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.