What is the treatment for knee joint hemorrhage?

Treatment for Knee Joint Hemorrhage

The management of knee joint hemorrhage requires immediate aspiration to remove blood from the joint, followed by appropriate immobilization, pain control, and targeted interventions based on the underlying cause of bleeding. 1

Initial Assessment and Management

• Immediate aspiration of hemarthrosis:

  • Aspiration helps minimize the harmful effects of blood in the joint, which can lead to cartilage degeneration 1
  • Blood in the joint space can cause hemosiderotic synovitis, oxidative stress, and accelerate cartilage degeneration 2

• Hemodynamic evaluation:

  • Assess vital signs, looking for signs of internal blood loss 3
  • For unstable patients, administer high FiO2, establish large-bore IV access, obtain baseline labs 3
  • Target systolic BP of 80-100 mmHg until major bleeding is controlled (if no brain injury) 4

Diagnostic Workup

• Imaging:

  • Plain radiographs to rule out fractures
  • Consider MRI to identify underlying soft tissue injuries (meniscal tears, ligament injuries)
  • For unstable patients, FAST ultrasound can detect free fluid 3

• Arthroscopy:

  • Indicated for recurrent or unclear hemarthrosis 5
  • Diagnostic arthroscopy reveals the cause in nearly 100% of cases 5
  • Common findings include anterior cruciate ligament tears (70%), cartilage/bone lesions (30%), and meniscal tears 5

Treatment Algorithm

1. Joint aspiration:

   • Remove blood from the joint to prevent cartilage damage
   • Send aspirate for cell count, culture, crystal analysis if etiology unclear

2. Immobilization:

   • Apply knee immobilizer or splint 6
   • Duration based on underlying pathology and severity

3. Pain management:

   • NSAIDs for pain and inflammation
   • Consider opioids for severe pain

4. Treatment based on underlying cause:

   • Ligament injuries: Referral to orthopedic specialist for possible surgical intervention
   • Meniscal tears: Arthroscopic resection for persistent hemarthrosis 6
   • Fractures: Appropriate fracture management

5. Coagulopathy management (if present):

   • Consider tranexamic acid (10-15 mg/kg followed by infusion of 1-5 mg/kg/h) 3
   • Target fibrinogen levels >1.5 g/L and platelet count >75 × 10⁹/L 3

Special Considerations

• Age-specific approach:

  • Younger patients (<30 years): Higher incidence of anterior cruciate ligament damage, especially with sports injuries 7
  • Older patients (>30 years): Higher incidence of crack fractures 7
  • Elderly patients with osteoarthritis: Often have degenerative meniscal tears as source of bleeding 6

• Thromboprophylaxis:

  • Initiate standard venous thromboprophylaxis as soon as bleeding is controlled 3
  • For isolated knee injuries requiring immobilization, pharmacologic thromboprophylaxis is not routinely recommended 4

Follow-up and Monitoring

• Regular assessment of pain levels and joint function
• Monitor for recurrent hemarthrosis
• For patients with significant injuries, referral to specialist knee clinic for further management 7

Potential Complications

• Recurrent hemarthrosis
• Post-traumatic arthritis
• Joint stiffness and decreased range of motion
• Infection (if aspiration performed without proper sterile technique)

Early diagnosis and appropriate management of knee hemarthrosis are crucial to prevent long-term complications such as early-onset osteoarthritis 1.