Physiotherapy — Referral to Orthopaedics for a Non-Progressing Knee
A physiotherapist refers a 45-year-old runner to an orthopaedic surgeon after a knee injury fails to respond to a structured rehabilitation programme. The referral must show what was tried, why it has not worked, and what assessment is now needed — the physiotherapy reasoning is the value the recipient cannot get elsewhere.
Letter type
Referral
Write to
Orthopaedic Surgeon
Target length
180–200 words
The case notes
Patient: Mr David Lindqvist, 45 years old, recreational runner
History: Twisting injury to right knee 4 months ago; immediate swelling, felt a 'pop'
Assessment: Positive McMurray's test; joint-line tenderness (medial); recurrent effusion after activity
Treatment to date: 12 weeks of physiotherapy: progressive strengthening, proprioception, activity modification
Response: Pain and giving-way persist; unable to return to running; effusion recurs after loading
Function: Difficulty with stairs and pivoting; pain limits work as a warehouse supervisor
Imaging: X-ray — no fracture, no significant osteoarthritis; MRI not yet performed
Medical history: Otherwise fit; no previous knee problems
Task: Write a referral letter to Mr Patel, Orthopaedic Surgeon, requesting assessment for a suspected meniscal tear that has not responded to conservative management.
Writing task
Write a referral letter to Mr Patel, Orthopaedic Surgeon, requesting assessment for a suspected meniscal tear that has not responded to conservative management.
What to include, what to cut
The hardest mark to win is selection. The same case notes contain decision-relevant facts and distractors. Here is what an examiner expects to see in a Grade B letter for this scenario, and what should be left out.
Include
-
The mechanism of injury and the positive McMurray's / joint-line signs
These point to a meniscal tear and justify the suspected diagnosis the referral is built around.
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The 12-week physiotherapy programme and the lack of response
The whole reason for referral is failed conservative management; this is the physiotherapist's unique contribution to the decision.
-
Recurrent effusion and persistent giving-way
Objective signs that the problem is mechanical and unlikely to settle with more rehabilitation.
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That MRI has not yet been done
Tells the surgeon the next investigative step and avoids duplication.
Leave out
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Session-by-session physiotherapy notes
Summarise the programme and its outcome. A detailed treatment diary belongs in the record, not the referral, and costs Conciseness & Clarity.
-
Recreational running as a stand-alone lifestyle note
Relevant only as the functional goal he cannot meet; mention it in that context, not as background colour.
Criterion in focus · Content
Allied-health referrals are graded on whether the recipient gains decision-relevant information they could not get from the patient alone. The failed rehabilitation course and the clinical signs are that information — omit them and the letter has no purpose.
Now write the letter — and find out what is blocking your Grade B
Write a 180–200 words referral letter from these notes, paste it into the free checker for an instant read, then submit it for a human grade against all six criteria. Dr Mariam's team returns line-by-line feedback, from $12.