GROUP C: MECHANICAL SYMPTOMS OR RECENT INJURY
Description and Diagnosis
In this group patients may complain of a recent injury or mechanical symptoms resulting in descriptions of giving way, clicking, catching or locking. There is usually a history of a recent soft tissue injury. There is usually no obvious osteoarthritis. They may have swelling associated with injury or have a history of acute severe swelling of the knee.
The usual causes include meniscal tear, cruciate ligament injury (anterior or posterior cruciate), chondral joint surface injury, osteochondritis dissecans causing loose bodies or patella instability etc.
There are various specific diagnostic patterns that indicate specific diagnoses:
A history of a twist and pop and sensation of distrust in the knee = anterior cruciate ligament until proved otherwise and should lead to direct referral to secondary care.
Medial joint line tenderness with history of joint swelling and twisting trauma = meniscal tear
Category and Action
Category I: Conservative options
This group includes patients with no history of giving way or locking. They may have mild pain but not intrusive. Additionally it includes patients who are within six weeks from injury but do not fit into moderate or severe groups (category II or III).
Treatment for these patients includes physiotherapy and clinical review. Patients less than six weeks from injury may settle with conservative treatment and do not need immediate referral unless in other categories.
Category II: Referral for MRI Scan or MSCAT Physiotherapy.
This category includes patients with joint line tenderness or effusion and symptoms persistent for six weeks or more. It also includes patients who have failed core basic physiotherapy.
Treatment options are referral for MRI scan and referral to MSCAT physiotherapy and assessment. Depending on the result of MRI they then may be candidates for referral to secondary care.
Category III: Symptoms Requiring Referral to Secondary Care.
This category is patients with specific scenarios including: a history of twist or pop and distrusting the knee (indicating ACL deficiency), true locking of the knee, MRI proven meniscal tear and greater than six weeks of joint line tenderness, effusion or failed physiotherapy. In addition this category includes patients who have failed conservative treatment with a normal MRI or anyone with another specific diagnosis on MRI.
Treatment options are referral to secondary care. Patients where ACL are suspected on the above history and patients with true locking of the knee should be referred via MRI scan. Referral for MRI should be made at the same time as MRI scan booked.