Title : Optimizing acute soft tissue knee injury management: A retrospective study on protocol implementation
Abstract:
Introduction: Soft Tissue Knee Injuries (STKI) are common presentations in emergency departments, yet no standardized protocol exists for their management. Delays in imaging, specialist review, and physiotherapy contribute to inefficiencies, increased healthcare costs, and prolonged patient recovery. This study aimed to evaluate current STKI management pathways and assess the impact of a physiotherapy-led protocol on streamlining care.
Methods: A retrospective study was conducted, including all first-time knee clinic attendees from January to May 2023. Patients with chronic knee conditions or inadequate documentation were excluded. Data collected included initial point of presentation (A&E, GP, or other), time intervals from presentation to knee clinic, MRI referral rates, and time taken for imaging and review. The financial impact of STKI management was also analyzed. Additionally, the effects of an Acute Knee Screening Service (AKSS), led by an experienced physiotherapist in A&E, were assessed.
Results: Of the knee clinic attendees, G4% initially presented to A&E, with 81% referred for MRI. However, 45% of MRI scans were deemed unnecessary for clinical decision-making. Delays were evident, with nearly G0% waiting over four weeks for MRI and only 11% receiving timely scan reviews. The AKSS demonstrated improved efficiency, with U5% of cases managed without further medical review. Among those referred for MRI, 88% showed significant pathology. The introduction of a physiotherapy-first protocol reduced knee clinic referrals by 30%, with a potential annual cost saving of £132,000.
Discussion & Conclusion: A physiotherapy-led approach in A&E significantly improves STKI management by reducing MRI overuse, expediting appropriate care, and cutting costs. Implementing structured assessment and referral pathways, such as Virtual Fracture Clinics and physiotherapy triage, enhances patient outcomes while optimizing healthcare resources. Future research should explore long- term patient outcomes following protocol implementation.
