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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.
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