Clinician-led. Surgeon-supported. Patient-focused.

Better decisions, together, for MSK patients.

Surgery when it is needed. A clear plan when it is not.

MSK (musculoskeletal) means muscle, bone and joint. Orwyn is a set of rules for knee problems, written and governed by a named consultant knee surgeon, Dr Arj Imbuldeniya. It helps first contact clinicians choose the right next step for each patient. The clinician decides.

Who it is for: first contact practitioners (FCPs), advanced practice physiotherapists and MSK physiotherapists. They are the clinicians a patient sees first about a knee problem.
What the patient gets: a letter in plain words, checked by their clinician. It says what was found, what happens next and when to get help sooner.

See the demo Get in touch

The demo uses draft rules awaiting final sign-off, and example patients only.

Got a text, email or letter from Orwyn?

Orwyn is being built through the NHS Clinical Entrepreneur Programme, Cohort 10.

Watch

See how Orwyn helps the clinician

Orwyn's result screen for an example patient with a suspected anterior cruciate ligament (ACL) rupture: the recommendation, the most likely diagnosis with its reasons, another diagnosis to consider, the choice to agree or change, and what to do today. — An example patient with a knee injury. Draft rules awaiting final sign-off. The clip has no sound.

How it works

Four steps. The clinician decides at each one.

The safety stop screen for an example patient with a hot, swollen knee. A banner says: Stop. A safety rule applies. The card below says A&E at once. A&E is the hospital emergency department. It gives three steps. Fluid is drawn from the joint and tested urgently for infection. If the test is positive, the orthopaedic team washes out the joint at once and antibiotics are given into a vein. No antibiotics are given before the fluid is drawn, unless the patient is very unwell from the infection. A patient that unwell belongs in A&E, not the MSK clinic. A list says what must not happen: routine rehabilitation alone, a steroid injection into the joint, or reassurance with pain relief alone. Below, three documents are ready: an urgent escalation letter, a letter to the patient and a clinic note. — **1. The safety questions come first.** They look for anything that needs urgent care. There is no result until the clinician has answered them. If a safety rule applies, Orwyn stops and says what to do, as here.

Orwyn's result screen for an example patient who hurt her knee. The recommendation reads: refer today to the acute knee clinic, request an MRI (magnetic resonance imaging) scan and start physiotherapy. The diagnosis is an anterior cruciate ligament (ACL) rupture or insufficiency, marked as likely. A medial meniscal tear (a tear of the cartilage on the inner side of the knee) is shown to also consider. Three reasons are listed: how it happened (landing from a jump, 2 days ago), ACL laxity (the clinician suspects the ligament is loose), and giving way. Below are the buttons to agree or change. Then come three things to do now: request the MRI, start physiotherapy, and refer to the acute knee clinic the same day. The last line says no red flags (signs of a serious problem) were found on the information given. — **2. The most likely diagnosis, and why.** Orwyn shows its reasons and what to do today. The clinician agrees or changes it.

The documents screen for an example patient. It says six documents are ready to copy or print, and that nothing is sent from this screen. Two are the letter to the patient and a copy of it for the GP (family doctor). The others are an imaging request to radiology, referrals to physiotherapy and to the acute knee clinic, and a clinic note. The letter to the patient is open below them. It is addressed to Priya Sharma, an example patient. In plain words it says what happened to her knee and what the clinician found. — **3. The letters and referrals, for the clinician to check.** A letter for the patient in plain words, and a referral or scan request where one is needed.

Two screens for an example patient with a knee injury. On the left, the patient's page on a phone, marked as a test site and as a draft not yet signed. It says what we think it is, an ACL injury, gives the medical name, and explains in plain words what the ACL is, that strengthening exercises come first for almost everyone, and when an operation helps. On the right, the clinician's guide to the Lachman test, anterior drawer and pivot shift: what the test is, how to do it step by step, what a positive result means and what to watch out for. Boxes for a picture and a video say coming soon. — **4. Teaching that supports the plan.** For the patient, a page that explains the diagnosis in plain words, such as what an anterior cruciate ligament (ACL) injury is. For the clinician, “Learn more” explains the diagnosis and how to do the examination tests. Pictures and short videos are being added.

The seven steps in detail, including what works in the demo today and what is planned: what Orwyn does.

The problem

Musculoskeletal care goes wrong in both directions

First contact clinicians decide every day whether a patient needs a surgeon’s opinion. The weak part is the system around them. A patient can be sent for a surgical opinion that was never going to lead to an operation, and wait months to hear it. Another can be managed for a year with a problem that needed surgery sooner. Neither is the fault of the clinician in the room. When they decide, they cannot see the thresholds specialists will use later. Nor can they see what happened to their past referrals.

One pathway, two ways to get it wrong. Both right outcomes are equal. The failures are a specialist wait that changed nothing and a referral that came too late.

NHS England calls the work of getting this right MSK referral optimisation. It is not the same as reducing referrals. We explain the terms in plain English: what MSK clinical decision support is, how MSK triage works, and who first contact practitioners are.

For commissioners

How Orwyn’s rules are checked

Each condition in Orwyn’s knee rules is being checked against 6 sources: the National Institute for Health and Care Excellence (NICE), Getting It Right First Time (GIRFT), the standards of the British Orthopaedic Association (BOA), called BOASTs, the British Association for Surgery of the Knee (BASK), PubMed and ClinicalTrials.gov. None is signed off by the clinical safety officer until it has been.
Every knee X-ray Orwyn asks for includes a skyline view of the kneecap, as GIRFT’s national knee replacement pathway (July 2026), co-badged by BASK and the BOA, asks for referrals.
Orwyn is being built to NICE’s latest standards for digital health tools. Its rules are being checked against current NICE guidance. Any departure from it is stated, and the clinical safety officer is responsible for it.
Clinical safety is run to NHS England’s DCB0129 standard by a named clinical safety officer. We are working towards NHS England’s Digital Technology Assessment Criteria (DTAC) and the Data Security and Protection Toolkit.

These are our own checks: none of these bodies has assessed or endorsed Orwyn.

For NHS services: first appointments that change nothing, waiting times and GIRFT’s knee replacement pathway.

Written and governed by a named consultant knee surgeon

Orwyn was founded by Dr Arj Imbuldeniya, who leads it. He is a consultant orthopaedic surgeon in knee, hip and trauma surgery, with more than 25 years in orthopaedics and musculoskeletal care. He has completed two specialist fellowships.

For years, physiotherapists and first contact clinicians across West London have phoned or emailed him about patients. He has learned as much from those conversations as they have.

About Dr Arj Imbuldeniya

Who it is for

Find the page for you

Clinicians

First contact practitioners, advanced practice physiotherapists and MSK physiotherapists.

NHS services

An MSK tool for NHS triage and first contact services.

Insurers and employee health

Surgeon-governed decision support on when a musculoskeletal case needs a surgeon.

Patients

What Orwyn is, and why your clinician will make every decision about your care.

Reference pages: how NHS MSK triage works, what MSK triage is, what an NHS MSK triage tool should do, and how artificial intelligence (AI) is used in NHS MSK triage.

Questions

Four questions we are asked first

What is Orwyn?

Orwyn is surgeon-governed decision support for first contact MSK clinicians. It puts a consultant knee surgeon’s written judgement into the first appointment, and the clinician decides.

Who is Orwyn designed for?

The clinician, while the patient is in front of them: first contact practitioners, advanced practice physiotherapists and MSK physiotherapists. Orwyn is not a patient app and not a questionnaire the patient fills in at home.

Is Orwyn artificial intelligence?

No. Orwyn runs on rules a named consultant surgeon has written, built from national guidance and research evidence. It is not a computer model with hidden reasoning. Anyone reviewing a result can be shown why Orwyn gave it.

Does Orwyn replace the clinician?

No. Orwyn does not check, approve or oversee the clinician’s work. The clinician assesses the patient and makes every decision.

Surgeon-governed decision support for first contact MSK clinicians.

See the demo Get in touch

The demo uses draft rules awaiting final sign-off, and example patients only.

Decision support for clinicians only. The clinician assesses the patient and makes every decision. Orwyn is not a service for patients and gives no advice directly to patients or the public.