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.
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.
That MRI has not yet been done
Tells the surgeon the next investigative step and avoids duplication.
Leave out
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 $15.