For Physiotherapists — Quick Referral & Co-Management

Why Refer to Mr Sam Nahas

• •New patient slots within a week for sports injuries and persistent knee pain
• •Rapid imaging pathway (X-ray/MRI/CT/US; usually within 7 days)
• •Clear plan within a week of first contact: non-operative or operative
• •Rehab-first philosophy with meniscal preservation and advanced ACL techniques where appropriate
• •Direct comms: concise clinic letter back to you (target 48 hours) with agreed goals and flags for progression or re-review. Happy for colleagues to contact directly

When to Refer Quickly (Within a Week)

• •Locked knee / repairable meniscus (acute bucket-handle, root tears)
• •Suspected ACL rupture with instability (consider early assessment, LET in high-risk)
• •PCL (may need specific bracing)
• •MCL (may need specific bracing)
• •Patella dislocation with effusion/osteochondral fragment concern
• •Multiligament injury (combined ACL/PCL/MCL/PLC) or knee dislocation history
• •Suspected osteochondral fracture/loose body
• •Failure to progress after an evidence-based rehab block

What Your Patient Can Expect

• •Consultation (history, examination, goals)
• •Imaging arranged promptly (often within a week)
• •Plan within 7 days: rehab, injection, bracing, or surgery if indicated
• •Communication back to you within 48 hours with agreed milestones

Imaging Pathways (Practical Notes)

• •X-rays: weight-bearing four views plus long-leg alignment when indicated
• •MRI (knee): where clinically indicated
• •CT: for complex bony detail, tunnel position (revision ACL), or alignment planning
• •Ultrasound: peri-patellar, tendons; US-guided injections available

All routine imaging is available at Circle Reading Hospital and other local units; specialist scanners (e.g., open MRI or pacemaker-conditional protocols) can be arranged via partner centres.

Surgical Indications We Commonly Consider

• •Meniscal repair/preservation (acute longitudinal, root, ramp) over meniscectomy where viable
• •ACL reconstruction (primary/revision), with LET in selected high-risk or revision cases
• •Patella instability: MPFL reconstruction ± tibial tuberosity realignment when indicated; referral onward for severe rotational/trochlear dysplasia
• •Realignment: HTO/DFO for unicompartmental overload in active patients
• •Arthroplasty: UKR/TKR when non-operative options exhausted and symptoms severe

Shared-Care Rehab (What We Will Agree Together)

• •Objective criteria: swelling control, full extension, progressive flexion, quad activation, gait normalisation
• •Milestone tests (as appropriate): step-downs, single-leg sit-to-stand, hop test battery, limb symmetry index guidance
• •RTS staging: strength ≥90% LSI, plyometric control, sport-specific drills, psychological readiness
• •Early communication if setbacks (persistent effusion, instability episodes, ROM plateaus)

Injections & Non-Operative Options

• •Steroid, Hyaluronic acid (visco), and PRP offered where evidence supports symptom relief and function gains
• •Bracing and load-management strategies for PF or unicompartmental disease
• •Close physio liaison to align deload/reload cycles with injection timing

Service Levels (Typical)

• •Appointment offered: within 7 days
• •Imaging: within 7 days (often sooner)
• •Clinic letter back to referrer: target 48 hours
• •Surgery (if required): as soon as safe after pre-op assessment and 5-day antibacterial wash protocol