Anterior knee pain | Right Decisions

Atraumtaic pain arising at the front of the knee.

History

Young-middle aged
May be bilateral
Mostly female
Possibly overweight
Diffuse ANTERIOR knee pain
Pain on stairs, kneeling, prolonged sitting

Signs

No obvious abnormality
Positive ‘grab’ sign (patient grabs front of knee)
Genu valgum (knock knees)
Squinting patellae (knee caps ‘face’ each other)
Patella apprehension – generally sore when examining
Possible patello-femoral crepitus
Difficulty kneeling/squatting

Who to refer, who not to refer, how to refer

Who to Refer

Only those who have failed non operative measures
Any abnormal MRI findings if MRI completed in community
Recurrent Patella dislocations

Urgent Referral Criteria

Suspicion of tumour/ infection

Who Not to Refer

Those who have not undergone non operative measures – See primary care management

Additional Info

Unlikely to require surgery
Usually adolescent knee pain – resolves at skeletal maturity
Unlikely to operate BMI >40

How to refer

We accept referrals through SCI gateway for those who are based in Scotland.

We also accept e referrals through the below email address using the attached form for those who are based just on the other side of the border.

E- Referral Email address - bor.orthoreferrals@borders.scot.nhs.uk

Referral form - E-Referral to Orthopaedics (Non Sci-Gateway)

Primary care management

Physio rehab- strengthening over extended period (1yr)
Regular maximum multimodal analgesia
CSI X 2-3 if possible – if over 45
Education
Podiatry, esp if flat footed
BMI >35 engage in wellbeing support

Resources and links

Primary Knee Pathway - developed by First Contact Practitioners Primary Knee Pathway

Local service details

orthopaedics@borders.scot.nhs.uk

bor.orthoreferrals@borders.scot.nhs.uk