XXXX : A persistently difficult diagnosis.

@entity1 @entity131 @entity341 @entity130
BACKGROUND: Historically anterior cruciate ligament (ACL) injuries have been diagnosed poorly. A paper published in Injury in 1996 showed that less than 10% of @entity1 with an @entity130 had the diagnosis made by the first physician to see them and that the average delay from first presentation to diagnosis was 21 months. The aim of our study was to investigate whether an improvement has been made over the last two decades in diagnosing @entity130 . METHODS: We identified 160 @entity1 who had an ACL reconstruction performed by a single surgeon between October 2004 and December 2011 and for whom a complete data set was available. Data was extracted retrospectively from the hospital notes and a dedicated @entity1 database. We performed a sub-group analysis comparing @entity1 seen prior to the introduction of an @entity131 clinic in April 2007 and @entity1 seen after the introduction of the clinic. RESULTS: 75.1% (120/160) of @entity1 presented first to an @entity341 ( @entity341 ) or to their general practitioner (GP), but only 14.4% (23/160) were diagnosed on initial presentation. The median number of healthcare professionals a @entity1 saw prior to a diagnosis of @entity130 was 3. The median delay from @entity130 was 0 weeks (range 0-885), injury to diagnosis 13 weeks (0-926), presentation to diagnosis 10 weeks (0-924), presentation to a specialist knee clinic 24 weeks (0-1006), and specialist knee clinic to surgery 13 weeks (0-102). The median total time from injury to surgery was 42 weeks (0-1047). Following the implementation of an @entity131 clinic in 2007, the median delay from presentation to surgery dropped from 59 weeks to 36 weeks (p = 0.050) and there was a significant decrease in the median delay from specialist knee clinic to surgery from 23 to 11 weeks (p=0.002). CONCLUSION: Over the past two decades there appears to have been little improvement in the early diagnosis of @entity130 , with only 14.4% of @entity1 being diagnosed correctly at initial presentation. We recommend further education of emergency and primary care clinicians in the diagnosis of @entity130 , emphasising the importance of the typical history of an @entity130 . The implementation of an @entity131 clinic may help minimise delays to surgery, which should result in better @entity1 outcomes.
