Pittsburgh knee rules

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The Pittsburgh knee rules are medical rules created to ascertain whether a knee injury requires the use of X-ray to assess a fracture.


  • Blunt trauma or a fall as mechanism of injury AND either of the following
    • Age younger than 12 years or older than 50 years
    • Inability to walk four weight-bearing steps in the emergency department.

If the patient satisfies the above criteria, they should receive an X-ray to assess for a possible fracture.


The sensitivity of using the Pittsburgh Knee rules is 99% with a specificity of 60%. That means the use of the above rules has a false negative result of 1% and a false positive result of 40%.

The false positive result is less important as if the patient is positive, they should receive an Xray to assess for a possible fracture which has a much higher specificity.

The use of the Pittsburgh Knee rules reduces the use of knee radiographs by 52%.[1]

See also[edit]


  1. ^ Tandeter HB, Shvartzman P (December 1999). "Acute knee injuries: use of decision rules for selective radiograph ordering". Am Fam Physician 60 (9): 2599–608. PMID 10605994.