Orthopedics - Knee Pain (Traumatic)

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Knee Pain - Traumatic

Diagnosis/Definition

Knee pain, instability or loss of motion related to a specific traumatic event.

Initial Diagnosis and Management

History (special attention to mechanism of injury) and physical examination.
Radiographs to rule out fractures.
Obvious fracture, instability, or motor disruption: refer (see below).
Initial exam may be difficult due to pain and/or significant effusion.
In these cases, treat w/ice and compression for 4-14 days and reassess.
Exercises should be initiated immediately to prevent loss of muscle tone and bulk (*consult PT for instruction and/or supervision of exercises).

Ongoing Management and Objectives

Repeat examination at 4 to 14 days for more definitive physical evaluation.
Medial or lateral collateral ligament strains (w/o instability): treat with bracing, activity limitations and appropriate knee rehabilitation exercises. Treat for 6-8 weeks.
MRI if effusion or other symptoms persist beyond 6-8 weeks.

Indications for Specialty Care Referral

Patients with the following should be referred to Orthopedics:
Any patient with obvious varus or valgus, or anterior or posterior drawer instability.
All fractures about the knee.
Inability to perform straight leg raise or if lock knee inability to move knee passively 30 to 0 or 30 to 90 degrees.
*Refer to Physical Therapy for above mentioned acute and rehabilitation exercises.

Criteria for Return to Primary Care

Patients may be returned to Primary Care following evaluation, with suggestions for ongoing management.
Patients will be returned to Primary Care following rehabilitation and stabilization of their orthopedic condition if they require surgical intervention. In such cases, there may be a necessity for periodic orthopedic evaluation.