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GP triage – Knee Menu

Common Knee Conditions
OA Knee
Affected Area
  • Usually >45yrs
  • Bulky joint + crepitus
  • May show Valgus/ Varus
  • Effusion +/- bakers cyst
  • Persistent knee pain
  • Limited ROM
  • Knee stiffness (30minutes after prolonged activity)
  • Reduced function, crepitus, restricted movement and bony enlargement
  • Education & advice
  • Exercise
  • Simple analgesics
  • NSAIDS
  • Walking aid as required
  • Physio/ OT referral
  • Consider 1 steroid injection
  • No investigations indicated in initial stages
  • If symptoms persist more than 6/52 despite treatment
  • Failed conservative treatment
  • Considering injection (if not available at GP surgery)
  • Consider referral for joint replacement surgery if patient restricted and willing
High impact / Sporting injury
Affected Area
  • Acute pain
  • Swelling
  • Effusion within 2 hours is Haemarthrosisand needs prompt assessment in A&E or fracture clinic
  • Instability
  • Locking
  • Mechanical symptoms: True locking/ giving way
  • Advice
  • First aid (PRICE)
  • NSAIDS
  • Analgesics
  • Physiotherapy
  • X-ray: weight-bearing AP/ lateral views
  • MRI
  • No response to conservative treatment – refer to MSK service
  • Confirmed meniscal injury; ACL injury; Chondral injury – refer to Orthopaedics
Local Knee Pain​
Affected Area
Pain local to knee
No trauma
Mild swelling (if any)
Education & advice
Exercise
Simple analgesics
NSAIDS
Walking aid as required
Physio referral for younger OA patients, activity mildly affected, minor x-ray findings, no true locking or giving way
X-ray: weight-bearing AP/ lateral views 
Poor response to analgesics
Symptoms affecting ADLs/ occupation
Significant X-ray findings
True locking/ Giving way
Low impact trauma​
Affected Area
  • Low impact injury
  • Twisting injury
  • Soft tissue injury
  • Pain and swelling
  • No true locking or instability
  • Advice & Education
  • First aid (PRICE)
  • Simple analgesics
  • NSAIDS
  • X-ray: weight-bearing AP/ lateral views
  • No response to conservative treatment – refer to MSK service
  • Confirmed meniscal injury; ACL injury; Chondral injury – refer to Orthopaedics
Patella Dislocation
Affected Area
  • Report of dislocation
  • Anterior knee pain/ swelling
  • Pain with knee flexion
  • Reduced ROM
  • Acute: Refer to physio
  • Chronic: Education/ advice; Exercise; physio
  • X-ray: weight-bearing AP/ lateral views
  • Acute: Refer physiotherapy
  • Chronic: Recurrent patella dislocations, Physiotherapy unhelpful, patient considering surgery – ref to orthopaedics
Tendinopathy / Muscle strain​
Affected Area
  • Local pain in muscle or tendon
  • Worse with stretch
  • Worse with contraction
  • Advice & Education
  • Exercise
  • NSAIDS/ Analgesics
  • Refer to Physio after 6/52 if not improving
  • Refer to physio before 6/52 if affecting ADLs
  • No investigations indicated in initial stages
  • Failed conservative treatment
  • ADLs severely restricted
  • Patient would consider invasive treatment
Popliteal cyst (Bakers cyst)​
Affected Area
  • Posterior knee swelling
  • Soft and non-tender
  • Posterior knee stiffness
  • Manage in Primary Care
  • Advice & Education
  • X-ray: weight-bearing AP/ lateral views 
  • If symptoms not improving after 12/52
  • Not managing with treatment