Soft Tissue Knee Injury Follow-up
- Author: David B Levy, DO, FAAEM; Chief Editor: Trevor John Mills, MD, MPH more...
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.
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.
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.
Prophylactic bracing with a knee immobilizer may prevent further injury.
Conditioning programs strengthen surrounding supporting structures.
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.
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.
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.
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