Recently one of my sons developed a swollen knee. He had been biking and felt it was due to biking. He says he did not hit his knee and we could not see any bruise. He saw a pediatrician. Blood was drawn. The CBC and ESR clotted despite a request for STAT blood work.
The knee got so bad, we had to take him to the ER. Dr. Theiss at Inova was amazing. He saw him, did an xray and tapped the joint and had the fluid analyzed all within 5 hours: that is fast for an ER.
Dr. Theiss removed 50cc of fluid. It looks like my son had an aseptic knee effusion: there was no bacteria seen initially though cultures will take days to return and only 7000 white blood cells. You need 15000 wbc present to say it is a Septic (or infected) knee joint.
Still now the question is why did he get this swollen joint so suddenly and prevent him for walking.
Here is the research on Aseptic Knee Effusion:
What are the Causes?
Knee effusions may be the result of trauma, overuse or systemic disease. An understanding of knee pathoanatomy is an invaluable part of making the correct diagnosis and formulating a treatment plan. Taking a thorough medical history is the key component of the evaluation. The most common traumatic causes of knee effusion are ligamentous, osseous and meniscal injuries, and overuse syndromes. Atraumatic etiologies include arthritis, infection, crystal deposition and tumor. It is essential to compare the affected knee with the unaffected knee. Systematic physical examination of the knee, using specific maneuvers, and the appropriate use of diagnostic imaging studies and arthrocentesis establish the correct diagnosis and treatment
What are the Treatments?
It depends on the cause but in general the options are: 1. Tap: sometimes frequent tapping 2. Treat underlying disorder always. 3. Inject steroids (also known as glucocorticoids) into joint 4. Arthroscopic Synovectomy 5. Stem Cell Injection: not FDA approved. No proof it helps yet (see end of post in Reference Section): but may help.
1. Introduction
Juvenile idiopathic arthritis (JIA) is a heterogeneous group of conditions for which a new classification scheme was developed in 1997, in Durban [1]. The management of knee involvement in patients with JIA is a common problem for rheumatologists. Intraarticular injection of a glucocorticoid (usually triamcinolone hexacetonide) is a widely accepted treatment modality that has been found effective in many studies [2]; [3]; [4]; [5]; [6] ; [7]. In practice, intraarticular glucocorticoid therapy has radically transformed the prognosis, relieving the symptoms for about 4–6 weeks in two-thirds of patients [8]. When repeated intraarticular glucocorticoid injections are ineffective, arthroscopic synovectomy is the accepted treatment [9]; [10]; [11] ; [12].
In adults, the results of randomized controlled trials have led to widespread acceptance of joint lavage with or without arthroscopy in the treatment of femorotibial osteoarthritis [13]; [14] ; [15]. In 1971, lavage of the knee to treat rheumatoid arthritis was not found significantly effective as compared to intraarticular glucocorticoid injections alone [16]. The few studies published since then [17]; [18]; [19] ; [20] have failed to provide definitive conclusions on the efficacy of joint lavage with or without arthroscopy. This uncertainty is ascribable to differences across studies in patient characteristics, evaluation criteria, and lavage techniques (arthroscopy or closed circuit, differences in needle size and saline volume, lavage alone or followed by injection of a glucocorticoid in various dosages). We are not aware of published studies of joint lavage in children.
We retrospectively evaluated the potential benefits of joint lavage followed by glucocorticoid injection to treat knee involvement in patients with JIA who were potential candidates for more invasive procedures such as synovectomy.
An 11 year-old girl developed a sterilekneeeffusion in association with vertebral osteomyelitis. Blood cultures grew Streptococcus Pneumoniae. Sterilejoint effusions and vertebral osteomyelitis are both rare complications of pneumococcal infection although this organism is a frequent cause of bacteremia in childhood.
Synovitis secondary to penetrating plant thorn injuries is not frequently reported. Historically, it is considered aseptic and treated with removal of the intraarticular foreign body and affected synovial lining. We report a 57-year-old healthy man who was admitted 2 weeks after being injured by a rose (Rosacea) thorn with subacute and mild synovitis with effusion of his right knee. No intraarticular foreign body was retained. Pantoea agglomerans was identified in the synovial fluid. Contrary to former teaching, effusions from joints violated by thorns should not be presumed sterile. Bacterial growth is reported infrequently, but when reported, Pantoea agglomerans is the most common organism found. We recommend removal of foreign bodies if present, arthroscopic total synovectomy, and beginning empiric antibiotic treatment with coverage against gram-negative enteric pathogens in all cases of thorn synovitis until the results of culture specimens are known. Improved physician awareness can result in more rapid diagnosis and improved clinical outcome in affected individuals.
To retrospectively evaluate the benefits of knee joint lavage with intraarticular glucocorticoid injection in patients who have juvenile idiopathic arthritis with knee involvement unresponsive to repeated intraarticular glucocorticoid injections.
PATIENTS:
Seventeen knees in 10 children (eight girls and two boys) were treated from 1997 to 2000. Mean age was 14 years 9 months and mean disease duration was 7.2 years. The diagnoses were juvenile oligoarthritis (n = 6, including two with extended disease), systemic arthritis (n = 2), juvenile spondyloarthropathy (n = 1), and juvenile dermatomyositis (n = 1). Repeated intraarticular triamcinolone hexacetonide injections had been performed in all the patients, the mean number of injections being 2.2 per patient within the last 30 months. Plain radiographs were normal in six of the eight patients. Mean erythrocyte sedimentation rate was 21.7 mm/h and mean C-reactive protein level was 20.6 mg/l. Joint fluid was obtained from 10 knees and had a mean cell count of 12?660 mm(-3). Second-line therapy was with methotrexate alone or combined with cyclosporine or azathioprine. Oral glucocorticoids and/or nonsteroidal antiinflammatory drugs were used for symptom relief. TREATMENT PROCEDURE: Lavage was performed under strict aseptic conditions with simple analgesia, on a day-hospital basis. After aspiration of the joint, lavage was performed with saline, and a delayed-action glucocorticoid was injected. The knee joint was immobilized in the extended position for 48 h. Efficacy criteria were presence of effusion, presence of pain, and presence of a systemic treatment-sparing effect.
RESULTS:
Freedom from effusion and pain was noted in all 17 knees after 1 month, in eight (47%) knees after 6 months, and in seven (41%) knees after 12 months. The patients with the longest lasting improvements had systemic polyarthritis. After joint lavage, second-line treatment was reduced in two patients and oral glucocorticoid therapy was stopped in two others. None of the variables studied (age, sex, disease duration, inflammatory syndrome, or joint fluid cytology) predicted a good response. No adverse effects were recorded.
CONCLUSION:
These preliminary results show that joint lavage with glucocorticoid injection is safe in children. The improvements were modest, but the patients had a history of arthritis refractory to multiple triamcinolone hexacetonide injections. Thus, joint lavage may have a place in the treatment pyramid just before synovectomy.
These are all the papers to date 5/4/17 on Aseptic Knee Effusion:
Looking to the injured knee for potential stem cell harvesting has attractive benefits. Stem cells can be successfully harvested but the concentrations with the current technology are lower than bone marrow or lipoaspirate sites. The technique of utilizing the kneeeffusion and tissue by-products after cruciate ligament injury shows future promise.
