Imaging & MRI Referral Pathway
A streamlined pathway for GPs and physiotherapists to access knee imaging and specialist review with Mr Sam Nahas at Circle Reading Hospital. Most imaging is arranged within 7 days, with a clear plan agreed within a week of first contact.
Who This Pathway Is For
- •Acute sports injuries (suspected ACL/MCL/meniscus, patella dislocation)
- •Persistent knee pain/arthritis assessment
- •Suspected meniscal root or osteochondral injury
- •Alignment questions (considering HTO/DFO or arthroplasty selection)
- •Post-operative concerns (pain, stiffness, instability)
Patients: Please book directly via the Book Appointment page.
Quick Triage (What to Send Today)
Please include a brief summary and any prior imaging. If you can't arrange first-line X-rays, refer anyway and we can organise them.
Ideal information in referrals
- •Mechanism/date of onset, sport/occupation, goals
- •Key findings: effusion, ROM, joint line tenderness, instability, locking
- •Red flags excluded/noted (fever, suspected fracture, wound issues, neurovascular)
- •PMH/anticoagulants/allergies/BMI/smoking
- •Imaging done (attach reports)
- •Your specific question (e.g. "repair vs trim?", "OK for RTS?", "alignment for osteotomy?")
Please ensure if transmitting patient data this is sent securely with the ideal referral information as above and attach imaging reports. Please inform the team where imaging was performed so that we can arrange transfer to Mr Nahas.
First-Line Imaging Guidance
X-ray (first line for pain/arthritis)
Views: weight-bearing AP, lateral, and skyline (patellofemoral)
MRI (soft tissue / internal derangement)
Indications: suspected meniscal tear (incl. root), ACL/PCL/MCL/LCL/PLC, osteochondral injury, mechanical symptoms
We arrange high-quality knee MRI with standard orthopaedic sequences; within a week where indicated
CT & Ultrasound
CT and Ultrasound are not usually a requirement for referrers. These will be arranged by Mr Nahas' team when clinically indicated for specific cases (e.g., tunnel position for revision ACL, peri-patellar assessment, ultrasound-guided injections).
Open MRI (claustrophobia) and special MRI protocols (e.g. pacemaker) can be arranged via our London partners when needed.
Learn more about Knee MRI & imaging →How the Pathway Runs
- 1.Referral received
Secure form/email triage by Mr Nahas' team.
- 2.Baseline imaging
If not already performed, we'll book X-rays (WB AP, lateral, skyline; long-leg if needed). MRI/CT/US arranged where indicated — typically within 7 days.
- 3.Specialist review
Images are reported by consultant radiologists and personally reviewed by Mr Nahas.
- 4.Consultation & plan
Patient seen (often within a week). A clear plan within 7 days:
- •Non-operative: physiotherapy, load management, bracing, steroid/HA/PRP injections
- •Operative: arthroscopy/meniscal repair, ACL/MPFL/PLC/MCL, HTO/DFO, UKR/TKR
- 5.Communication back to referrer
Clinic letter with diagnosis, imaging summary, and milestones (target prompt turnaround).
Indications That Warrant Rapid Imaging/Referral
- •Locked knee / likely repairable meniscus (bucket-handle/root)
- •Acute ACL/PCL/MCL/PLC with instability or giving way
- •Patella dislocation with large effusion/fragment concern
- •Osteochondral fracture/loose body
- •Post-op red flags (contact us; true emergencies to A&E)
Emergencies (suspected septic arthritis, fracture with deformity, neurovascular compromise) → A&E.
Ultrasound-Guided Injections (On Request)
- •Corticosteroid, Hyaluronic acid (visco)
- •Typically arranged at Circle or partner centres; useful adjunct to rehab for selected indications
Alignment & Osteotomy Work-Up
For suspected unicompartmental overload or deformity:
- •Long-leg alignment X-rays (hip-knee-ankle) mandatory
- •High-quality, properly centred standing images are essential
- •Mr Nahas uses digital planning software for HTO/DFO to set precise correction
Patellofemoral Instability Notes
- •Baseline X-rays incl. skyline
- •MRI for MPFL/osteochondral injury
- •Severe rotational/trochlear dysplasia: we will discuss and refer to subspecialist colleagues if required
Contact & Referrals
One-click referral (preferred) or send a secure email with the minimum dataset above and attach reports (DICOM via secure link where possible).
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