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AuditofAcute KneeInjuryimagingin theBRI Supervision:Mr.Sven Putnis(Cons)liardosBackground – Anteriorcruciateligament(ACL)injuryisacommoninjury resultingfromnon-contactdecelerationorchangeof direction(fixed, valgus twisting injury) – Followingacuteinjury,rapidonsetofalargetense effusion over 0-2 hoursissuggestiveofaligamentousinjury, particularlytheACL,orafractureordislocation. – Meniscal tears areoftenassociatedwithACLinjury. – Associated meniscal or chondral injuries canchangethe urgencyfortheatreandmanagementbycomplicatingthe initialpresentation. Background – significantly affectingknee stability, can require surgicalintervention and rehabilitation to return to normalfunction, once the patient is optimised fortheatre, delaying can worsen the prognosis for recovery. – Plain radiographshave little value unless there has been an injury due to direct impact. – MRI of the knee is most indicatedin patients with suspectedinjuriesof the menisciandof the cruciate ligaments.With diagnostic medialmeniscusandACLbe achieved forthe StandardsforManagementofAnterior CruciateLigament(ACL)InjuriesGuidelines Summary of the standards: – Specialised clinician required toassess patient (Virtual FractureClinic-VFCis not specialised) – MRI imaging modality of choice – Imaging must be done within 14 days of presentation Was MRIcarriedout? Investigation Criteria Was MRIwithin 14days of presentingin specialist clinic? What we did: - Screened acute knee injury patients referred toBRITrauma& Orthopaedic department betweenJuly -September 2023 - Patients fromVFC,ED,NB andGPReferrals - Reviewed uploadedVFCrecords and imaging records toaudit Methods whetherX-ray imaging and MRIimaging were performed and when. - Established the rate of MRIimaging and whether the imaging was within2 weeks of presentation - Total 1406 patients. - 115Acute knee presentations Total Patients 1406 Total MRIs Acute Knee Patients 115 Excluded Patients 23 42.39% Results TotalKnee Patients for 92 (VFC7/23–9/23) Screening MRIs and MRIs 39 within 2W MRIswithin 2W 29 31.52% SpecialistedAcuteKnee clinic to be implemented. Proposed changes Lower-limbfracture consultants ledclinics Whatwedid: – Acutekneeclinic wasestablishedon16/10/23.ItraneveryMondayon alternativeweeksandwasledbylowerlimbfractureconsultants. – RecordswereaccessedforpatientsreferredtoBRIOrthopeadics betweenOctober2023–January2024. – Duetolimitedslotsforkneeclinics(14slotspermonth)wecontinued Phase2:RE- toscreenVFC referredpatientswhoalsopresentedwithacute knee injuriesduringthisperiod. AUDITafter – ExaminedimagingrecordstoauditwhetherMRIimagingwas performedandwhetherthiswaswithinthe14daywindow. AKC – ComparedMRIimagingrate before andafterAcuteKneeClinic had beenestablishedattheBRI(16/10/23) –Total Patients: 1865 –Total Knees: 151 oIncluding 34AKC Patients Total Patients 1865 Total MRIs Knee injury Patients 195 Excluded Patients 37 52.53% Results (VFC+AKC10/23– TotalKnee Patients for 158 Screening 1/24) MRI and TotalMRIs 83 within 2W MRIswithin 2 weeks 74 46.83% Total Patients 42 Total MRIs Acute Knee Patients 42 Excluded Patients 6 75.00% ResultsAKC TotalKnee Patients for 36 Screening only MRI and within 2W TotalMRIs 27 MRIswithin 2 weeks 26 72.22% MRI carried out within 2W of presenting PreAKC PostAKC AKCOnly PrevsPost 31.52% 46.83% 72.22% AKC 2WeekMRI The implementationoftheAcute KneeClinicsignificantly improvedtheratesof2WMRIsforsuspectedligamentous incidence injuriesintheknee. The BOASTsStandards assessedinthis audit: ü Specialised clinician requiredtoassess patient (Virtual FractureClinic-VFCis not specialised) o MRI imagingmodalityofchoice o Imagingmustbedonewithin 14 daysofpresentation IncreasedAcuteKneeClinic patient allocations (weekly basis vs bi- Proposed weekly). changes Access to imagingfor patients referredfromexternal carecentres.Many thanks toJuliett Pittman for facilitating access to EPR andpatient records Special thanks to MrSven Putnis for supervising and guiding us during this audit andproviding thelogistical Thankyou support to fulfil therequirements for theaudit. Any questions? (Audit guidance and slides will bemade available)