J Korean Orthop Assoc.  2014 Dec;49(6):480-484. 10.4055/jkoa.2014.49.6.480.

Therapeutic Embolization for Spontaneous Recurrent Hemarthrosis of the Knee in the Elderly

• Lee KW
• Song Y
• Song DG
• Choy WS

• KMID: 2185163
• DOI: http://doi.org/10.4055/jkoa.2014.49.6.480

Abstract

Without traumatic history, spontaneous hemarthrosis of the knee is a relatively rare condition, and there is no report of the diagnosis and treatments in Korea. In this case, magnetic resonance imaging and arthroscopic findings showed hemarthrosis and a lateral meniscus tear. Hemarthrosis of the patient remained after meniscus resection and coagulation; we then, found rupture of the lateral geniculate artery by computed tomography-angiography. We report on a case of successful treatment of spontaneous hemarthrosis with therapeutic embolization with a thorough review of the relevant literatures.

Keyword

hemarthrosis; therapeutic embolization; lateral menisci

MeSH Terms

Aged*
Arteries
Diagnosis
Embolization, Therapeutic*
Hemarthrosis*
Humans
Knee*
Korea
Magnetic Resonance Imaging
Menisci, Tibial
Rupture

Figure

• 

  Figure 1 Plain radiograph showed asymmetric joint space narrowing (lateral side) of the left knee.

• 

  Figure 2 Magnetic resonance imaging showed hemarthrosis with increased suprapatellar fluid collection and air-fluid level and showed a bucket-handle type tear of the lateral meniscus with empty space in the lateral femorotibial joint space. (A) Sagittal plane. (B) Coronal plane.

• 

  Figure 3 (A) On arthroscopic finding, there was degenerative change in the lateral compartment and a bucket-handle tear was observed on the lateral meniscus and no abnormal finding of synovium. (B) Partial meniscectomy and coagulation was performed.

• 

  Figure 4 CT angiography showed contrast leakage on posterior and hemarthrosis of the left knee.

• 

  Figure 5 (A) Active bleeding and hypervascularity (arrow) were seen in intervention radiography. (B) After embolization, there was a significant reduction (arrow) in abnormal vascularity.

Reference

1. Wilson JN. Spontaneous haemarthrosis in osteoarthritis of knee; a report of five cases. Br Med J. 1959; 1:1327–1328.

2. Kawamura H, Ogata K, Miura H, Arizono T, Sugioka Y. Spontaneous hemarthrosis of the knee in the elderly: etiology and treatment. Arthroscopy. 1994; 10:171–175.

3. Sasho T, Ogino S, Tsuruoka H, et al. Spontaneous recurrent hemarthrosis of the knee in the elderly: arthroscopic treatment and etiology. Arthroscopy. 2008; 24:1027–1033.

4. Arnoczky SP, Warren RF. Microvasculature of the human meniscus. Am J Sports Med. 1982; 10:90–95.

5. Shim SS, Leung G. Blood supply of the knee joint. A microangiographic study in children and adults. Clin Orthop Relat Res. 1986; 208:119–125.

6. Waldenberger P, Chemelli A, Hennerbichler A, et al. Transarterial embolization for the management of hemarthrosis of the knee. Eur J Radiol. 2012; 81:2737–2740.

7. Son KM, Kim JK, Seo YI, Kim HA. A case of bilateral hemarthrosis due to pseudoaneurysms in a patient on anticoagulation therapy. J Clin Rheumatol. 2013; 19:206–208.

8. Given MF, Smith P, Lyon SM, Robertson D, Thomson KR. Embolization of spontaneous hemarthrosis post total knee replacement. Cardiovasc Intervent Radiol. 2008; 31:986–988.

9. Bagla S, Rholl KS, van Breda A, Sterling KM, van Breda A. Geniculate artery embolization in the management of spontaneous recurrent hemarthrosis of the knee: case series. J Vasc Interv Radiol. 2013; 24:439–442.