Ottawa knee rules: Difference between revisions
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==Criteria== | ==Criteria== | ||
X-ray is only required in patients who have an acute injury | *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 | |||
==Diagram== | ==Diagram== | ||
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==Radiographs== | ==Radiographs== | ||
*Three-vew radiograph is generally sufficient. | |||
**Anteroposterior view, lateral view, and Merchant's view (for the patellofemoral joint) | |||
*Teenage patients who report chronic knee pain and recurrent knee effusion → consider a notch or tunnel view (posteroanterior view with the knee flexed to 40 to 50 degrees) | |||
**Needed to detect radiolucencies of the femoral condyles (most commonly the medial femoral condyle), which indicate the presence of osteochondritis dissecans | |||
==Caveats== | ==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> | *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> | ||
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==External Links== | ==External Links== | ||
[http://www.mdcalc.com/ottawa-knee-rules/ MDCalc - Ottawa Knee Rules] | *[http://www.mdcalc.com/ottawa-knee-rules/ MDCalc - Ottawa Knee Rules] | ||
==See Also== | ==See Also== | ||
Revision as of 09:16, 7 November 2017
Background
- 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
- 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
Diagram
Radiographs
- Three-vew radiograph is generally sufficient.
- Anteroposterior view, lateral view, and Merchant's view (for the patellofemoral joint)
- Teenage patients who report chronic knee pain and recurrent knee effusion → consider a notch or tunnel view (posteroanterior view with the knee flexed to 40 to 50 degrees)
- Needed to detect radiolucencies of the femoral condyles (most commonly the medial femoral condyle), which indicate the presence of osteochondritis dissecans
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
- ↑ 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.