Re: Delay in diagnosis and management of adolescent ACL injuries

Issue: BCMJ, vol. 63, No. 7, September 2021, Pages 272-273 Letters

I am not surprised by the finding that discrepancies exist in the W0 time between individuals. Further studies on this, as suggested in the article [BCMJ 2021;63:211-216], would be helpful. However, I am concerned that the authors’ recommendation that all adolescent patients presenting with an acute hemarthrosis be referred for an MRI will only lengthen the W0 time. These patients will join the ever-ballooning pool of people waiting for unnecessary musculoskeletal MRIs.

It also suggests that the presence of a hemarthrosis is, in fact, identified. In today’s medical climate of COVID-19, precipitated telephone consultations, and Babylonesque primary care that may not be the case.

The paper referenced in Dr Leveille’s article (Ardern CL and colleagues), recommending the need for an MRI, itself references a paper by Kocher MS and colleagues (Am J Sports Med 2001;29:292-296) to support this recommendation. This is perplexing, as the conclusion of that paper is “MRI does not provide enhanced diagnostic utility over clinical examination.”

Having recently treated two adolescents with locked knees who presented late due to the wait for unnecessary MRIs, I would advocate for Dr Leveille and colleagues’ other recommendation: the urgent referral of all adolescents with an acute knee hemarthrosis (swollen knee) from the primary care or urgent care provider.
—Roger Purnell, MBChB
Orthopaedic surgeon, UHNBC
Prince George

This letter was submitted in response to “Delay in diagnosis and management of adolescent anterior cruciate ligament injuries in patients with lower socioeconomic status.”

Read the authors’ response in “Re: Delay in diagnosis and management of adolescent ACL injuries.”

Roger Purnell, MBChB, FRCSC. Re: Delay in diagnosis and management of adolescent ACL injuries. BCMJ, Vol. 63, No. 7, September, 2021, Page(s) 272-273 - Letters.

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