All information is correct at time of printing and is subject to change without notice. The Devon Formulary and Referral Website is not in any way liable for the accuracy of any information printed and stored by users. For the most up-to-date information, please refer to the website.
Conservative management is main stay of treatment; rest, analgesia and primary care physiotherapy
Leave the decision to MRI scan to the Extended Scope Physiotherapist (ESP) or Integrated Clinical Assessment and Treatment (ICAT) clinician; GP's are no longer able to order MRI through the Any Qualified Provider (AQP) process.
Please note primary care is requested to follow In Shape for Surgery best practice which can be seen here.
Please note that referrals for arthroscopy and washout for global knee pain due to osteoarthritis will no longer be considered. This is now considered a low value procedure as the evidence for long term benefit is limited.
Degree of signs/ symptoms depend on severity of injury and mechanism
Assessment following the Ottawa knee rules – see below:
A knee x-ray is only required for knee injury patients with any of these findings:
Septic Arthritis – refer to Emergency Department
Tumour - Sarcoma service guidelines and other suspicious swellings - see Southwest Sarcoma guidelines and complete urgent referral form
High energy impact
Clinically
The following red flags should be sent through the Fast Track Knee Service:
Consider x-ray if osteoarthritis is suspected following the Ottawa knee rules
The vast majority of rapid and atraumatic knee pain should be managed with conservative treatment in primary care including rest, analgesia and physiotherapy
If knee is painful and swollen, advice regarding PRICE:
Consider paracetamol and/or topical NSAIDs as a safe method of mild to moderate pain relief (oral NSAIDs, unless contra-indicated, may be considered if non-responsive) (see section 10.1 Drugs used in rheumatic diseases and gout)
Early physiotherapy recommended.
All of these may be arranged through the community service MSK Interface service (OCAS) where this facility is available
ABSOLUTE: current infection of knee; other site of infection; muscular dysfunction; severe vascular disease; presence of functional knee arthrodesis
RELATIVE: history of osteomyelitis; skin conditions around knee; neuropathy of knee joint; obesity)
Non disabling soft tissue trauma should be managed with conservative treatment in primary care including rest, analgesia and physiotherapy
Referral to specialist secondary care:
Refer where there is persistent pain and disability not responding up to 12 weeks of evidence based non-surgical treatment (British Orthopaedic Association commissioning guide 2013).
All patients with knee pain will be expected to have had a recent course of physiotherapy prior to onward referral unless evidence can be provided that this is not necessary. Unless it is clearly stated in the referral, these may be returned to the referrer.
All referrals must include:
Please note primary care is requested to follow In Shape for Surgery best practice which can be seen here.
Assessment following the Ottawa knee rules – see below:
A knee x-ray is only required for knee injury patients with any of these findings:
DRSS will review the referral letter and direct to Orthopaedics if:
Refer direct to ED/ Orthopaedic on call team – see Red Flags
All patients with a non-disabling injury due to trauma
Referral to Orthopaedics via e-Referral Service
2WW Referral form for suspected sarcoma
Shared decision making – osteoarthritis of the knee
Patient will have full assessment and receive treatment and advice which may include:
This guideline has been signed off by the East Cornwall Locality on behalf of NHS Devon.
Publication date: 02 April 2015