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Soft Tissue Knee Injury Follow-up

  • Author: David B Levy, DO, FAAEM; Chief Editor: Trevor John Mills, MD, MPH  more...
 
Updated: Feb 20, 2016
 

Further Outpatient Care

The type and degree of injury dictate the timing and specifics of follow-up care. Arrange checkups, preferably within 24 hours, for any patient sustaining soft-tissue injury of the knee in which (1) muscle spasm precludes adequate knee assessment, (2) the mechanism of injury suggests a more serious injury, or (3) the patient perceives a snap or pop at the time of the incident and a hemarthrosis evolves.

Promote RICE therapy for mild to moderately severe strains and/or sprains.

  • R - Rest (crutch ambulation without weight bearing for initial 24-48 h)
  • I - Ice (application of ice on injured region for 20 min of each waking hour during the initial 48 h after injury)
  • C - Compression (with knee brace or splint, if necessary)
  • E - Elevation (above the level of the heart)

After pain and inflammation subside, the goal of the second phase is to regain strength and pain-free range of motion (ROM). Arrangements for physical therapy can be made after reassessment in the next 3-5 days.

When the diagnosis remains in doubt, the orthopedic consultant usually decides on the necessity for arthroscopy or MRI to clarify the diagnoses.

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Further Inpatient Care

Consequential soft-tissue damage of the knee with concurrent serious disorder, such as vascular compromise, threatening compartment syndrome, or multiple trauma, warrants admission to the appropriate surgical or orthopedic service for monitoring and potential surgical intervention.

Injuries requiring timely surgery, such as knee dislocation, complete quadriceps tendon rupture, open knee joint injuries, and total patellar tendon rupture, may necessitate admission to the general orthopedic service.

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Transfer

Patients with soft-tissue knee injuries complicated by vascular impairment or additional confounding trauma may require transfer to a facility capable of evaluating and treating such injuries.

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Deterrence/Prevention

Prophylactic bracing with a knee immobilizer may prevent further injury.

Conditioning programs strengthen surrounding supporting structures.

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Complications

Specific dislocations and fractures predispose the knee to popliteal artery and/or peroneal nerve damage.

Significant soft-tissue injuries of the knee and lower leg put the lower leg at risk for compartment syndrome.

Knee joint instability may follow unrecognized ligament damage.

Complications of anterior cruciate ligament (ACL) injuries include abnormal knee motion, which eventually causes major degenerative changes in the knee joint.

Recurrent locking, damage to the articular cartilage, and ensuing arthritis may follow missed meniscal injuries.

Infection may arise from abrasions, lacerations, aspiration, or injection of the knee. If unrecognized, knee joint destruction results.

Spontaneous rupture of tendons may follow use of intra-articular steroids.

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Prognosis

Most grade I or II collateral ligament sprains heal uneventfully after a 4- to 6-week course of conservative therapy; however, patients may have chronic pain and a tendency for recurrent injury. Grade III collateral sprains invariably give rise to tears of the posterior capsule, and patients frequently require bracing and physical therapy for 3 months or longer before returning to unrestricted activity.

Outlook for ACL injuries depends on numerous factors, including extent of the lesion, age, activity level desired, and presence of coexistent injuries.

A high rate of recurrence follows simple aspiration of a Baker cyst, while these cysts reappear less than 5% of cases after surgical correction.

Infection and chronic weakness of the extensor apparatus may follow surgical repair.

Development of recurrent locking, popping, or effusions subsequent to an adequate trial of conservative therapy for meniscal tears may suggest the need for surgical intervention.

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Patient Education

Failure to respond to conservative treatment may indicate a missed or overlooked diagnosis, such as complicated ligamentous or meniscal damage.

Follow-up care is essential. Inadequate treatment may result in chronic instability and/or degenerative joint disease. Concurrent collateral ligament injuries and meniscal tears are often difficult to diagnose; this situation increases the importance of follow-up care.

Physical therapy is focused on quadriceps strengthening and extensor stretching, in conjunction with ultrasound modalities and phonophoresis.

After the immediate problems are under control in patients recovering from a patellar subluxation or dislocation, focus further therapy on quadriceps strengthening and use of a patellar cutout brace.

For patient education resources, see the First Aid and Injuries Center and Arthritis Center. Also see the patient education articles Knee Pain, Knee Injury, Sprains and Strains, and Knee Dislocation.

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Contributor Information and Disclosures
Author

David B Levy, DO, FAAEM Senior Consultant in Emergency Medicine, Waikato District Health Board, New Zealand; Associate Professor of Emergency Medicine, Northeastern Ohio Universities College of Medicine

David B Levy, DO, FAAEM is a member of the following medical societies: American Academy of Emergency Medicine, Fellowship of the Australasian College for Emergency Medicine, American Medical Informatics Association, Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Coauthor(s)

Howard I Dickey-White, MD Teaching Attending Physician, Department of Internal Medicine, St Elizabeth Hospital Medical Center

Howard I Dickey-White, MD is a member of the following medical societies: American Academy of Clinical Toxicology, American College of Emergency Physicians, American College of Physicians, American Institute of Ultrasound in Medicine, Sigma Xi, Society of Critical Care Medicine

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Chief Editor

Trevor John Mills, MD, MPH Chief of Emergency Medicine, Veterans Affairs Northern California Health Care System; Professor of Emergency Medicine, Department of Emergency Medicine, University of California, Davis, School of Medicine

Trevor John Mills, MD, MPH is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians

Disclosure: Nothing to disclose.

Additional Contributors

Eric M Kardon, MD, FACEP Attending Emergency Physician, Georgia Emergency Medicine Specialists; Physician, Division of Emergency Medicine, Athens Regional Medical Center

Eric M Kardon, MD, FACEP is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Medical Association of Georgia

Disclosure: Nothing to disclose.

Acknowledgements

June E Sanson CNRP, MSN Nurse Practitioner, Take Care Health Systems

Disclosure: Nothing to disclose.

Tom Scaletta, MD President, Smart-ER (http://smart-er.net); Chair, Department of Emergency Medicine, Edward Hospital; Past-President, American Academy of Emergency Medicine

Tom Scaletta, MD is a member of the following medical societies: American Academy of Emergency Medicine

Disclosure: Nothing to disclose.

References
  1. Gray AM, Buford WL. Incidence of Patients With Knee Strain and Sprain Occurring at Sports or Recreation Venues and Presenting to United States Emergency Departments. J Athl Train. 2015 Nov. 50 (11):1190-8. [Medline].

  2. Kapur S, Wissman RD, Robertson M, et al. Acute knee dislocation: review of an elusive entity. Curr Probl Diagn Radiol. 2009 Nov-Dec. 38(6):237-50. [Medline].

  3. Shah MK. Simultaneous bilateral rupture of quadriceps tendons: analysis of risk factors and associations. South Med J. 2002 Aug. 95(8):860-6. [Medline].

  4. Tuite MJ, Kransdorf MJ, Beaman FD, Adler RS, Amini B, Appel M, et al. ACR Appropriateness Criteria Acute Trauma to the Knee. J Am Coll Radiol. 2015 Nov. 12 (11):1164-72. [Medline].

  5. [Guideline] Pavlov H, Saboeiro GR, Campbell SE, Dalinka MK, Daffner RH, DeSmet AA, El-Khoury GY, Kneeland JB, Manaster BJ, Morrison WB, Rubin DA, Schneider R, Steinbach LS, Weissman BN, Haralson RH III, Expert Panel on Musculoskeletal Imaging. Acute trauma to the knee. [online publication]. Reston (VA): American College of Radiology (ACR); 2005. [Full Text].

  6. Parwaiz H, Teo AQ, Servant C. Anterior cruciate ligament injury: A persistently difficult diagnosis. Knee. 2015 Nov 6. [Medline].

  7. Hurdle MF, Wisniewski SJ, Pingree MJ. Ultrasound-guided intra-articular knee injection in an obese patient. Am J Phys Med Rehabil. 2012 Mar. 91(3):275-6. [Medline].

  8. Shaerf D, Banerjee A. Assessment and management of posttraumatic haemarthrosis of the knee. Br J Hosp Med (Lond). 2008 Aug. 69(8):459-60, 462-3. [Medline].

  9. Akseki D, Ozcan O, Boya H, Pinar H. A new weight-bearing meniscal test and a comparison with McMurray's test and joint line tenderness. Arthroscopy. 2004 Nov. 20(9):951-8. [Medline].

  10. Andersen RE, Crespo CJ, Ling SM, Bathon JM, Bartlett SJ. Prevalence of significant knee pain among older Americans: results from the Third National Health and Nutrition Examination Survey. J Am Geriatr Soc. 1999 Dec. 47(12):1435-8. [Medline].

  11. Arroll B, Goodyear-Smith F. Corticosteroid injections for osteoarthritis of the knee: meta-analysis. BMJ. 2004 Apr 10. 328(7444):869. [Medline].

  12. Bachmann LM, Haberzeth S, Steurer J, ter Riet G. The accuracy of the Ottawa knee rule to rule out knee fractures: a systematic review. Ann Intern Med. 2004 Jan 20. 140(2):121-4. [Medline].

  13. Bahk MS, Cosgarea AJ. Physical examination and imaging of the lateral collateral ligament and posterolateral corner of the knee. Sports Med Arthrosc. 2006 Mar. 14(1):12-9. [Medline].

  14. Berfeld J, Ireland ML, Wojtys EM. Pinpointing the cause of acute knee pain. Patient Care. 1997. 31(18):100-117.

  15. Calmbach WL, Hutchens M. Evaluation of patients presenting with knee pain: Part I. History, physical examination, radiographs, and laboratory tests. Am Fam Physician. 2003 Sep 1. 68(5):907-12. [Medline].

  16. Chandrashekar N, Mansouri H, Slauterbeck J, Hashemi J. Sex-based differences in the tensile properties of the human anterior cruciate ligament. J Biomech. 2006. 39(16):2943-50. [Medline].

  17. Christain EP. Extensor mechanism injuries of the knee. Top Emerg Med. 1995. 17(2):25-35.

  18. Christian SR, Anderson MB, Workman R. Imaging of anterior knee pain. Clin Sports Med. 2006 Oct. 25(4):681-702. [Medline].

  19. Davids JR. Pediatric knee. Clinical assessment and common disorders. Pediatr Clin North Am. 1996 Oct. 43(5):1067-90. [Medline].

  20. Emparanza JI, Aginaga JR. Validation of the Ottawa Knee Rules. Ann Emerg Med. 2001 Oct. 38(4):364-8. [Medline].

  21. Gupta A, Bodin L, Holmstrom B, Berggren L. A systematic review of the peripheral analgesic effects of intraarticular morphine. Anesth Analg. 2001 Sep. 93(3):761-70. [Medline].

  22. Ireland ML. The female ACL: why is it more prone to injury?. Orthop Clin North Am. 2002 Oct. 33(4):637-51. [Medline].

  23. Jackson JL, O'Malley PG, Kroenke K. Evaluation of acute knee pain in primary care. Ann Intern Med. 2003 Oct 7. 139(7):575-88. [Medline].

  24. Jacobson KE, Chi FS. Evaluation and treatment of medial collateral ligament and medial-sided injuries of the knee. Sports Med Arthrosc. 2006 Jun. 14(2):58-66. [Medline].

  25. Karachalios T, Hantes M, Zibis AH. Diagnostic accuracy of a new clinical test (the Thessaly test) for early detection of meniscal tears. J Bone Joint Surg Am. 2005 May. 87(5):955-62. [Medline].

  26. Karistinos A, Paulos LE. "Ciprofloxacin-induced" bilateral rectus femoris tendon rupture. Clin J Sport Med. 2007 Sep. 17(5):406-7. [Medline].

  27. Katz JN, Brophy RH, Chaisson CE, de Chaves L, Cole BJ, Dahm DL, et al. Surgery versus Physical Therapy for a Meniscal Tear and Osteoarthritis. N Engl J Med. 2013 Mar 18. [Medline].

  28. Louden K. Physical therapy as effective as surgery for meniscal tear. Medscape Medical News. March 20, 2013. Available at http://www.medscape.com/viewarticle/781102. Accessed: April 1, 2013.

  29. Munshi M, Davidson M, MacDonald PB, et al. The efficacy of magnetic resonance imaging in acute knee injuries. Clin J Sport Med. 2000. 10(1):34-9. [Medline].

  30. O'Shea KJ, Murphy KP, Heekin RD, Herzwurm PJ. The diagnostic accuracy of history, physical examination, and radiographs in the evaluation of traumatic knee disorders. Am J Sports Med. 1996 Mar-Apr. 24(2):164-7. [Medline].

  31. Perryman JR, Hershman EB. The acute management of soft tissue injuries of the knee. Orthop Clin North Am. 2002 Jul. 33(3):575-85. [Medline].

  32. Richman PB, McCuskey CF, Nashed A, et al. Performance of two clinical decision rules for knee radiography. J Emerg Med. 1997 Jul-Aug. 15(4):459-63. [Medline].

  33. Robertson A, Nutton RW, Keating JF. Dislocation of the knee. J Bone Joint Surg Br. 2006 Jun. 88(6):706-11. [Medline].

  34. Simon LV, Matteucci MJ, Tanen DA. The Pittsburgh Decision Rule: triage nurse versus physician utilization in the emergency department. J Emerg Med. 2006 Oct. 31(3):247-50. [Medline].

  35. Solomon DH, Simel DL, Bates DW, et al. The rational clinical examination. Does this patient have a torn meniscus or ligament of the knee? Value of the physical examination. JAMA. 2001 Oct 3. 286(13):1610-20. [Medline].

  36. Stannard JP, Sheils TM, Lopez-Ben RR, McGwin G Jr, Robinson JT, Volgas DA. Vascular injuries in knee dislocations: the role of physical examination in determining the need for arteriography. J Bone Joint Surg Am. 2004 May. 86-A(5):910-5. [Medline].

  37. Twaddle BC, Bidwell TA, Chapman JR. Knee dislocations: where are the lesions? A prospective evaluation of surgical findings in 63 cases. J Orthop Trauma. 2003 Mar. 17(3):198-202. [Medline].

  38. Wang CY, Wang HK, Hsu CY, Shieh JY, Wang TG, Jiang CC. Role of sonographic examination in traumatic knee internal derangement. Arch Phys Med Rehabil. 2007 Aug. 88(8):984-7. [Medline].

 
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Anatomy of the knee.
Knee ballottement.
Lachman test.
Anterior drawer sign.
Pivot test.
McMurray test.
Apley compression test.
 
 
 
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