Initial pre-referral workup

Clinical history

When did the injury occur (acute or chronic)?

What caused the injury?

Does the knee catch, lock or give way?

Can the patient bear weight?

Can the leg fully straighten?

Has there been prodromal knee pain?

Physical examination

• swollen knee
• inability to straighten
• stiffness
• pain on palpation of femoral condyles

Investigations

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

GP management

Rule out acute fracture.

If the patient has loose body, refer for urgent assessment.

If the patient has stable osteochondritis dissecans on MRI, refer for semi urgent assessment and stop sporting activities, closed kinetic chain activities only and protected weight bear.

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

Indications for specialist referral

Urgent

• locked knee
• clicking, locking or mechanical symptoms
• pain on knee movement

Semi-urgent

• MRI diagnosis of stable osteochondritis dissecans.