• A thorough and detailed history is important to establish the diagnosis ^[1].
• Initial assessment should include screening for red flags (symptoms of serious pathology) ^[2]. Examination techniques may assist in identifying serious underlying pathology (red flags), although they may lack specificity for diagnosing knee disorders ^[2].
• Indications for radiography include a history of trauma, sudden onset of severe pain, or clinical features of a serious condition ^[1]. There are several knee rules (The Ottawa Knee Rule, Pittsburgh Knee Rule and Bauer Rule) which provide a guide to indicate whether radiological investigations are necessary ^[1].
• Psychosocial and occupational risk factors (yellow flags) are associated with progression from acute to chronic pain ^[1]. These issues should be considered from day one. Explicit screening for yellow flags should be undertaken where no improvement has occurred four to six weeks following the injury.

• Providing education and information about knee injuries and treatment options is an important intervention ^[1].
• Mild knee injuries (no apparent ligament laxity or meniscal damage) should be treated with R.I.C.E (rest, ice, compression, elevation) and avoiding H.A.R.M (heat, alcohol, running, massage) for up to 72 hours post injury ^[2].
• Simple medication for pain relief (such as paracetamol) and joint mobilisation may provide short-term symptom control ^[1].
• It is important to resume as much usual (pre-injury) activity, including work, as possible as pain and swelling settles ^[1].
• Follow up is required after seven days where symptoms persist ^[2].
• People with suspected acute mensical presentations (who do not require immediate surgery) should be referred for a trial of rehabilitation for six to eight weeks. If symptoms and functional restrictions persist beyond that time they should be referred to a medical specialist for further management opinion ^[2].
• Rehabilitation should focus upon the attainment of functional goals rather than passive treatment modalities in isolation ^[2].
• An outcome measure or screening tool (eg, the Knee Injury and Osteoarthritis Outcome Score) should be used to evaluate treatment effectiveness.

1. Australian Acute Musculoskeletal Pain Guidelines Group. Evidence-based management of acute musculoskeletal pain. Bowen Hills: Australian Academic Press; 2003.
2. Accident Compensation Corporation. The Diagnosis and Management of soft tissue knee injuries: Internal Derangements - Best practice evidence-based guideline. July 2003.

Where an individual has not recovered within the expected recovery timeframe, the diagnosis and management plan should be reconsidered. Reassess for serious underlying pathology (red flags), undertake screening for psychosocial risk factors (yellow flags), and reconsider treatment type and intensity.

Note: Once the first 72 hours have passed, most injured workers with knee injuries will be able to undertake seated work. In these cases medical providers who are able to certify should document this level of capacity on the WorkCover Medical Certificate (WMC). Early contact with employers regarding the provision of seated duties where applicable is very important.

Expected recovery timeframes for knee injuries can be found below.

Sprain/strain
Expected healing time: 2-6 weeks
Notes: Sprain/strain injuries generally heal in 2-6 weeks. Sometimes this is a provisional diagnosis and a different diagnosis is made when expected healing does not occur.

Bruises/contusions
Expected healing time: 2 weeks
Notes: If there is significant associated tissue injury, particularly with a crush injury, healing may be slower.

Meniscal (cartilage) injury treated surgically
Expected healing time: 2-4 weeks
Notes: Arthroscopic treatment of a damaged meniscus should be followed by rapid restoration of function arising from the damaged meniscus unless there are other concurrent pathologies within the knee joint.

Lacerations
Expected healing time: 2 weeks
Notes: Generally activity can continue while healing occurs, particularly if the affected area can be kept dry.

The provision of information and education about the injury is an important intervention, which can promote effective self management of symptoms. A number of fact sheets are available to provide to an injured worker. Examples include:

WorkCoverSA Caring for your knee sprain/strain

National Health and Medical Research Council Anterior Knee Pain Information sheet.

Accident Compensation Corporation – New Zealand

The Diagnosis and Management of Soft Tissue Knee Injuries: Internal Derangements

National Health and Medical Research Council

Evidence-based management of musculoskeletal pain
Evidence-based Management of Musculoskeletal Pain – A Guide for Clinicians