Description and scenario

Patient presenting with non-mechanical pain, intermittent or permanent swelling in the knee, possible deformity and symptoms related to activity.


Main appropriate investigation is plain x-ray with 3 views:

• PA 30º weight bearing view
• Lateral at 30 – 45º flexion
• Skyline view single knee at 30 – 45º flexion

Category and Action

Category I: conservative options

This group is patients with controllable pain, no deformity and minimal loss of joint space seen on x-ray.

Treatment options include referral for physiotherapy, education and advice, simple analgesia and anti-inflammatories, other non operative interventions including advice on weight loss and activity modification etc.

Category II: referral to MSCAT treatment

This category is for patients with moderate symptoms who are not down to bare bone on x-ray, tablets are helping, symptoms are not too bad or intrusive, they are no longer mild and have failed category I level treatment.

Treatment options include specialised assessment and physiotherapy, injections or orthotics.

Category III: severe symptoms for referral to secondary care

This category is for those patients with severe pain or symptoms affecting quality of life, complete loss of joint space seen on x-ray, symptoms bad enough that they may accept surgery and patients who have failed category I & II treatment conservative options.

These patients are more likely to need consideration for unloading braces or surgery including arthroplasty, osteotomy, and arthroscopic treatment.