Patella balloting is a condition in which the patella sinks into the joint during pressure until it contacts the underlying bones, and when the pressure stops, it rises back. Indicates the presence of fluid in the joint. It is caused by the accumulation of blood - hemarthrosis or inflammatory fluid - synovitis. It occurs with injuries, degenerative and inflammatory diseases of the joint, and some other pathologies. To diagnose diseases accompanied by balloting of the patella, radiography, ultrasound, CT, MRI, puncture, arthroscopy and other procedures are prescribed. Before making a diagnosis, it is necessary to ensure the rest of the limb.
Reasons for balloting the patella
Injuries and operations
In the first days after the injury, balloting is caused by hemarthrosis, which occurs with any intra-articular and some extra-articular injuries. Subsequently, hemarthrosis is sometimes replaced by synovitis, in such cases, the patella, when examined, can run after several weeks and even months. The symptom is observed with the following injuries:
- knee injury;
- damage to the ligaments of the knee joint: external, internal, cruciate;
- damage to the ligaments of the patella: own ligament, tendon of the quadriceps muscle;
- meniscus damage;
- fractures: condyles and intercondylar eminence of the tibia, epicondyles of the femur, patella.
Due to the inevitable accumulation of blood, balloting is considered the norm in the early postoperative period during the removal of menisci, ligament suturing and plastics, and osteosynthesis of the bones that form the knee joint.
Arthritis
In inflammatory lesions, balloting of the patella occurs due to synovitis. It May be seen in the following types of arthritis:
- Nonspecific infectious arthritis. It develops after open intra-articular injuries, infection during puncture, or surgery. It is observed during the transition of inflammation from nearby tissues with phlegmon, abscesses, osteomyelitis, and other purulent processes.
- Specific infectious arthritis. It can be diagnosed with articular tuberculosis, syphilis, and other diseases.
- Primary aseptic arthritis. It is noted for rheumatism and other systemic diseases with articular syndrome. A variety of primary pathology is reactive arthritis that occurs after intestinal and genitourinary infections.
- Secondary aseptic arthritis. It is found in sarcoidosis, malignant neoplasms, and diseases of the blood, digestive and respiratory systems.
Ballooning of the patella
Other pathologies
Other pathologies with balloting due to synovitis include:
- gonarthrosis;
- infrapatellar bursitis;
- enchondromatosis;
- freely lying bodies;
- allergic synovitis;
- tumors of bones and soft tissues of the joint area.
With scurvy, hemorrhagic diathesis, and hemophilia, the patella ballots due to hemarthrosis that occurs against the background of minor injuries or synovitis due to secondary changes in the joint.
Diagnostics
Traumatologists-orthopedists or rheumatologists are engaged in the diagnosis of diseases in which there is balloting of the patella. If necessary, appoint consultations with other specialists. The fact of balloting is established during an objective examination. To clarify the diagnosis, the following procedures are performed:
- Radiography. It confirms the violation of the integrity of bones in fractures, the presence of degenerative changes in arthrosis, and damage to bone structures in specific and nonspecific infectious arthritis.
- Ultrasound of the knee. Detects fluid in the joint cavity, and articular torsion. Effective in detecting intra-articular bodies, tears, and torn ligaments.
- CT and MRI. Appointed to clarify the results of ultrasound and radiography. Computed tomography displays in detail the state of solid structures, MRI is effective mainly in the study of soft tissues.
- Puncture of the knee joint. It is carried out for diagnostic or therapeutic-diagnostic purposes. Allows you to confirm hemarthrosis or synovitis, to establish the nature of the fluid.
- Arthroscopy. The most reliable and informative research method. It provides for the possibility of visual inspection of the articular structures, and sampling of material for laboratory research. In some cases, it includes therapeutic measures.
- Laboratory tests. Microscopic examination is performed to determine the composition of the fluid, sowing is carried out to establish the nature of the pathogenic microflora, and cytological and histological examination of the fluid or biopsy specimens is carried out if tumor processes are suspected. For systemic pathologies, special tests are prescribed.
Ultrasound of the knee joint
Treatment
First aid
With all injuries and diseases accompanied by accumulation of fluid, it is necessary to give the leg an elevated position, to ensure peace. In case of traumatic injuries, cold should be applied to the damaged area to reduce swelling. In case of fractures, complete ruptures of ligaments, or purulent arthritis, immobilization is carried out using a splint. In other cases, it is enough to apply a fixing bandage.
Intense pain is an indication of taking an analgesic. A large amount of fluid or blood in the joint always resolves for a long time and with the formation of adhesions. Therefore, a patient with a ballot should be taken to a specialist even if other symptoms are mild.
Conservative therapy
Conservative treatment for diseases with balloting of the patella includes the following measures:
- Puncture. Produced upon admission. Subsequently, it is performed on an outpatient basis or in a hospital as fluid accumulates.
- Protective mode. Patients are advised to limit the load on the limb. According to indications, a plaster cast is applied, and it is advised to use crutches or a cane.
- Drug therapy. Taking into account the nature of the pathology, NSAIDs, antibiotics, painkillers, and other medicines are prescribed.
- Non-drug methods. UHF, drug electrophoresis, laser therapy, magnetotherapy, and other physiotherapy methods are used. Physiotherapy is complemented by exercise therapy and massage.
Surgery
Depending on the characteristics of the disease when balloting the patella, the following surgical interventions can be performed:
- Fractures: osteosynthesis of supracondylar fractures of the femur, tibial condyles, and patella.
- Ligament injuries: open and arthroscopic surgeries for torn ligaments, plastic surgery of the patellar ligament and quadriceps tendon.
- Meniscus injuries: meniscus removal, arthroscopic meniscectomy, meniscus suture.
- Loose bodies: arthroscopic removal of intra-articular bodies.
- Infectious arthritis: arthrotomy, arthroscopic debridement.
- Oncological lesions of the joint: excision of benign tumors, amputation or disarticulation of the thigh for malignant neoplasia.
Arthroplasty, arthrodesis, or arthroplasty are performed according to the indications for the consequences of injuries and diseases of the joint.