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Guidelines - Knee Pain and Mobility Impairments
This tool provides information to facilitate the management of knee pain,
mobility impairments, knee meniscal and articular lesions.
Focused examination
1. Patient History
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Rule out risk factors for major structural or other pathologies. If required, refer to an appropriate healthcare provider.
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Identify and assess other conditions and co-morbidities. Manage using appropriate care pathways.
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Address prognostic factors that may delay recovery.
Major structural or other pathologies (red flags):
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Sharp pain, persistent nagging ache, unexplained deformity, swelling, or redness of the skin, weakness not due to pain, fever/chills/feeling ill, pain at rest
Examples of other conditions/co-morbidities:
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Physical conditions: back pain, headache
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Psychological conditions: depression, anxiety
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Co-morbidities: diabetes, heart disease
Examples of prognostic factors that may delay recovery:
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Symptoms of depression or anxiety, passive coping strategies, job dissatisfaction, high self-reported disability levels, disputed compensation claims, somatization
2. Physical Examination
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Rule out major structural or other pathologies.
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Assess for neurological signs.
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Identify patient's baseline status relative to pain, function and disability; detect asymmetries; assess global knee function; determine the patient's readiness to return to activities using appropriate assessments.
Clinical findings of mensicus injury:
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Twisting injury, tearing sensation at time of injury, delayed effusion (6-24 hours post injury), history of 'catching' or 'locking', pain with forced hyperextension, pain with maximum passive knee flexion, pain or audible click with McMurray's maneuver, joint-line tenderness, discomfort or sense of locking or catching in the knee over either the medial or lateral joint line during the Thessaly test when performed at 20° of knee flexion
Clinical findings of articular cartilage injury:
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Acute trauma with hemarthrosis (0-2 hours), insidious onset aggravated by repetitive impact, intermittent pain and swelling, history of 'catching' or 'locking', joint-line tenderness
3. Management
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Offer information on nature, management, and the course of knee pain and mobility impairments.
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Discuss the range of effective interventions with the patient and, together, select a therapeutic intervention.
Patient Handouts
Therapeutic Management
Provide structured patient education (advice to stay active, reassurance, promote and facilitate return to work and normal activities, self-care advice) and any one of the following therapeutic interventions*:
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Consider early progressive active and passive knee motion
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Consider early stepwise progressive weight bearing
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Consider early progressive return to activity
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Consider in-clinic exercise and home-based exercise with education
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Consider progressive range-of-motion exercises, progressive strength training of the knee and hip muscles, and neuromuscular training
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Consider neuromuscular stimulation/re-education to increase quadriceps strength, functional performance, and knee function
*Interventions are recommended if guidelines used terms such as ‘recommended for consideration’ (e.g., ‘offer’, ‘consider’), ‘strongly recommended’, ‘recommended without any conditions required’, or ‘should be used’. Recommendations from low-quality evidence are not listed.
Care Pathway for the management of knee pain
4. Reevaluation and Discharge
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Reassess the patient at every visit to determine if: (1) additional care is necessary; (2) the condition is worsening; or (3) the patient has recovered.
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Monitor for any emerging factors that may delay recovery.
5. Referrals and Collaboration
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Refer the patient to an appropriate healthcare provider for further evaluation at any time during their care if they develop worsening symptoms and new physical or psychological symptoms.