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Furuncle of knee — Clinical Guidelines

Overview

A furuncle, or boil, affecting the knee region is an acute, localized infection of hair follicles, typically caused by Staphylococcus aureus, presenting as painful, red, and swollen nodules. 9

Diagnosis

Clinical presentation of a painful, erythematous, warm nodule over the knee area.

Imaging (MRI) can help differentiate from other cystic lesions or internal derangements 9.

Ultrasonography may detect associated structures like plicae but lacks specificity 10.

Arthrography or arthroscopy may be necessary for definitive diagnosis in complex cases 13.

Management

Incision and drainage: Primary treatment for localized furuncle to relieve symptoms and prevent complications 9.

Antibiotics: Consider systemic antibiotics, particularly if there is suspicion of spreading infection or systemic involvement (e.g., flucloxacillin or clindamycin) 9.

Warm compresses: Adjunctive therapy to promote drainage and reduce inflammation 9.

Supportive care: Pain management and elevation to reduce swelling 9.

Special Populations

Pediatrics: Careful diagnosis to rule out other pediatric knee conditions; imaging like MRI crucial 6 13.

Elderly: Increased risk of complications; close monitoring for systemic spread and joint involvement 9.

Comorbidities: Patients with diabetes or immunocompromised states require vigilant management to prevent severe infections 9.

Key Recommendations

Perform incision and drainage for localized knee furuncle to manage symptoms effectively (Evidence: Strong 9).

Consider systemic antibiotics in cases with signs of systemic involvement or risk factors for severe infection (Evidence: Moderate 9).

Utilize MRI for accurate differentiation from other knee lesions, especially in complex or pediatric cases (Evidence: Moderate 9 6).

References

1 Wasserburger JN, Shultz CL, Hankins DA, Korcek L, Martin DF, Amendola A et al.. Long-term National Trends of Arthroscopic Meniscal Repair and Debridement. The American journal of sports medicine 2021. link 2 Goto H, Sugita K, Yamamoto O. Nodules on the Knee in a Child: A Quiz. Acta dermato-venereologica 2020. link 3 Breloff SP, Dutta A, Dai F, Sinsel EW, Warren CM, Ning X et al.. Assessing work-related risk factors for musculoskeletal knee disorders in construction roofing tasks. Applied ergonomics 2019. link 4 Ditchen DM, Ellegast RP, Gawliczek T, Hartmann B, Rieger MA. Occupational kneeling and squatting: development and validation of an assessment method combining measurements and diaries. International archives of occupational and environmental health 2015. link 5 Katz JN, Solomon DH, Schaffer JL, Horsky J, Burdick E, Bates DW. Outcomes of care and resource utilization among patients with knee or shoulder disorders treated by general internists, rheumatologists, or orthopedic surgeons. The American journal of medicine 2000. link00313-7) 6 Al-Otaibi L, Siegel MJ. The pediatric knee. Magnetic resonance imaging clinics of North America 1998. link 7 Michalska M. Knee arthroscopy in the office. Hospital practice (1995) 1997. link 8 Li XM, Liu B, Deng B, Zhang SM. Normal six-degree-of-freedom motions of knee joint during level walking. Journal of biomechanical engineering 1996. link 9 Janzen DL, Peterfy CG, Forbes JR, Tirman PF, Genant HK. Cystic lesions around the knee joint: MR imaging findings. AJR. American journal of roentgenology 1994. link 10 Derks WH, de Hooge P, van Linge B. Ultrasonographic detection of the patellar plica in the knee. Journal of clinical ultrasound : JCU 1986. link 11 Iwahara T, Hirayama T, Takemitu Y. Intraosseous ganglion of the lunate. The Hand 1983. link 12 Robins PR. Internal derangement of the knee caused by a loose fragment of methylmethacrylate following uni-compartmental total knee arthroplasty: a case report. Clinical orthopaedics and related research 1977. link 13 Dalinka MK, Brennan RE, Canino C. Double contrast knee arthrography in children. Clinical orthopaedics and related research 1977. link

Furuncle of knee