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
• pain on palpation of proximal tibia

Investigations

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

GP management

Rule out acute fracture.

If the patient has acute meniscal injury, refer for urgent assessment.

If the patient has bucket-handle tear or locked knee, refer to ED for urgent assessment.

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

Indications for specialist referral

Urgent

• locked knee
• any acute meniscal injury in a paediatric patient