Cystic swelling and inflammation of MCL of knee joint managed with homeopathy; a case study with literature review and diagnostic pitfalls

Knee pain is the most frequently encountered complaint in clinical practice among diverse age groups. In India, osteoarthritis alone covers 25-35 % of all rheumatological conditions. That stands out as one of the common causes of misdiagnosis of all other soft tissue and ligamentous diseases of the knee joint. However, in light of common clinical manifestations like osteoarthritis, many cases go neglected and remains in the grey area of literature. Here we are reporting a case of a 65-year-old female patient who presented with knee pain, and difficulty walking, and she was previously diagnosed with osteoarthritis. However, ultrasonography (USG) revealed a cystic enlargement measuring 12.3 × 5.4mm distal to the medial-cutaneous ligament (MCL) with inflammation and local edema. Following a thorough case evaluation, the patient was prescribed Ruta graveolens 200CH, followed by Thuja occidentalis 200CH. The anti-inflammatory, anti-tumor, and anti-cancer properties of both these medicines have been thoroughly demonstrated via many scientific experiments. We believe the positive effect is due to their alkaloids, but we have not questioned how they maintain their qualities at such high dilutions. The Lysholm Knee Score and Tegner Activity Scale (TLSS) were used to quantify progressive improvement. Significant improvement was observed with the following remission of cystic edema and local irritation. The TLSS climbed to 78 at the end of treatment from 56 at the beginning. Despite being a rare clinical presentation of knee pain, this case report is valuable in homeopathy since it is the first attempt to analyze knee joint functionality using TLSS.