Ottawa knee rules
They state that an x-ray is required only in patients who have an acute knee injury with one or more of the following:
- Age 55 years or older
- Tenderness at head of fibula
- Isolated tenderness of patella
- Inability to flex the knee greater than 90°
- Inability to bear weight both immediately and in the emergency department (4 steps)
The Ottawa knee rules were derived to aid in the efficient use of radiography in acute knee injuries and have since been prospectively validated on multiple occasions in different populations and in both children and adults. Some studies found sensitivities for the Ottawa knee rules of 98-100% for clinically significant knee fractures, meaning if the patient is negative for all criteria, the patient is likely not to have a knee fracture. However, specificities for the Ottawa knee rules are typically poor, meaning a medical provider cannot say without proper testing what injury the patient may have. The Pittsburgh knee rules have been found to be more specific in diagnosis.
- Stiell IG, Wells GA, Hoag RH, Sivilotti ML, Cacciotti TF, Verbeek PR, Greenway KT, McDowell I, Cwinn AA, Greenberg GH, Nichol G, Michael JA (1997). "Implementation of the Ottawa Knee Rule for the use of radiography in acute knee injuries.". JAMA. 278 (27): 2075–9. doi:10.1001/jama.1997.03550230051036. PMID 9403421.
- Cheung TC, Tank Y, Breederveld RS, Tuinebreijer WE, de Lange-de Klerk ES, Derksen RJ (2013). "Diagnostic accuracy and reproducibility of the Ottawa Knee Rule vs the Pittsburgh Decision Rule.". Am J Emerg Med. 31 (4): 641–5. doi:10.1016/j.ajem.2012.11.003. PMID 23399332.
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