Ottowa knee rules

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Rule

If any of the following are present, order XR:

  1. age 55 or older
  2. isolated tenderness of patella (no bone tenderness of knee other than patella)
  3. tenderness of head of fibula
  4. inability to bear weight both immediately and in the emergency department for 4 steps (unable to transfer weight twice onto each lower limb regardless of limping)

Validation

  • Prospectively validated in 1024 adults [1]
  • Sensitivity for fractures of knee is 100% (95% confidence interval: 0.94 to 1.0)

Sources

  1. ↑ Stiell IG, et al, Prospective validation of a decision rule for the use of radiography in acute knee injuries., JAMA. 1996 Feb 28;275(8):611-5. PMID: 8594242
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