OTHER ASPECTS OF KNEE PATHWAY
Indications for MRI Scanning
MRI scans are indicated for patients with meniscal tears, patients with difficulty diagnosing ACL or ligamentous injury of the knee and for patients with traumatic chondral injuries. MRI is also indicated for patients with unexplained pain that do not fit any diagnostic categories.
MRI scans should be restricted to patients with recent injury, aged under 60 (scanning over 60 is rarely helpful). Patients with problems more than six weeks after injury and for patients with suspected key diagnosis that needs confirming.
Knee Radiographic Views
The following three key views are expected for all patients undergoing knee imaging investigation.
- Weight bearing PA 30º view.
- Lateral at 30 – 45º with condyles overlapping.
- Skyline x-rays single knee at 30 – 45º flexion.
Post op TKR views
- Supine AP and Lateral
Post op ACL reconstruction views (Series of four x-rays).:
- AP standing,
- lateral at 30º,
- lateral in hyperextension (heel supported and knee unsupported),
- skyline at 30º.
What the Consultant wants
For each of the group categories the Orthopaedic Consultant wants to see the following key features in order to help reduce the “oven ready” scenario that will help patients achieve early appropriate treatment.
A. Osteoarthritic Knee
- X-rays showing loss of joint space.
- Significantly severe symptoms.
- Previous trial of physiotherapy.
- Failed full conservative package including attempted weight loss, analgesia, exercise programme etc.
B. Anterior Knee Pain
- Painful Mechanical crepitus that has failed full conservative physiotherapy treatment.
- Mal-alignment failed conservative treatment.
- Patients with multiple dislocations.
- Mechanical/recent injury.
- Patients with meniscal tear, ACL deficiency ligament injury or chondral defects diagnosed on MRI.