Table of Contents  
CASE REPORT
Year : 2015  |  Volume : 8  |  Issue : 2  |  Page : 258-260  

Foreign body in the knee with no history of trauma


Department of Physical Medicine and Rehabilitation, K J Nursinghome, 272, T. H. Road, Old Washermenpet, Chennai, India

Date of Web Publication13-Mar-2015

Correspondence Address:
Jesudoss Prabhakaran
K J Nursinghome, 272, T. H. Road, Old Washermenpet, Chennai - 600 021
India
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0975-2870.153181

Rights and Permissions
  Abstract 

Foreign bodies in the knee joint are not uncommon. We report a case of sewing needle that migrated and embedded inside the knee with no history of trauma. Searching for any small foreign body in the knee joint is not easy in either open or arthroscopic procedures. In this case, the surgery was made by open method avoiding arthroscopy due to technical reasons. We emphasize careful history taking, clinical examination and, preferably, an open procedure for migrating tiny foreign bodies to facilitate accurate diagnosis, superior visualization and easier instrumentation to remove embedded foreign bodies in the knee.

Keywords: Arthroscopy, foreign body, intra-articular, knee, needle


How to cite this article:
Prabhakaran J, Amutha, Prashanth J. Foreign body in the knee with no history of trauma. Med J DY Patil Univ 2015;8:258-60

How to cite this URL:
Prabhakaran J, Amutha, Prashanth J. Foreign body in the knee with no history of trauma. Med J DY Patil Univ [serial online] 2015 [cited 2020 Jan 29];8:258-60. Available from: http://www.mjdrdypu.org/text.asp?2015/8/2/258/153181


  Introduction Top


The presence of foreign body in the knee is rare, but is usually encountered on occasions by a trauma. We report a case of sewing needle that migrated inside the knee joint of a 50-year-old woman. Awareness of the difficulties in operative exploration and removal of the tiny needle is needed to avoid complications. Temporary joint immobilization with a splint is beneficial to avoid intra-articular migration of tiny foreign bodies in the knee. The judicial administration of antimicrobial drugs may be necessary from the preoperative period onwards to prevent the most common microorganisms causing septic arthritis in the presence of foreign body in the knee. [1] This usually requires treatment with an extended course of antimicrobial agents. Migration of foreign body in and out of the knee joint resulted in pain and restricted movements of the joint, very similar to a ruptured meniscus or a degenerating chondral lesion. Several authors highlighted the importance of accurate history taking and thorough physical examination for such cases. [2]


  Case Report Top


A 50-year-old woman presented to the outpatient department of our hospital reporting pain in the right knee for a period of more than 1 week. The patient felt the pain in the right knee when she noticed an insect biting the popliteal area, which woke her up while asleep. Several hours later, she felt mild discomfort in the right knee, which was progressively worsened on the next day. She had consulted the private medical practitioners nearby and had her medication as prescribed by them. When she found no relief, she consulted an orthopedician and was referred to a physiotherapist for further management. Unable to bear the worsening pain with difficulty in walking, she was brought to our hospital by her son to consult a neurosurgeon. The neurosurgeon persuaded her to report to a physician where the clinical examination and laboratory investigations were carried out. On examination, no swelling or deformity was noted. No abrasion was found around the right knee [Figure 1]a and b. She was tender over the superomedial side of the popliteal fossa. Knee extension was normal but flexion was limited to 60 degrees and straight leg raise to 25 degrees by pain. Because of the absence of a clear cause but with definite clinical findings, it was decided to radiograph the right knee joint. Radiographs disclosed a foreign body in the posteromedial aspect of the knee at the level of the intercodylar eminence [Figure 2].
Figure 1:

Click here to view
Figure 2: X-ray of the right knee showing a foreign body

Click here to view


Tetanus prophylaxis was administered and, after 2 h, knee surgery was performed by making a small incision on the medial side of the popliteal fossa. When the knee was explored toward the anteromedial and superomedial aspects, it revealed the presence of a sewing needle in the posterior compartment of the joint [Figure 3] and [Figure 4]. The needle was embedded in the synovium covering the fat pad, between the origin of the anterior cruciate ligament and medial femoral condyle. It was removed with its entirety by using a grasping forceps. The joint was then carefully inspected and generously irrigated before closure. Antibiotic prophylaxis with a first-generation cephalosporin was administered for 7 days. No complications were observed. Two weeks postoperatively, the patient showed a complete recovery and has remained symptom free.
Figure 3: Sewing needle seen embedded in the right knee jo

Click here to view
Figure 4: Retrieved sewing needle

Click here to view



  Discussion Top


The clinical events of this case were interesting. A small needle in the relatively thick fat planes may be sufficiently bound and is comparatively painless. [3] In our case, a sewing needle was retained within the patient's knee for more than 1 week. The ability to detect the presence of this fine foreign body on clinical examination is difficult with a peculiar history that has no correlation for her presenting complaints. It was at this point that her son rather hesitantly volunteered that, unknown to her mother, his sister carried out some sewing work on the bed and must have left that sewing needle without the thread. We presume that after the prick of the needle the blood must have oozed out and the insect as the patient claims must have been attracted by its odor. The knee movements during sleep must have pushed the needle into the joint. Retrieving a moving needle in the knee joint is not an easy procedure. A foreign body that is superficial initially may later enter deeper planes or the joint itself. The surgeon must be aware of the possibility of migration. Difficult retrieval should be anticipated. Appropriate expertise must be used, and to visualize it arthroscopically is challenging. Arthroscopic direct visualization and transillumination of soft tissues are some techniques described to help retrieve foreign bodies from the knee joint. [4],[5],[6] A magnetic probe was considered, but was disappointing because they can only pick up extremely light objects and must be used very close to the object because of the weak magnetic field. Although arthroscopy is recommended for intra-articular foreign body of the knee, the cost of treatment is expensive. Arthrotomy, an open procedure, allows an accurate visualization of the minute-sizes migrating foreign body that is very difficult to be removed by arthroscopy. [7] This case emphasizes the importance of attention to preoperative clinical symptoms and events, intraopertaive clues and the judicious use of readily available operative techniques when trying to localize a target considering the economical background of the patient.


  Conclusion Top


In this case, the patient had no history of trauma and no external or internal abrasions or scars. Although it is a more invasive procedure, the mini-arthrotomy incision provided direct visualization of the foreign body and enabled improved access to the femoral condyle thus facilitating the complete removal of the tiny foreign body. The root cause of this injury proved to be an ill-advised self-help teaching of tailoring. Therefore, it is a mandate that sewing needles have always to be replaced in the respective containers or to be kept as threaded to avoid an element of bad luck.

 
  References Top

1.
O′Connell RL1, Fageir MM, Addison A. Be aware of wood in the knee. BMJ Case Rep 2011;4551:1-4.  Back to cited text no. 1
    
2.
Devgan A, Mudgal KC. An unusual case of foreign body knee that spontaneously migrated inside and out of joint: Arthroscopic removal. Knee Surg Sports Traumatol Arthrosc 2007;15:758-60.  Back to cited text no. 2
    
3.
Yeung Y, Wong JK, Yip DK, Kong JK. A broken sewing needle in the knee of a 4 year old child: Is it really inside the knee? Arthroscopy 2003;19:E18-20.  Back to cited text no. 3
    
4.
Hafez MA, Al Dars AM. Glass foreign bodies inside the knee joint following intra-articular injection. Am J Case Rep 2012;13:238-40.  Back to cited text no. 4
    
5.
Nikolic D, Vulovic R. Arthroscopy of the knee in war injuries. Injury 1996;27:175-6.  Back to cited text no. 5
    
6.
Kim SJ, Lee YT, Kim HJ. Arthroscopic extraction of astainless steel foreign body imbedded in the tibial plateau. Arthroscopy 1998;14:103-5.  Back to cited text no. 6
    
7.
Haspl M, Bojanic I, Pecina M. Arthroscopic retrieval of metal foreign bodies from the knee joint after war wounds. Injury 1996;27:177-9.  Back to cited text no. 7
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4]



 

Top
   
 
  Search
 
    Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
    Access Statistics
    Email Alert *
    Add to My List *
* Registration required (free)  

 
  In this article
Abstract
Introduction
Case Report
Discussion
Conclusion
References
Article Figures

 Article Access Statistics
    Viewed3284    
    Printed38    
    Emailed0    
    PDF Downloaded136    
    Comments [Add]    

Recommend this journal