The evidence from studies and guideline recommendations may be summarised as stating that: ‘GPs should only consider referring patients for ankle ultrasound or knee MRI of acute injuries when diagnosis is unclear after a targeted patient history and physical examination, and if confirming diagnosis will change management.’
The one knee MRI referral made by Dr Rees to help him make a diagnosis during his 8-year career as a GP (he has also referred two other patients, but these were requested by a surgeon) happened earlier this year when he had some doubt about an anterior cruciate ligament tear.
His physical examination found the patient’s uninjured knee had similar laxity to that of the injured knee. Dr Rees wondered if it was a case of unusually lax ligaments. But because the patient wanted to play competitive sport and was open to having surgical reconstruction, an accurate diagnosis was essential.
So Dr Rees ordered an MRI, which confirmed the patient had an ACL tear, and the patient went on to have a surgical reconstruction.
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