The Knee Examination for Video Telemedicine Encounters

• Type of Material: Article
• Authors: Joseph Lamplot, Emory University; Sridhar Pinnamaneni, Signature Medical Group; Stephanie Swensen-Buza, Hospital for Special Surgery; Cort D Lawton, OrthoIllinois; Joshua S Dines, Hospital for Special Surgery; Danyal H Nawabi, Hospital for Special Surgery; Warren K Young, Hospital for Special Surgery; Scott A Rodeo, Hospital for Special Surgery; Samuel A Taylor, Hospital for Special Surgery
• Language: English
• Date: 2021-02-01
• Publisher: SAGE PUBLICATIONS INC
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © The Author(s) 2020
• License: Creative Commons Attribution-NonCommercial 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1177/1556331620975039
• Title of Journal or Parent Work: HSS JOURNAL
• Volume: 17
• Issue: 1
• Start Page: 80
• End Page: 84
• Grant/Funding Information: The author(s) received no financial support for the research, authorship, and/or publication of this article.
• Keywords: knee injury; Life Sciences & Biomedicine; Orthopedics; Science & Technology; telehealth; physical examination; body sites; Surgery; PHYSICAL-EXAMINATION; SHOULDER EXAMINATION; telemedicine; knee examination; diagnostic modalities; ANTERIOR; LAXITY; SPECIAL TESTS; knee
• Research Categories: Health Sciences, Medicine and Surgery

Abstract

Although over the past 2 decades improvements in audiovisual communication technologies have led to an increased use of telemedicine across many health care disciplines [1,27], it had not been widely adopted in orthopedic surgery and other musculoskeletal specialties within the United States until the onset of the COVID-19 pandemic [19]. However, mandated social distancing measures and restrictions on in-person consultations have forced both clinicians and patients to become familiar with web-based videoconferencing platforms for care delivery. To continue providing musculoskeletal care during the pandemic, there has been a dramatic increase in telemedicine visits [2,20]. Previous studies on telemedicine have shown that these visits increase access to care while having lower overall costs and maintaining patient satisfaction [5,9]. With increased access to high-speed videoconferencing platforms, widely available personal computing devices, and patient demand for high-quality, convenient, efficient specialty care, telemedicine is an effective medium for musculoskeletal care that will endure beyond the COVID-19 pandemic [2,19,20,22,24,28]. One particular challenge to the long-term adoption of telemedicine in musculoskeletal specialties has been a widely held perception that remote visits are markedly limited by the inability to perform an in-person physical examination [3,12,13,29,30]. In particular, it has been thought that examination maneuvers requiring manual motor testing for strength, motion assessment, stability, and provocative testing for pain may be difficult to perform remotely [20]. However, in a randomized controlled trial of orthopedic visits in which telemedicine encounters were compared with in-person consultations, physicians rated their ability to examine patients as good or very good in 98% of telehealth visits, with no significant differences between groups and no adverse safety events [4]. When specifically considering the physical examination of the knee, closer review suggests that most of the examination can actually be successfully performed remotely with some modifications. The purpose of this commentary is to describe a comprehensive knee physical examination for video telemedicine encounters, including (1) verbal instructions in layman’s terms of each examination maneuver, (2) annotated images of each examination maneuver that can be provided to patients via screen share options, and (3) checklists for documentation.