In general terms, there are a number of features which typify a more significant knee injury:
Firstly, a significant amount of swelling, especially associated with a hemarthrosis, is a giveaway that something more serious has taken place.
Secondly, if the matter is very troublesome and the patient cannot weight bear after a week, it usually indicates that there has either been a very serious intra-articular injury such as an anterior cruciate ligament tear or meniscal lesion, or indeed that there is a fracture.
Thirdly, patients who are unable to straighten their knee a week after injury often have a more significant factor in play. Matters such as a bucket handle tear of the meniscus which is locked into the joint or perhaps a loose piece of cartilage or bone are also candidates for inability to extend the knee. These patients require investigation and usually surgical management.
Fourthly, if the patient continues to experience feelings of apprehension or marked discomfort especially with nocturnal pain, there is usually a more significant factor at play.
Number five, the final factor is very rare but does require some consideration: If a patient has night pain and if they are losing weight, one must always think of infection and tumor. Both of these matters require investigation. Night pain should always be taken seriously.
Remember that I am always prepared to take phone calls where you are having difficulty managing patients. Please do not hesitate to call me on my mobile phone or via my secretarial service.