Initial pre-referral workup

Clinical history

When did the injury occur (acute or chronic)?

What caused the injury (e.g. direct blow, pivoting, cutting, jumping)?

Does the knee catch, lock or give way?

Can the patient bear weight?

Can the leg fully straighten?

Physical examination

• swollen knee
• inability to straighten
• stiffness
• anterior/posterior draw
• pain on palpation

Investigations

• plain X-rays (AP, lateral, notch and skyline)
• consider MRI if clinically suspicious

GP management

Rule out acute fracture.

If fracture is identified, the patient should be assessed at the nearest ED.

If the patient has acute injury - knee splint, use protected weight bearing with crutches and refer for urgent assessment.

If the patient has chronic injury, assess for instability symptoms, refer to physiotherapy and for semi-urgent assessment.

Please instruct patients to bring films to their specialist appointments at the RCH.

Indications for specialist referral

Urgent

• acute locked knee
• stiff knee
• significant instability or giving way

Semi-urgent

• chronic injury
• intermittent instability symptoms

Indications for Escalation

• increased catching and locking
• increased pain