# Acute knee injury (soft tissue) - Category: acute - Review status: reviewed (every claim checked against a document named on this page) - Sources: Ibuprofen 400 mg film-coated tablets SmPC sections 4.1 Therapeutic indications and 4.2 Posology (eMC product 7020) · Kong C et al. Australas Emerg Care 2020 (PMC7476189) · Paracetamol 500 mg Tablets SmPC sections 4.1 Therapeutic indications and 4.2 Posology (eMC product 5164) · Voltarol 1.16% Emulgel SmPC sections 4.1 Therapeutic indications and 4.2 Posology (eMC product 366) · Gerena LA, Mabrouk A, DeCastro A. Knee Effusion. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2026 Jan-. Last Update: February 26, 2024. - Verified date: 2026-08 ## Verified against - Ibuprofen 400 mg film-coated tablets SmPC sections 4.1 Therapeutic indications and 4.2 Posology (eMC product 7020) - Kong C et al. Australas Emerg Care 2020 (PMC7476189) - Paracetamol 500 mg Tablets SmPC sections 4.1 Therapeutic indications and 4.2 Posology (eMC product 5164) - Voltarol 1.16% Emulgel SmPC sections 4.1 Therapeutic indications and 4.2 Posology (eMC product 366) ## Treatment metadata - Decide the X-ray with the Ottawa knee rule - Diclofenac diethylamine — topical.gel - Ibuprofen — 400 mg — oral.solid - Paracetamol — 500 mg — oral.solid ## Complete treatment card ```text ACUTE KNEE INJURY (SOFT TISSUE) Sources: Ibuprofen 400 mg film-coated tablets SmPC sections 4.1 Therapeutic indications and 4.2 Posology (eMC product 7020) · Kong C et al. Australas Emerg Care 2020 (PMC7476189) · Paracetamol 500 mg Tablets SmPC sections 4.1 Therapeutic indications and 4.2 Posology (eMC product 5164) · Voltarol 1.16% Emulgel SmPC sections 4.1 Therapeutic indications and 4.2 Posology (eMC product 366) · Gerena LA, Mabrouk A, DeCastro A. Knee Effusion. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2026 Jan-. Last Update: February 26, 2024. Review status: REVIEWED against 4 sources listed above (2026-08) IS IT THIS? - reference only, to read alongside your own examination RED FLAGS (3) - Any one of the five rules positive - X-ray - Knee locked in flexion, or a large tense effusion within an hour - refer, this is not a simple sprain - Absent pulses, cold foot or a deformed knee - immediate referral SYMPTOMS - what the patient reports (2) - Twisting injury or a direct blow, then pain and difficulty weight-bearing [joint pain · knee pain] - Ask their age - 55 or over is one of the five rules on its own SIGNS - what you find (3) - Palpate the head of the fibula and the patella separately - the patella rule is ISOLATED tenderness - Ask them to flex to 90 degrees - Watch them take four steps TESTS (1) - No blood test. The rule decides the X-ray Score Ottawa knee rule - Does this knee need an X-ray? Source Kong C, Sivalingam K, Fitzgerald M, Mitra B. Validation of the Ottawa knee rule in adults: a single centre study. Australas Emerg Care 2020 (PMC7476189) Status traced to the source above 1. DECIDE THE X-RAY WITH THE OTTAWA KNEE RULE [1st line] Adult Open the Ottawa knee rule before requesting a film. If no rule is positive, an X-ray is not needed. Peds No paediatric dose is stated in the sources held for this drug. Source Kong C et al. Australas Emerg Care 2020 (PMC7476189) Why A rule that says when NOT to image is the useful half. Imaging every twisted joint is how a clinic fills its X-ray list with normal films. Caution A 2020 single-centre validation found 71% sensitivity (95% CI 49-87), well below the near-100% of the original studies - if the knee still worries you, image it. The patella rule is ISOLATED tenderness: bone tenderness anywhere else on the knee does not satisfy it. Bearing weight must be checked at the time of injury AND now. 2. DICLOFENAC DIETHYLAMINE [1st line] Adult 2-4 g (a circle 2.0-2.5 cm across) rubbed in 3-4 times daily - review after 14 days Peds Contraindicated under 14 years (SmPC 4.2). It is not a smaller dose for a younger child - the product is not licensed for them at all. Source Voltarol 1.16% Emulgel SmPC sections 4.1 Therapeutic indications and 4.2 Posology (eMC product 366) Why Named first because its label names this injury: SmPC 4.1 covers trauma of tendons, ligaments, muscles and joints due to sprains, strains and bruises. A topical NSAID reaches the painful tissue without the gastric and renal exposure of a swallowed one. Caution Do not apply to broken skin, open wounds, or mucous membranes. Avoid in the last trimester of pregnancy. Wash hands after applying unless the hands are the site treated. Egypt VOLTAREN 1% EMULGEL 25 GM NOVARTIS > GL... 39.00 EGP DICLOPRO 1% GEL 50 GM DBK PHARMA > ... 52.00 EGP VOLTAREN 1% EMULGEL 50 GM NOVARTIS > GL... 68.00 EGP VOLTAREN 1% EMULGEL 100 GM NOVARTIS > GL... 101.00 EGP 3. IBUPROFEN [2nd line] Adult 200-400 mg orally 3-4 times daily with food, at least 6 hours apart - maximum 1200 mg in 24 hours; shortest duration that controls the pain Peds A limping child after an ankle or knee injury is not managed as a sprain. The growth plate is weaker than the ligament, so the same force that sprains an adult fractures a child - assess for a physeal injury rather than prescribing and waiting. Source Ibuprofen 400 mg film-coated tablets SmPC sections 4.1 Therapeutic indications and 4.2 Posology (eMC product 7020) Why SmPC 4.1 lists painful swelling and inflammation after soft tissue injuries. Second line to the gel only because a swallowed NSAID exposes the whole patient to reach one joint. Caution Avoid in active peptic ulcer, and in severe heart, liver or kidney disease. Co-prescribe a PPI if elderly or at GI risk. Avoid in the third trimester of pregnancy. Egypt DAJUANOFEN 400 MG 20 F.C. TABS. COPAD PHARMA 5.00 EGP (0.25/unit) FLABU 400MG 10 F.C.TAB. DELTA PHARMA 3.75 EGP (0.38/unit) NOVA-PROFEN 400MG 30 F.C. TABLETS SANOFI 12.75 EGP (0.42/unit) IBUPROFEN 400 MG 10 TAB. SEDICO 6.00 EGP (0.60/unit) MAFO 400 MG 30 F.C.TABS EIPICO 42.00 EGP (1.40/unit) BRUFEN 400 MG 30 TABS. KAHIRA > ABBO... 78.00 EGP (2.60/unit) PROFUSOL 400MG 20 S.G CAPS. EUROPEAN EGYP... 31.00 EGP ANALGIPROF 400 MG 25 SACHETS EVA PHARMA 37.50 EGP NOVA-PROFEN 100MG/5ML ORAL SUSP. 100ML SANOFI 2.25 EGP -> ? strength differs, ? different route - not oral solid BRUFEMOL-N SUSP. 60 ML ARAB DRUG COM... 4.50 EGP -> ? strength differs, ? different route - not oral solid 4. PARACETAMOL [add-on - not a substitute] Adult 1 g (two 500 mg tablets) orally every 4-6 hours - maximum 4 g in 24 hours; not more than 3 days without review Peds Paediatric dosing is by weight and is not given here; see the child's own condition entry. Source Paracetamol 500 mg Tablets SmPC sections 4.1 Therapeutic indications and 4.2 Posology (eMC product 5164) Why Add-on for a patient who should not have an NSAID, or alongside one. It does not replace the NSAID - it has no anti-inflammatory action on the injured ligament. Caution Count every other product the patient is taking that contains paracetamol. Reduce the dose in low body weight, chronic alcohol use or hepatic impairment. Egypt FEBRIMOL 500 MG 20 TAB. PHARCO 3.50 EGP (0.17/unit) CETAMOL 500 MG 20 TABS. MEMPHIS 8.00 EGP (0.40/unit) PARACETAMOL-MUP 500MG B.P. 20 TABS. MUP 13.00 EGP (0.65/unit) CETAL 500 MG 20 TABS. EIPICO 24.00 EGP (1.20/unit) ARKADOLOW 500 MG 30 F.C. TABS. UTOPIA 42.00 EGP (1.40/unit) PARAMOL 500MG 20 TAB. MISR 38.00 EGP (1.90/unit) ADOL 500MG 24 CAPLETS JULPHAR 32.00 EGP AUGICETAMIDE 500 MG 20 SACHETS AUG PHARMA 50.00 EGP FEBRIMOL ORAL DROPS 20 ML PHARCO 4.00 EGP -> ? strength differs, ? different route - not oral solid THERA-LO 3.2G/100ML ORAL SUSP. 100 ML PHAROPHARMA 5.00 EGP -> ? strength differs, ? different route - not oral solid Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy. ``` --- Dawaa Reference is a reference for prescribers, not a medical device, and does not replace clinical judgement. [Privacy policy](/privacy)