The use of early immobilization in the management of acute soft-tissue injuries of the knee: results of a survey of emergency physicians, sports medicine physicians and orthopedic surgeons

The use of early immobilization in the management of acute soft-tissue injuries of the knee: results of a survey of emergency physicians, sports medicine physicians and orthopedic surgeons

Can J Surg 2014;58(1):48-53 | PDF

Mark Sommerfeldt, MD, BScPT; Martin Bouliane, MD; David Otto, MD; Brian H. Rowe, MD, MSc; Lauren Beaupre, PT, PhD

Abstract

Background: Evidence-based guidelines on the use of immobilization in the management of common acute soft-tissue knee injuries do not exist. Our objective was to explore the practice patterns of emergency physicians (EPs), sports medicine physicians (SMPs) and orthopedic surgeons (OS) regarding the use of early immobilization in the management of these injuries.

Methods: We developed a web-based survey and sent it to all EPs, SMPs and OS in a Canadian urban centre. The survey was designed to assess the likelihood of prescribing immobilization and to evaluate factors associated with physicians from these 3 disciplines making this decision.

Results: The overall response rate was 44 of 112 (39%): 17 of 58 (29%) EPs, 7 of 15 (47%) SMPs and 20 of 39 (51%) OS. In cases of suspected meniscus injuries, 9 (50%) EPs indicated they would prescribe immobilization, whereas no SMPs and 1 (5%) OS would immobilize (p = 0.002). For suspected anterior cruciate ligament injuries, 13 (77%) EPs, 2 (29%) SMPs and 5 (25%) OS said they would immobilize (p = 0.005). For lateral collateral ligament injuries, 9 (53%) EPs, no SMPs and 6 (32%) OS would immobilize (p = 0.04). All respondents would prescribe immobilization for a grossly unstable knee.

Conclusion: We found that EPs were are more likely to prescribe immobilization for certain acute soft-tissue knee injuries than SMPs and OS. The development of an evidenced- based guideline for the use of knee immobilization after acute soft-tissue injury may reduce practice variability.

Résumé

Contexte : Il n’existe pas de lignes directrices factuelles sur le recours à l’immobilisation pour la prise en charge des traumatismes aigus communs qui affectent les tissus mous du genou. Notre objectif était d’explorer les habitudes de pratique des urgentologues, des médecins du sport et des chirurgiens orthopédistes quant au recours à l’immobilisation pour la prise en charge initiale de ces blessures.

Méthodes : Nous avons conçu un sondage Web et l’avons fait parvenir à tous les urgentologues, médecins du sport et chirurgiens orthopédistes d’un centre urbain canadien. Le sondage visait à évaluer la probabilité que l’immobilisation soit prescrite et à dégager les facteurs associés à ce type de décision chez les praticiens de ces 3 disciplines.

Résultats : Le taux de réponse global a été de 44 sur 112 (39 %) : 17 urgentologues sur 58 (29 %), 7 médecins du sport sur 15 (47 %) et 20 chirurgiens orthopédistes sur 39 (51 %). Dans les cas où l’on soupçonnait une blessure du ménisque, 9 urgentologues (50 %) ont indiqué qu’ils prescriraient l’immobilisation, contre aucun médecin du sport et 1 (5 %) chirurgien orthopédiste (p = 0,002). Dans les cas où l’on soupçonnait une blessure du ligament croisé antérieur, 13 urgentologues (77 %), 2 médecins du sport (29 %) et 5 chirurgiens orthopédistes (25 %) ont affirmé qu’ils immobiliseraient (p = 0,005). Dans les cas de blessure au ligament collatéral latéral, 9 urgentologues (53 %), aucun médecin du sport et 6 chirurgiens orthopédistes (32 %) immobiliseraient (p = 0,04). Tous les répondants ont dit prescrire l’immobilisation pour un genou manifestement instable.

Conclusion : Nous avons constaté que les urgentologues étaient plus susceptibles de prescrire l’immobilisation pour certains traumatismes aigus affectant les tissus mous du genou comparativement aux médecins du sport et aux chirurgiens orthopédistes. La formulation de lignes directrices factuelles sur le recours à l’immobilisation du genou après un traumatisme aigu des tissus mous pourrait réduire la variabilité des pratiques.


Accepted for publication July 23, 2014

Acknowledgements: The authors thank the University of Alberta Department of Emergency Medicine and Division of Orthopedic Surgery for their cooperation with this survey. The study team thanks the physicians from all groups who participated in the study. B. Rowe was supported by a Tier I Canada Research Chair in Emergency-based Medicine from the Canadian Institutes of Health Research (CIHR). L. Beaupre receives salary support through a Population Health Investigator Award from Alberta Innovates — Health Solutions and a New Investigator Award (Patient Oriented Research) from CIHR.

Affiliations: Department of Surgery (Sommerfeldt, Bouliane, Otto), Department of Emergency Medicine (Rowe) and Department of Physical Therapy (Beaupre), University of Alberta, Edmonton, Alta.

Competing interests: None declared.

Contributors: All authors designed the study. M. Sommerfeldt, B. Rowe and L. Beaupre acquired and analyzed the data, which M. Bouliane also analyzed. M. Sommerfeldt, B. Rowe and L. Beaupre wrote the article, which all authors reviewed and approved for publication.

DOI: 10.1503/cjs.004014

Correspondence to: L. Beaupre, 2-50 Corbett Hall, University of Alberta, Edmonton, AB, T6G 2G4; lbeaupre@ualberta.ca