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
• varus/valgus instability
• pain on palpation

Investigations

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

GP management

Rule out acute fracture.

If the patient has an avulsion or complete tear, refer for urgent assessment.

Otherwise use RICE, physiotherapy, bracing and routine referral.

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

Indications for specialist referral

Urgent

Complete intrasubstance tear or avulsion.

Semi-urgent

Ongoing pain or instability in patients with incomplete tears after six weeks of bracing and physiotherapy.