Accelerating care for knee injuries: Impact of a novel acute knee injury virtual triage clinic on timely diagnosis and treatment.

INTRODUCTION

Knee injuries are a common presentation to Emergency Departments (ED). Initial assessment prioritizes the exclusion of fractures, dislocations and other urgent pathologies. However, subsequent soft-tissue knee injuries referral pathways to orthopedic services remains inconsistent. Variability in orthopedic referral pathways may lead to delays in definitive diagnosis and intervention, potentially compromising recovery and long-term functional outcomes.

METHODS

This study reviews the first 250 patients referred from ED to an acute knee injury virtual triage clinic. Virtual clinic referrals were reviewed by orthopaedic consultant specialising in soft-tissue knee injuries or knee specialist physiotherapist. Data collected included patient demographics, injury characteristics, imaging and immobilization in the ED, time intervals from ED presentation to virtual review, MRI utilisation, and the need for surgical intervention.

RESULTS

Of the 250 patients reviewed, 111 (44.4%) were female and 139 (55.6%) were male, with a mean age of 30.3 years (SD 8.7). Injuries were evenly distributed between right (49.6%) and left (50.4%) knees. Sports accounted for 40.4% of injury mechanisms, with football alone representing 21.2%. ED radiographs were obtained in 82.4% of patients, and a non-hinged splint was applied in 73.6%. The median time from ED attendance to virtual review was within 72 h (mean 2.74 days). Thirty-six patients (14.4%) were discharged after virtual assessment, and 34.8% were referred for MRI. Overall, 19.6% underwent surgery, with a mean time from injury to operation of 51 days (range 4-268, median = 29.5). Sports-related injury was associated with higher MRI use (OR 2.5, 95% CI 1.4-4.4; p = 0.002).

CONCLUSION

An acute knee virtual triage clinic enabled timely specialist review, selective MRI use, and targeted surgical referral, safely avoiding unnecessary face-to-face visits in over one in seven cases. This streamlined pathway appears to improve efficiency and supports early decision-making for clinically stable patients with suspected knee soft injuries following ED assessment.