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X-ray is required only in pts who have acute injury w/ one or more of the following:
==Background==
#Age >55
[[File:Knee diagram2.png|thumb|Anatomy of anterolateral aspect of right knee.]]
#TTP fibula head
*98.5% sensitive and 48.6% specific in determining knee fracture<ref>Bachmann LM, Haberzeth S, Steurer J, et al. The accuracy of the Ottawa knee rule to rule out knee fractures: a systematic review. Ann Intern Med. 2004; 140(2):121-4.</ref>
#TTP patella
*Can be applied to pediatric population<ref>Bulloch B, Neto G, Plint A, et al. Validation of the Ottawa Knee Rule in children: a multicenter study. Ann Emerg Med. 2003; 42(1):48-55.</ref>
#Inability flex >90 deg
*Rule has been retrospectively and retrospectively validated<ref>Stiell IG, Greenberg GH, Wells GA, et al. Derivation of a decision rule for the use of radiography in acute knee injuries. Ann Emerg Med. 1995; 26(4):405-13.</ref><ref>Stiell IG, Greenberg GH, Wells GA, et al. Prospective validation of a decision rule for the use of radiography in acute knee injuries. JAMA. 1996; 275(8):611-615.</ref><ref>Stiell IG, Wells GA, Hoag RH, et al. Implementation of the Ottawa Knee Rule for the use of radiography in acute knee injuries. JAMA. 1997; 278(23):2075-2079.</ref>
#Inability to walk 4 steps immediately and in the ED


==Source==
==Criteria==
Stiell IG, Wells GA, Hoag RH, Sivilotti MLA, Cacciotti TF, Verbeek PR, Greenway KT, McDowell I, Cwinn AA, Greenberg GH, Nichol G, Michael JA. Implementation of the Ottawa Knee Rule for the Use of Radiography in Acute Knee Injuries. Journal of the American Medical Association 1997; 278:2075-2079
{{Ottawa knee rules}}


[[Category:Ortho]]
==Caveats==
*99% sensitive in children OVER age 5<ref>Vijayasankar D, Boyle AA, Atkinson P. Can the Ottawa knee rule be applied to children? A systematic review and meta-analysis of observational studies. Emerg Med J. 2009; 26(4):250-3.</ref>
*Beware of the Tillaux Fracture in adolescents with anteromedial ankle pain, as they would not qualify for imaging according to this rule.
 
==External Links==
*[http://www.mdcalc.com/ottawa-knee-rules/ MDCalc - Ottawa Knee Rules]
 
==See Also==
*[[Acute knee injury]]
*[[Ottawa Ankle Rules]]
 
==References==
<references/>
 
[[Category:Orthopedics]]

Revisión actual - 21:48 5 mar 2025

Background

Anatomy of anterolateral aspect of right knee.
  • 98.5% sensitive and 48.6% specific in determining knee fracture[1]
  • Can be applied to pediatric population[2]
  • Rule has been retrospectively and retrospectively validated[3][4][5]

Criteria

Ottawa knee rules

Ottawa knee rules points of tenderness (image of left knee).

X-ray is only required in patients who have an acute injury and one or more of the following:

  • Age >55
  • Isolated tenderness of the patella
  • Tenderness at the fibular head
  • Inability flex to 90 degrees
  • Inability to walk 4 steps BOTH immediately after the injury and in the ED

Caveats

  • 99% sensitive in children OVER age 5[6]
  • Beware of the Tillaux Fracture in adolescents with anteromedial ankle pain, as they would not qualify for imaging according to this rule.

External Links

See Also

References

  1. Bachmann LM, Haberzeth S, Steurer J, et al. The accuracy of the Ottawa knee rule to rule out knee fractures: a systematic review. Ann Intern Med. 2004; 140(2):121-4.
  2. Bulloch B, Neto G, Plint A, et al. Validation of the Ottawa Knee Rule in children: a multicenter study. Ann Emerg Med. 2003; 42(1):48-55.
  3. Stiell IG, Greenberg GH, Wells GA, et al. Derivation of a decision rule for the use of radiography in acute knee injuries. Ann Emerg Med. 1995; 26(4):405-13.
  4. Stiell IG, Greenberg GH, Wells GA, et al. Prospective validation of a decision rule for the use of radiography in acute knee injuries. JAMA. 1996; 275(8):611-615.
  5. Stiell IG, Wells GA, Hoag RH, et al. Implementation of the Ottawa Knee Rule for the use of radiography in acute knee injuries. JAMA. 1997; 278(23):2075-2079.
  6. Vijayasankar D, Boyle AA, Atkinson P. Can the Ottawa knee rule be applied to children? A systematic review and meta-analysis of observational studies. Emerg Med J. 2009; 26(4):250-3.