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Haemarthrosis (knee or other) and lasting damage?

 Poster: A snowHead
Poster: A snowHead
How many of you had bleeding into the joint after a knee or other similar joint structure injury, and if so, how bad? (I did, pretty bad, I think.)
I thought that it was fairly common with ACL rupture, but not sure how common is common.
My current physio says that blood in the joint is now known to cause lasting damage to internal knee structures (she wasn't terribly precise as to what or why), so thinks I might be left with lasting problems or damage simply because of this; maybe why I'm getting pain still. If so, well, not 100% great, but it separates out another possible problem from a pure ligament one.
It's all a bit academic, and I'm not finding a great amount on Google thus far, bar to support cartilage damage in an in vitro study. So, really, I'm hoping that the esteemed Jonathan Bell will pop around sometime with some words if wisdom... Smile
But if anyone else has experience or knowledge, please share.
Ta.
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 Obviously A snowHead isn't a real person
Obviously A snowHead isn't a real person
@Grizzler, I also thought it was pretty inevitable if the ACL/ other ligaments tore / bones broke? I had at least some for sure with ACL/MCL/meniscus. The bruising wasn’t very visible to me but the surgeon spotted it immediately. And I’m fairly sure there was lots of it with the surgery. The bruising was spectacular.
I’m a bit confused about how that is damaging though - I know meniscus repairs often work better if done at the same time as ACLrs because the bleeding in the joint from the ACL recon helps the meniscus suture to heal.
Watching with interest!
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Well, the person's real but it's just a made up name, see?
I was not aware of any real visible external bruising (odd, given how hard I must have slammed down) except on my side buttock where the b**ch pushed me with her fists/poles Evil or Very Mad

If you want some bedtime reading, try: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4297157/
I have no clue how valid it is as a paper, but there is a suggested mechanism of damage. Just all I could find on a quick Googlette last night.

The blood in joint bit always confuses me when they also say that the ACL can't self heal like other ligaments because of a lack of blood or other healing chemicals and cascades and things... Puzzled
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Oh, and joint issues are a definite recognised problem with hemophiliacs too (hence the "micro bleed" reference in the paper above), without them having to throw themselves down slippery hills to initiate it (sadly for them, I mean).
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@Grizzler, thank you, I’ll read through. I thought - correct me if I’m wrong - that the ACL can’t heal because where it is in the knee the synovial fluid washes away the blood before it can clot - and clotting is the “scaffold” for the tissue to rebuild. Also parts of the meniscus can’t heal even if stitched up, because they haven’t got blood supply to do the clotting. For the parts of the meniscus that do have their own blood supply, the blood in the joint from the ACL recon can help with this clotting and “scaffolding” process. I may have got it all wrong though.
On the other hand it could still be the case that blood “sitting around” in the joint long term is bad for it?
I didn’t spot - or didn’t want to see - the bruising after the injury. So before the MRI, when I was still in denial, I said to the consultant “but it can’t be that bad, I have no swelling or bruising”. “Yes you do” he said and pointed them both out. And sure enough there was the bruising - very faint, but there.
Your accident sounds very traumatic. What happened if I’m not too nosy? Did she push you deliberately????
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@BorntoRun, your explanation sounds about right to me (or familiar, whatever) - except how's all that synovial fluid washing away all the blood if there's a lot of blood, which doesn't go away for several days plus? I wonder if a large haemarthrosis therefore does assist with some degree of ACL healing or reattachment to something via clotting scaffolding type pathways? (Though like many folks I was on anticoagulants post injury too.)
I don't know; not a specialist at this level, and can't find anyone else who can explain it either.

As for the 'accident', I was hit from side rear by some totally unaware woman travelling from diagonally behind me across a piste which I was going straight down (cutting up loads of others too, but she only hit me). She was at very high speed in a race crouch, hands and poles out front (not that she was exactly race skier standard...). Instead of pulling up or skidding/turning off (she would have been able to do something, I'm told - and I caught her in peripheral vision, yelped a warning and was turning away), she just kept on coming in a straight line and deliberately shoved me out of her way via my rear end, probably why I went up in the air and somersaulted before landing on my front. This is all 2nd hand, via Mr G who saw it all from behind. She didn't lose her balance, fall or even stop...
Hey ho, it happens. I'm just a tad nervous on populated pistes now rolling eyes
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 Then you can post your own questions or snow reports...
Then you can post your own questions or snow reports...
@Grizzler, yikes, didn’t even stop!!! That’s unspeakable. From your description there’s no way she wouldn’t have realised what she’d done - in fact could have expected other injuries too if you somersaulted. Can’t have been nice for Mr G to watch either. I’m very sorry. No wonder about the populated pistes. No one came anywhere near doing anything like that to me, but even so I’ve said choice words to a few people in the past - especially overconfident idiots who overtake aggressively on the inside on narrow ledgy runs. You’ve got all my respect for getting back on the horse and still having fun in the snow.
I had physio this morning so I asked my physio if he’s seen anything about bleeding in the joint causing damage. He hadn’t. Let’s see if Jonathan Bell gives a view though, as you say.
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@Grizzler, when I 'had an issue' with my tibial plateau a few years back I definitely bled into my knee - the Doc in the trauma centre took around 60mls of blood out of it & I have a picture to prove it Shocked

Chatting with my Consultant on return to the UK they apparently take a sample to see if there are any fat globules present (indicating marrow leakage & therefore bone, rather than just soft tissue, damage). The trauma guy removed that volume to relieve pressure on the joint capsule (which is where most of the pain originates from).
Marcus (the Consultant) didn't seem particularly fussed about the blood in my knee - he was more concerned with getting my consent to use images from my MRI scan to use in future lectures (those T2-weighted images (?) were pretty exceptional...). Oh, and calling me a lucky bucking fastard several times (with prods for emphasis, might I add...).

Consent was given without a second thought & since I apparently didn't require surgery and as he's a friend of the family I graciously accepted the 'lucky' observation & prodding.

Timeline: injured Jan '15, next ski holiday was PreBB in 2016, have skied 14 or 15 weeks since then & taken a load of lessons to improve technique.

My knee has only really been genuinely 'pain-free' this season when skiing (has been 'achey' but pretty sure that also happened pre-injury; I'm not getting younger either).
Work-wise (& I have a fairly physical job) I have been pain-free for 18 months-or-so. My colleagues at work haven't recently commented that I'm limping (that's just me being lazy & walking in a 'non-Physio approved'* fashion) due to a numb bum from driving excessive miles or laziness (as my Physio would say).

*The body/brain is remarkable at rapidly changing the firing-order of muscles in order to reduce the discomfort/pain with each step.
Retraining the correct sequence following an injury takes a lot, lot longer.
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