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Brief Summary

GUIDELINE TITLE

Knee complaints.

BIBLIOGRAPHIC SOURCE(S)

  • Knee complaints. Elk Grove Village (IL): American College of Occupational and Environmental Medicine (ACOEM); 2004. 31 p. [87 references]

GUIDELINE STATUS

This is the current release of the guideline.

This guideline updates a previous version: Harris, J, ed. Occupational Medicine Practice Guidelines: American College of Occupational and Environmental Medicine. Beverly Farms, MA: OEM Press; 1997.

** REGULATORY ALERT **

FDA WARNING/REGULATORY ALERT

Note from the National Guideline Clearinghouse: This guideline references a drug(s) for which important revised regulatory information has been released.

BRIEF SUMMARY CONTENT

 ** REGULATORY ALERT **
 RECOMMENDATIONS
 EVIDENCE SUPPORTING THE RECOMMENDATIONS
 IDENTIFYING INFORMATION AND AVAILABILITY
 DISCLAIMER

 Go to the Complete Summary

RECOMMENDATIONS

MAJOR RECOMMENDATIONS

Recommendations are followed by evidence classification (A-D) identifying the type of supporting evidence. Definitions for the types of evidence are presented at the end of the "Major Recommendations" field.

Summary of Recommendations for Evaluating and Managing Knee Complaints (refer to the original guideline document for more detailed information)

Clinical Measure Recommended Optional Not Recommended
History Basic history, with careful search for mechanism of injury (C, D)    
Physical exam Focused physical exam, including ligament testing and careful search for any swelling (C, D)    
Patient education Patient education

Full disclosure of diagnostic accuracy, prognosis, and expectations of treatment (D) 		   
Medication (See Chapter 3 in the original guideline document) Acetaminophen

Aspirin (C, D) 		Opioids for severe pain

Non-steroidal anti-inflammatory drugs (NSAIDs) (C, D) 		Use of opioids for more than 2 weeks (C, D)
Physical treatment methods Nonoperative rehabilitation for medial collateral ligament injuries (C, D)

Short postoperative rehabilitation for anterior cruciate ligament (ACL) repair prior to home exercise program (D)

Conservative treatment for selected ruptures of the ACL (D)

Exercises for cases of anterior knee pain or ligament strain(D) 		  Passive modalities without exercise program (D)

Manipulation (D)
Aspirations and injections Aspiration of tense acute effusions (D)

Aspiration of tense prepatellar bursa (D) 		Repeated aspirations or corticosteroid injections (D) Aspiration through infected area (D)
Rest and immobilization Short period of immobilization after an acute injury to relieve symptoms (C) Functional bracing as part of a rehabilitation program (D) Prophylactic braces (D)

Prolonged bracing for ACL deficient knee (D)
Activity and exercise Stretching

Aerobic exercise

Maximal activity of other parts while recovering from knee injury (D) 		  Excessive rest (may lead to generalized debilitation) (D)
Detection of neurologic abnormalities     Electrical studies (contraindicated for nearly all knee injury diagnoses) (D)
Radiography Plain-film radiographs for suspected red flags (C) Plain-film radiographs for tense hemarthroses (C) Routine radiographic film for most knee complaints or injuries (C)
Imaging Magnetic resonance imaging (MRI) study to determine extent of ACL tear preoperatively (C)   MRI for ligament collateral tears (C)
Surgical considerations Arthroscopic meniscectomy or repair for severe mechanical symptoms and signs or serious activity limitations if MRI findings are consistent for meniscal tear (C, D)

ACL repair for symptomatic instability (i.e., serious activity limitation) if results of Lachman and pivot-shift tests and MRI are positive (C, D) 		ACL reconstruction before rehabilitation has been attempted (C, D) Surgical repair of isolated medial collateral ligament (MCL) ruptures (D)

Immediate surgical reconstruction of all ACL tears on basis of MRI findings without physical findings confirming diagnosis or worker life demands requiring high knee performance (D)

Definitions:

Levels of Evidence

A = Strong research-based evidence (multiple relevant, high-quality scientific studies).

B = Moderate research-based evidence (one relevant, high-quality scientific study or multiple adequate scientific studies).

C = Limited research-based evidence (at least one adequate scientific study of patients with knee complaints).

D = Panel interpretation of information not meeting inclusion criteria for research-based evidence.

CLINICAL ALGORITHM(S)

The following clinical algorithms are provided in the original guideline document:

  • American College of Occupational and Environmental Medicine Guidelines for care of acute and subacute occupational knee complaints
  • Initial evaluation of occupational knee complaints
  • Initial and follow-up management of occupational knee complaints
  • Evaluation of slow-to-recover patients with occupational knee complaints (symptoms >4 weeks)
  • Surgical considerations for patients with anatomic evidence of torn meniscus or ligament and persistent knee symptoms
  • Further management of occupational knee complaints
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EVIDENCE SUPPORTING THE RECOMMENDATIONS

TYPE OF EVIDENCE SUPPORTING THE RECOMMENDATIONS

The type of supporting evidence is identified and graded for each recommendation (see "Major Recommendations").

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IDENTIFYING INFORMATION AND AVAILABILITY

BIBLIOGRAPHIC SOURCE(S)

  • Knee complaints. Elk Grove Village (IL): American College of Occupational and Environmental Medicine (ACOEM); 2004. 31 p. [87 references]

ADAPTATION

Not applicable: The guideline was not adapted from another source.

DATE RELEASED

1997 (revised 2004)

GUIDELINE DEVELOPER(S)

American College of Occupational and Environmental Medicine - Medical Specialty Society

SOURCE(S) OF FUNDING

American College of Occupational and Environmental Medicine

GUIDELINE COMMITTEE

American College of Occupational and Environmental Medicine Practice Guidelines Committee

COMPOSITION OF GROUP THAT AUTHORED THE GUIDELINE

Chapter Lead: Lee S. Glass, MD

Committee Members: Jennifer H. Christian, MD, MPH, FACPM; Philip I. Harber, MD, MPH, FACOEM, FCCP; John P. Holland, MD, MPH, FACOEM; Kathryn L. Mueller, MD, MPH, FACEP, FACOEM; Douglas J. Patron, MD, MSPH; Bernyce M. Peplowski, DO, MS; and Jack Richman, MD, CCFP, DOHS, FACOEM

Timothy J. Key, MD, MPH, FACOEM, as Responsible Officer and ACOEM President Elect, and Edward A. Emmett, MD, MS, FACOEM, Chair of the ACOEM Council on Occupational and Environmental Medical Practice, contributed to the development of the guidelines as well.

FINANCIAL DISCLOSURES/CONFLICTS OF INTEREST

Not stated

GUIDELINE STATUS

This is the current release of the guideline.

This guideline updates a previous version: Harris, J, ed. Occupational Medicine Practice Guidelines: American College of Occupational and Environmental Medicine. Beverly Farms, MA: OEM Press; 1997.

GUIDELINE AVAILABILITY

Print copies are available from ACOEM, 25 Northwest Point Boulevard, Suite 700, Elk Grove Village, IL 60007; Phone: 847-818-1800 x399. To order a subscription to the online version, call 800-441-9674 or visit http://www.acoempracguides.org/.

AVAILABILITY OF COMPANION DOCUMENTS

None available

PATIENT RESOURCES

None available

NGC STATUS

This NGC summary was completed by ECRI on May 31, 2006. The information was verified by the guideline developer on November 3, 2006.

COPYRIGHT STATEMENT

The American College of Occupational and Environmental Medicine, the signator of this license, represent and warrant that they are the publisher of the guidelines and/or possess all rights necessary to grant the license rights to AHRQ and its agents.

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DISCLAIMER

NGC DISCLAIMER

The National Guideline Clearinghouse™ (NGC) does not develop, produce, approve, or endorse the guidelines represented on this site.

All guidelines summarized by NGC and hosted on our site are produced under the auspices of medical specialty societies, relevant professional associations, public or private organizations, other government agencies, health care organizations or plans, and similar entities.

Guidelines represented on the NGC Web site are submitted by guideline developers, and are screened solely to determine that they meet the NGC Inclusion Criteria which may be found at http://www.guideline.gov/about/inclusion.aspx .

NGC, AHRQ, and its contractor ECRI Institute make no warranties concerning the content or clinical efficacy or effectiveness of the clinical practice guidelines and related materials represented on this site. Moreover, the views and opinions of developers or authors of guidelines represented on this site do not necessarily state or reflect those of NGC, AHRQ, or its contractor ECRI Institute, and inclusion or hosting of guidelines in NGC may not be used for advertising or commercial endorsement purposes.

Readers with questions regarding guideline content are directed to contact the guideline developer.
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