The Knee Examination for Video Telemedicine Encounters
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 . 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 . 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 . 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.