Patellar balloting is a condition in which the patella sinks into the joint during pressure until it comes into contact with 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 patellar balloting, radiography, ultrasound, CT, MRI, puncture, arthroscopy and other procedures are prescribed. Before the diagnosis is made, it is necessary to ensure the rest of the limb.
Causes for patellar balloting
Injuries and surgeries
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 during examination may run in a few weeks or even months. The symptom is observed with the following injuries:
- knee joint contusion;
- damage to the ligaments of the knee joint: external, internal, cruciate;
- damage to patellar ligaments: own ligament, quadriceps tendon;
- meniscal damage;
- fractures: condyles and intercondylar elevation of the tibia, femoral condyles, patella.
Due to the inevitable accumulation of blood, balloting is considered the norm in the early postoperative period with the removal of menisci, suturing and plastic ligaments, osteosynthesis of the bones forming the knee joint.
In inflammatory lesions, patellar balloting occurs due to synovitis. It can be detected with the following types of arthritis:
- Nonspecific infectious arthritis. 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, other systemic diseases with joint syndrome. A type of primary pathology is reactive arthritis, which occurs after intestinal and genitourinary infections.
- Secondary aseptic arthritis. It is found in sarcoidosis, malignant neoplasms, diseases of the blood, digestive and respiratory systems.
Other pathologies with balloting due to the development of synovitis include:
- infrapatellar bursitis;
- free-lying bodies;
- allergic synovitis;
- tumors of bones and soft tissues of the joint area.
With scurvy, hemorrhagic diathesis and hemophilia, the patella runs due to hemarthrosis that occurs against the background of minor injuries or synovitis caused by secondary changes in the joint.
Orthopedic traumatologists or rheumatologists are engaged in the diagnosis of diseases in which patellar balloting is observed. If necessary, they 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. Confirms the violation of the integrity of bones in fractures, the presence of degenerative changes in arthrosis, damage to bone structures in specific and nonspecific infectious arthritis.
- Ultrasound of the knee joint. Detects fluid in the joint cavity, joint inversions. It is effective in detecting intra-articular bodies, tears and ruptures of ligaments.
- CT and MRI. They are prescribed 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 and diagnostic purposes. Allows you to confirm hemarthrosis or synovitis, to establish the nature of the fluid.
- Arthroscopy. The most reliable and informative research method. Provides for the possibility of visual inspection of articular structures, sampling of material for laboratory studies. In some cases, it includes therapeutic measures.
- Laboratory tests. Microscopic examination is performed to determine the composition of the liquid, seeding is carried out to establish the nature of the pathogenic microflora, cytological and histological examination of the liquid or biopsies is carried out if tumor processes are suspected. In case of systemic pathologies, special tests are prescribed.
With all injuries and illnesses accompanied by fluid accumulation, it is necessary to give the leg an elevated position, to ensure rest. In case of traumatic injuries, cold should be applied to the damaged area to reduce swelling. In case of fractures, complete ruptures of ligaments, 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 for 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 balloting should be taken to a specialist even with minor severity of other symptoms.
Conservative treatment for diseases with patellar balloting includes the following measures:
- Puncture. Made upon receipt. 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 the indications, a plaster cast is applied, it is advised to use crutches or a cane.
- Drug therapy. Taking into account the nature of the pathology, NSAIDs, antibiotics, painkillers, and other medications are prescribed.
- Non-drug methods. UHF, medicinal electrophoresis, laser therapy, magnetotherapy and other physiotherapy techniques are used. Physiotherapy is complemented by physical therapy and massage.
Depending on the characteristics of the disease , the following surgical interventions can be performed during patellar balloting:
- Fractures: osteosynthesis of supracondylar fractures of the femur, tibial condyles and patella.
- Ligament injuries: open and arthroscopic operations for ligament ruptures, plastic surgery of the patellar ligament and quadriceps tendon.
- Meniscus injuries: meniscus removal, arthroscopic meniscectomy, meniscus suture.
- Free bodies: arthroscopic removal of intra-articular bodies.
- Infectious arthritis: arthrotomy, arthroscopic rehabilitation.
- Oncological lesions of the joint: excision of benign tumors, amputation or exarticulation of the hip in malignant neoplasia.
According to the indications, arthroplasty, arthrodesis or endoprosthetics are performed with the consequences of injuries and diseases of the joint.