LAUSR

Although over the past 2 decades improvements in audio­ visual 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 COVID­19 pandemic [19]. However, mandated social distancing measures and restric­ tions on in­person consultations have forced both clinicians and patients to become familiar with web­based videocon­ ferencing 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 main­ taining patient satisfaction [5,9]. With increased access to high­speed 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 COVID­19 pandemic [2,19,20,22,24,28]. One particular challenge to the long­term adoption of tele­ medicine in musculoskeletal specialties has been a widely held perception that remote visits are markedly limited by the inability to perform an in­person 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 vis­ its 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 per­ formed remotely with some modifications. The purpose of this commentary is to describe a compre­ hensive 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.