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Soft tissue injury of the knee.

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Good Evening. I am Nick, 25, and formerly on Active Duty. I had hurt my knee pretty bad recently, which resulted in making an appearance at the ER. Though swollen and mildly warm, it was decided tapping the knee was not needed at the time. I was sent to an orthopedic surgeon at which point the surgeon attempted to relieve pressure by using a needle and syringe. Basically I was informed they got a lot less fluid than initially expected but due to the fluid being so thick, tapping the knee did not work, and the fluid they did get was never sent to lab. My leg is swollen, and have very noticeable bruising all the way to the backside top of my thigh. Of note, I have had multiple knee repairs, and even had to get admitted for 2 days on IV antibiotics and the drain was placed in the OR. Any suggestions or a possible idea of what I am dealing with here?.

Category: Orthopedic Surgeon

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Category: Spine Surgeon
Dr. Mukesh Tiwari is online now

Expert:  Dr. Mukesh Tiwari replied 4 Days.

Hello Nick,
Welcome at DoctorSpring.
I have read your question with diligence.
If there is blood in the tap from the knee, then there may soft tissue injury within the knee. There are various soft tissue structures in the knee like menisci, ligament and cartilage.
In case of an acute injury, due to the presence of swelling, it is difficult to make a correct clinical diagnosis on examination. At this stage if after doing clinical examination, there are some positive findings then you should get an MRI done to confirm the diagnosis. Depending of the diagnosis , treatment will be suggested.

If there is no serious impairment you should avoid a knee surgery, as it may lead to stiffness.
It is difficult to say what exactly is your knee condition right now, but as I said earlier, it is likely you have a soft tissue injury.
You can follow up with your MRI reports and I will help you accordingly.

I hope this has helped.


Patient replied :

There was blood from the knee tap, however I was told they were unable to extract an amount that would make improvements possible. The reason for not being able to get more blood was because it was just to thick. Post visit, I have developed a pretty large bruise going all the way up behind my thigh. Would a soft tissue injury cause the amount of bruising I have now?

Expert:  Dr. Mukesh Tiwari replied 3 Days.

Bruise may develop after soft tissue injury and it may go away within 1-2 weeks. It is likely that during the injury, you also pulled your hamstring muscles, or got hit or blow at the back of your thigh, resulting in braking of some capillary vessels which resulted in the bruise at the back of your knee and thigh. Such a bruise usually starts at the thigh and goes down upto the knee. If they are unable to tap the large amount of blood then probably it is not there or clotted.There is no need to worry in that ,it will be resorbed. If there is no giving away sensation during walking and no locking sensation then you should not worry.Take rest then start physiotherapy according to your doctor's advice.
I would advise you to keep ice pack on the swelling and bruise for about 20 minutes, 2-3 times a day.
Try and rest with your leg elevated.
You can take the tablet Ibuprofen 400 mg 3 times a day for 3 day after food.
The bruise will gradually change colour to dark red, to bluish, then greenish and gradually yellow.

The history of multiple knee injuries / procedure is of a concern. In your case I would have actively considered a MRI for diagnosis. Please discuss this with your Doctor. As I said earlier as long as there is not mechanical problem the prognosis is better.

Hope this will help you.
Feel free to ask followups
With best wishes.

Patient replied :

So would you say it is pretty unlikely I have an infection going on? Sorry for all the questions. It is just I had a very similar injury to my other knee in the fall of 2012, same sequence of events (Referred to Orpthpedic Surgeon through the ER) was initially set up for an MRI that ended up cancelled because the surgeon had the fluid sent to lab for testing and I ended up in the operating room the next morning where an I/D was done and spent 2 days in the hospital on IV Antibiotics. Had no fever or chills then, so I am curious what would prompt someone in your line of work to send fluid taken to lab for testing. So I just want to make sure I am not in the same situation again. I was referred to MRI this time as well, and still waiting for them to inform me when I can come in. Thanks.

Expert:  Dr. Mukesh Tiwari replied 2 Days.


This incident , I am not sure whether you had an infection. It does not seem so. You did mention that there was an injury, so probably this is traumatic. Whenever you had the IV antibiotics it could be due to an infection - A secondary infection from a procedure or an primary infection of the joint known as Septic arthritis.

In Septic arthritis there will be join pain, tenderness, fever etc. Since you did not have these features most likely you were given antibiotics are a precautionary measure after the knee procedure.

You SHOULD discuss with your Doctor regarding the diagnosis. You seem to be ill informed. You have the right to be informed about the disease condition. Do consider a MRI scan

Hope this helps
Thank you

Patient replied :

Ill informed in terms of what? I think I know what you are referring to however I don't like to assume. Yes, I was and still am unclear as to what prompted the need for surgery to begin with when I was not having any signs of being sick aside from a swollen knee that was warm to the touch. I was also unclear on what prompted the need for me to remain hospitalized following surgery for IV Antibiotic therapy for 2 days. Basically I have the mindset you people are the professionals, and know what is going to help me in the long term. So whatever I am told, I don't spend much time inquiring for information because people in your line of work went to school, and went to school for a pretty long time. I didn't Also, I did speak to my provider today and once I mentioned to him that the soonest MRI appointment I could get is March 4th at which point he told me that is to long of a wait so he informed me that he was going to resubmit the MRI order as a stat order and I just got finished with the MRI about 2 hours ago and am now being told he would like to see me weekly until this issue is resolved. If you do not mind, once I get the results back, I would really appreciate it if you could also review the results. To be blunt if I may, I don't have the slightest idea of what 95% of the terminology even means. Thank you again very much for taking the time to help me get a better understanding of the information I am getting.

Expert:  Dr. Mukesh Tiwari replied 1 Day.

I am glad you were able to get your MRI done. I will try my best in helping you with your queries. You can upload your MRI reports as and when you get them & I shall advise you accordingly.

Best wishes.

Dr. Mukesh Tiwari
Category: Spine Surgeon
Fellowship - Khandaka Hospital, Jaipur
Residency - MS, Rabindranath Tagore Medical College, Udaipur, 2000
Medical School, Internship - MBBS, SMS Medical College, Jaipur, 1995
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