Management of Knee Injuries After Falls
Initial Evaluation and Management
- The American College of Radiology recommends that management should be guided by the specific findings on imaging, with MRI without IV contrast being the most appropriate next imaging study after radiographs do not show fracture, to evaluate for suspected occult fractures or internal derangement 1, 2
- For Grade III medial collateral ligament (MCL) injuries, surgical repair may be required if unstable 1
- For anterior cruciate ligament (ACL) injuries, complete tears typically require surgical reconstruction, especially in younger, active patients 1
- For posterior cruciate ligament (PCL) injuries, surgical intervention may be required for multi-ligament injuries or persistent instability 1
- For tibial plateau fractures identified on MRI after negative radiographs, further evaluation with CT may be appropriate 1, 3
- For bone marrow edema/contusions, monitor for development of osteonecrosis in severe cases 1
- If knee dislocation is suspected or confirmed, evaluate for vascular injury with CTA lower extremity with IV contrast 1, 4
- Popliteal artery injuries require prompt surgical intervention to preserve limb function 4
- MRA may be performed simultaneously with MRI for evaluation of internal derangement and vascular injuries 1, 5