Evaluation of knee consultations to a referral-only orthopedic clinic in a managed care system.

Abstract

One hundred sixty-five knee consultations to a referral-only orthopedic service over a 2-year period were reviewed to document the gatekeeper diagnosis and initial treatment plan. These data were compared to the orthopedic evaluation. The majority of gatekeeper referral diagnoses were nonspecific or inaccurate. Several misdiagnoses resulted in prolonged patient recovery (delayed quadriceps tendon repair) and reinjury (recurrent instability of unrecognized anterior cruciate ligament-deficient knees). These findings suggest the gatekeeper model may be inadequate to appropriately manage knee disorders.