Ottawa Knee Rules
- 98.5% sensitive and 48.6% specific in determining knee fracture
- Can be applied to pediatric population
- Rule has been retrospectively and retrospectively validated
X-ray is only required in patients who have an acute injury with one or more of the following:
- Age >55
- Isolated tenderness of the patella (no other bony tenderness).
- Tenderness at the fibular head.
- Inability flex to 90 degrees
- Inability to walk 4 steps BOTH immediately after the injury and in the ED
- 99% sensitive in children OVER age 5
- Beware of the Tillaux Fracture in adolescents with anteromedial ankle pain, as they would not qualify for imaging according to this rule.
- 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.
- 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.
- 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.
- 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.
- 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.
- 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.