THE EFFICACY OF A PHYSIOTHERAPY LED ACUTE KNEE INJURY CLINIC AT LEEDS GENERAL INFIRMARY

Abstract

Aim: Assessment of a new protocol, were acute soft tissue knee injuries are referred initially to a physiotherapy led knee assessment clinic.

Patients and methods: Patients reviewed in the acute knee assessment clinic (KAC) over a 6 month period were included. Patient demographics, specialist referrals, investigations, surgical interventions, and clinical outcomes were analysed.

Patients who were managed by the KAC only, were followed up for a minimum of 6 weeks and were asymptomatic at discharge.

Patients referred to a specialist were followed up prospectively in order to identify the accuracy of the initial diagnosis made in the KAC.

Results: The study included 191 patients (125 males, 66 females) with a mean age of 34.6 years.

Patients were seen in the KAC after an average 10.5 days from injury. Initial diagnoses included 35 patelo-femoral pathologies, 30 non-specific soft tissue injuries, 28 collateral ligament injuries, 27 cruciate ligament injuries, 21 combined meniscal and ligamentous injuries, 19 meniscal injuries, 17 patients with knee arthritis, 2 combined cruciate and collateral ligament injuries, 5 patellar dislocations, and 7 non-specific knee effusions.

Overall, only 52 patients (27.2%) were referred to a rheumatologist (n=6) or an orthopaedic surgeon (n=46). A total of 25 patients were referred for further investigation (Magnetic resonance imaging (MRI) n=14, Arthroscopy n=10, or both n=2). Patients who missed > 2 appointments and had no further episodes were excluded from further analysis (n=20).

The initial diagnosis correlated positively with that of the specialist in 26 out of 32 patients (81.3%) who completed a full treatment episode. The diagnosis by the physiotherapist and the specialist correlated with MRI or arthroscopy findings in 85.0% and 95.0% of cases respectively.

Conclusion: We believe that our physiotherapy led acute knee assessment clinic is effective and safe as a first referral point for acute knee injuries.