“All acute knees should be referred “
Another great seminar presented last night by the likes of Mark Wotherspoon, Adrian Wilson and Mike Risebury.
The message they were bringing :
“We (first contact practitioners) are failing acute knees”
So how can we do our part?
As physiotherapists we should be extremely familiar with the mechanism of injury:
- Usually non contact injury.
- Immediate swelling.
- Fell to ground, couldn’t play on.
- Changing direction.
- Heard a POP.
Next patient usually:
- Limping 3-4 weeks
- Function returns.
- Tries to return to sport but knee gives way.
Usual route which we need to change
- A and E – saw a triage nurse
- X-Ray – Normal – Go home and if doesn’t resolve see your GP. (tries to return to sport gives way)
- GP – Physio
- Referred back to GP recommending ortho opinion
- Referred to consultant.
- Time lapse between each stage average in uk: One year injury to MRI.
Recommendations after brain stormings::
Short flashcard/ sheet for GP’s/ sport physicians (Refer acute knee with ACL mechanism of injury).
5 bullet letter to GP’s – patient’s suitable for acute knee service.
Direct number to refer to: 01256 357111 ask for Jennie and ask for the acute knee service.
Patient education: “Protect the knee, educate that serious injury, potential ligament damage, protect your knee until we have checked with a surgeon, straight lines, don’t do anything silly”.
Anything more that a Grade I MCL needs to be assessed for brace, 30 degree bracing immediately.
Consider ACL repair in those older that 50.
Physio’s can refer directly to surgeon.
They also discussed osteotomies and their use for the ‘younger patients (30-55)’ as an alternative for knee replacements.
This operation looks to offload the lateral compartment (depending on deformity) and aims to reduce pain and improve function in those who wish to be active. The surgeons aim to regain normal alignment by correcting through a wedge osteotomies. A large, strong fixation allows patients to weight bear from day 1 and patients can be expected to be off crutches and back at work at 6 weeks. Operation time is 30 mins
Most patients will partial weight bear as pain allows but can be back to activity relatively quickly. Can potentially return to impact exercise ie tennis etc. Consider this for those who are too young for a TKR who need something to reduce pain and improve function.
The advice that was given regarding the Acute Knee service was that patients could be seen in the first instance by:
- The Consultants in Sport and Exercise Medicine, Drs Mark Wotherspoon and Mike Rossiter whose skill is in diagnosis (bringing years of relevant experience), including access to all the diagnostic tools on offer either privately or through the NHS (MRI, CT, xray and ultrasound).
- If the patient needs surgical intervention, then they get referred to the Knee Surgeons, with all the appropriate investigations done – Mssrs Neil Thomas, Adrian Wilson and Mike Risebury, either privately or through the NHS
- If the patient does not need surgical intervention, then they get referred back to the original physio with all the investigative information to hand and with a plan to work towards their recovery
Overall an informative evening and some great snacks too!
All Sports medicine sec: Julie Fourt : email@example.com or 01256 377637