What's the best course of treatment for a knee injury with swelling from a 6ft fall, able to bear weight, with a negative X-ray for fracture?

Management of Knee Injury with Swelling After 6ft Fall

For a knee injury with swelling from a 6ft fall where the patient is able to bear weight and X-ray is negative for fracture, the recommended treatment is conservative management with RICE protocol (rest, ice, compression, elevation), pain control, and early physical therapy with gradual return to activity. 1

Initial Assessment and Management

• Since X-rays are already negative and the patient can bear weight, this rules out most significant fractures requiring surgical intervention 2, 1
• Initial management should focus on controlling pain and swelling with:
  • Rest and limited weight-bearing as tolerated 1, 3
  • Ice application for 15-20 minutes every 2-3 hours for the first 48-72 hours 3
  • Compression with an elastic bandage or knee sleeve 3
  • Elevation of the limb above heart level when possible 3
  • Appropriate analgesics (NSAIDs if not contraindicated) 3

Further Evaluation

• Despite negative X-rays, soft tissue injuries may still be present and should be evaluated 1
• Physical examination should assess:
  • Joint stability (collateral and cruciate ligaments) 2, 3
  • Range of motion limitations 4
  • Presence of joint effusion 2, 4
  • Localized tenderness patterns 2, 1
• Consider MRI as the next imaging study if there is:
  • Significant joint effusion 2
  • Inability to fully bear weight after 5-7 days 2, 1
  • Mechanical symptoms (locking, catching) suggesting meniscal injury 2
  • Joint instability suggesting ligamentous injury 2, 1

Rehabilitation Protocol

• Early mobilization with progressive weight-bearing as tolerated 3
• Begin with isometric quadriceps strengthening exercises 3
• Progress to range of motion exercises as pain allows 3
• Gradually increase activity level based on symptoms 3
• Physical therapy is recommended to:
  • Restore normal range of motion 3
  • Strengthen supporting musculature 3
  • Improve proprioception 3
  • Provide gait training if needed 3

Indications for Specialist Referral

• Persistent joint effusion beyond 1-2 weeks 2, 1
• Mechanical symptoms (locking, catching) 2
• Instability with walking or other activities 2
• Failure to improve with conservative management after 2-3 weeks 1, 3

Return to Activity Guidelines

• Gradual return to activities when:
  • Full range of motion is restored 3
  • No pain with weight-bearing 3
  • Normal strength compared to uninjured side 3
  • No instability with functional movements 3

Important Considerations

• Even with negative X-rays, occult fractures or significant soft tissue injuries may be present 2
• The ability to bear weight is a positive prognostic sign but doesn't rule out all significant injuries 2, 4
• Most isolated medial collateral ligament injuries and small meniscal tears can be managed conservatively 3
• Anterior cruciate ligament, lateral collateral ligament, and large meniscal tears typically require surgical management if diagnosed 3