Spontaneous Recurrent Hemarthrosis of the Knee: A Report of Two Cases with a Source of Bleeding Detected during Arthroscopic Surgery of the Knee Joint

Abstract

We report two cases of the spontaneous recurrent hemarthrosis of the knee. In these cases lateral meniscus was severely torn and a small tubular soft tissue with pulsation was identified on the synovium in the posterolateral corner during arthroscopic surgery of the knee joint. Gentle grasping of this tissue by forceps led to pulsating bleeding, which stopped by electrocoagulation. This soft tissue was considered a source of bleeding, since no recurrence of hemarthrosis was observed for more than four years after surgery. It was highly probable that this soft tissue was the ruptured end of the lateral inferior genicular artery or its branch. This case report strongly supports the theory that the bleeding from the peripheral arteries of the posterior portion of the lateral meniscus is the cause of spontaneous recurrent hemarthrosis of the knee.

MR imaging findings for differentiating nonhemophilic hemosiderotic synovitis from diffuse-type tenosynovial giant cell tumor of the knee

“…Lateral meniscus tear is less common than medial meniscus tear, because the lateral meniscus is more mobile than the medial meniscus, owing to its looser connections to the capsule and ligaments. However, spontaneous recurrent hemarthrosis has been reported to be a pathologic condition in elderly individuals, which results in recurrent hemarthrosis of the knee joint associated with lateral-dominant osteoarthritis and/or lateral meniscal injury [20][21][22]. The reason for this may be the location and size of the genicular arteries, which supply blood to the meniscus [20].…”

“…However, spontaneous recurrent hemarthrosis has been reported to be a pathologic condition in elderly individuals, which results in recurrent hemarthrosis of the knee joint associated with lateral-dominant osteoarthritis and/or lateral meniscal injury [20][21][22]. The reason for this may be the location and size of the genicular arteries, which supply blood to the meniscus [20]. The lateral inferior genicular artery courses adjacent to the peripheral border of the lateral meniscus [23], whereas the medial genicular arteries do not course so close to the medial meniscus.…”

Recurrent Hemarthrosis Secondary to Erosive Patellofemoral Arthritis Treated with Arthroplasty

“…These studies have identified genicular artery or synovial bleeding as the cause of spontaneous hemarthrosis in the elderly population with OA 16,17,23 . Less has been documented about bleeding resulting from the eroded subchondral bone.…”

“…It was reported that arthroscopic resection of this portion of the meniscus resolved the bleeding 23 . Other arthroscopic reports assert that genicular artery bleeding secondary to meniscal injury can be the cause of spontaneous hemarthrosis of the knee joint 17 . Another case reported a meniscal ganglion cyst causing recurrent hemarthrosis corrected with the resection of the meniscus 24 .…”

“…S pontaneous hemarthrosis of the knee joint in the elderly population is a rare phenomenon 16 and is mostly seen in those with OA 17 . The identified causes of spontaneous hemarthrosis in this demographic include subchondral bone bleeding, meniscal tear, genicular artery bleeding, and the use of anticoagulants 16 .…”