Haemarthrosis

Haemarthrosis is usually seen in haemophilia and can occur spontaneously or as a result of apparently minor injury.

It is most commonly classified into 3 categories: traumatic, nontraumatic, and postoperative. Traumatic injury is the most common cause of hemarthrosis. Nontraumatic hemarthrosis can be caused by a variety of bleeding disorders that are either hereditary or acquired. Hereditary bleeding disorders include haemophilia and other inherited coagulation factor deficiencies, such as factor XI deficiency. (1)

Based on a cohort study of 1145 consecutive patients who developed a traumatic hemarthrosis of the knee (2) approximately half had an anterior cruciate ligament (ACL) injury, and the annual incidence of ACL injury was 77 per 100,000 inhabitants, with a significant difference between men (91 per 100,000) and women (63 per 100,000).

In those 16 years of age or younger, lateral patellar dislocation was the most frequent structural injury associated with traumatic hemarthrosis of the knee both in boys (39%) and girls (43%); in this age group, the annual incidence of lateral patellar dislocation was 88 per 100,000 and higher in boys (113 per 100,000) than girls (62 per 100,000)

The damage to the joints usually begins before the age of 15. A joint may be acutely distended by blood, which is then slowly resorbed. There is a variable amount of inflammation, and the synovium becomes hypertrophic and haemosiderin-stained. Damage to the articular cartilage is a common consequence of repeated haemarthroses; furthermore intraosseous haemorrhage may lead to bone resorption and the development of bone cysts.

The history differentiates it from inflammatory arthritis.

Reference

1. Souabni L, Meddeb N, Ajlani H, Ben Romdhane N, Sellami S. Hemarthrosis revealing congenital factor XI deficiency. Joint Bone Spine. 2008 May;75(3):348-9
2. Olsson O, Isacsson A, Englund M, Frobell RB. Epidemiology of intra- and peri-articular structural injuries in traumatic knee joint hemarthrosis - data from 1145 consecutive knees with subacute MRI. Osteoarthritis Cartilage. 2016 Nov;24(11):1890-1897