intra-articular corticosteroid injection should be considered when:

1. There is persistent effusion despite oral anti-inflammatory treatment
2. Pain is limiting rehabilitation progress
3. Inflammation is not adequately controlled with oral medications
4. Patient needs rapid relief to begin physical therapy 1

Monitoring and Follow-up

• Reassess pain, function, and quality of life regularly
• If not responding to conservative treatment after 6-8 weeks, consider referral to orthopedic specialist 1
• Monitor for potential side effects of medications

Caution

• Avoid prolonged immobilization as functional treatment has been shown to be superior 2
• Use NSAIDs at the lowest effective dose for the shortest duration 1
• For patients with significant trauma, radiographs should be obtained to rule out fracture 2

The combination of appropriate anti-inflammatory treatment (oral or injectable) followed by structured physical therapy offers the best approach for recovery from knee inflammation after an acute fall 1, 2.