Our consultant knee surgeon, Mr Dominic Spicer, discusses swollen knees after injury and why a correct early diagnosis is important.

When the first ski injury of the Northern Hemisphere season presented to us in mid-October, it looked like a bumper year for ski injuries. The snow was initially poor in the Alps but it has fortunately improved. The Winter months are a busy time of year for orthopaedic surgeons – particularly knee surgeons. A serious knee injury can occur as easily on an Olympic slalom run as falling off a button lift. But what they have in common is that they all need an accurate and early diagnosis.

Difficulty in getting such a diagnosis can lead to difficulties in initiating correct management plans. Recent work from the leading surgeons at London Bridge Orthopaedics has shown that, despite advances in treatment, many serious sports injuries, such as including ski injuries, still remain undiagnosed. Sometimes, a serious sports injury may linger for months after the event.

Despite presenting to acute units and casualty departments potentially devastating injuries can be missed. Although appearing normal a simple X-ray can provide false reassurance to the unwary – even in the presence of sometimes serious soft tissue injuries.

Often the injury mechanism alone can alert the wary to the likely diagnosis. Rapid swelling of the knee joint, which is often noted within a matter of a few hours of injury, can indicate blood in the joint – a major red flag to the surgeon. It indicates ‘something bad has happened. Swollen knees could represent a fracture, with bleeding from the actual bone. In fact, this more commonly develops after a significant ligament injury, usually damage to the anterior cruciate ligament (one of the main stabilising ligaments in the knee joint).

So, why are so many of these injuries still missed?

Lack of awareness accounts for the vast amount of the problems. A high index of suspicion is absolutely necessary. Asking the right questions and being aware of the possibility of serious injury, alongside seeking early expert advice, is absolutely necessary.

People assume an MRI scan is all that is needed but an MRI is only part of the answer. Perhaps, surprising to some, an MRI can, on occasion, show an apparently normal knee. Accurate interpretation, correlating the story, examining the joint and THEN using an MRI on the joint, should it be needed.

In many cases, an MRI is only used to corroborate what a good clinician suspects already.

Whatever your sport, whether it is winter sports, martial arts, racquet sports, contact or non-contact sports, remember: if it’s swollen rapidly after injury then your knee needs assessing properly!

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