Questioning the need for ankle and knee imaging


14 Dec 2016
A new program advising health professionals on the latest imaging recommendations for ankle and knee injuries was launched in by NPS MedicineWise in October. The program was developed in conjunction with musculoskeletal experts and in line with RANZCR, Australian Physiotherapy Association and Australian College of Nursing Choosing Wisely Australia® recommendations, as well as RACGP clinical guidance for MRI referral.

The new ankle and knee program provides health professionals with the latest imaging recommendations for the acute knee and ankle injuries commonly seen in general practice. Australian data* suggests:

•    about 20% of all the sprains and strains managed by GPs in Australia during 2011–12 were ankle injuries
•    about 5% were knee injuries
•    ankle ultrasounds are requested in almost 40% of newly presenting cases despite Australian guidelines not recommending ultrasound to investigate ankle sprains.

Key factors

The program includes key factors to consider when deciding whether to refer people for imaging and, when imaging is indicated, guidance on selecting the most appropriate imaging modality. It emphasises the importance of good physical examination skills which, in combination with patient history, can be as good as imaging in diagnosing these injuries. 

Program resources 

A range of resources are available, including:
•    Choosing Wisely Australia campaign –The Royal Australian and New Zealand College of Radiologists, Australian Physiotherapy Association and Australian College of Nursing recommendations
•    Educational visits for GPs – register your interest now
•    An NPS MedicineWise Action Plan to help health professionals have good conversations with patients about the best care for their injury
•    Health professional publication Medicinewise News: Acute knee pain presentations in middle-aged patients: what role does MRI play?
•    Interactive online case study for GPs
•    New evidence-based, best practice videos demonstrating physical examination tests and Ottawa Rules for the diagnosis of common acute ankle and knee injuries.

For more information visit nps.org.au/ankle-knee-imaging

*2014 BEACH study: Evaluation of imaging ordering by general practitioners in Australia 2002–03 to 2011–12.

Last reviewed 14 December 2016