knee swelling

4 weeks ago I fell very hard on a concret floor. I hit my knee- just inder the knee cap.  It didn't bruise or swell although it was painful tothe touch and I couldn't put any pressure on it. The next week it swelled a lot.  Still no color. I iced and heated it while using anti inflammatory.  The 3rd week it was still painfull to the touch but now swelling. This week the swelling is back.  Any ideas??

[Michael L Gross, MD]

Sounds like post-traumatic prepatella bursitis. The bursa is a thin lining of tissue that sits in front of the patella(knee cap). There are bursae in many areas of the body, wherever a tendon attaches to a bone superficially.
When you fell, you caused bleeding into the bursa, this caused the swelling and eventual bruise like appearance.
First, you should have an Xray, to be safe, and make sure you didnt actually fracture your patella. If not, warm soaks to soften and mobilize the hematoma are helpful, followed by ice packs to reduce the inflammation and swelling. Ocassionally, these have to be aspirated, drained, in the office.If the selling continues without resolution, the bursa may have to be removed surgically.