Ottawa Knee Rules | Knee Fractures

The Ottawa knee rules are a tool used in the primary care setting to identify which cases of knee injury require radiographic imagery. Various studies have identified values of sensitivity ranging from 84.6 to 100% (see references below). The contents of the Ottawa knee rules are similar to those of the Ottawa ankle rules we have covered in another video

Execution:

According to the protocol X-Rays should be done if any of the following criteria apply:

1. The patient is 55 or older
2. Isolated pain or tenderness over the patella
3. Pain or tenderness at the head of the fibula
4. Knee flexion < 90 degrees
5. The Patient is not able to walk four consecutive steps immediately and in the emergency department. It doesn’t matter how the patient is walking.

Another common rule to screen for fractures in the knee joint is the Pittsburgh Decision Rule.

If you are curios about screening for ankle fractures, check out the following posts:

• Ottawa Ankle Rules.
• Bernese Ankle Rules
• Low Risk Ankle Rule for Ankle Fractures in Children
• Malleolar Zone Algorithm for Fractures in Children
• Midfoot Zone Algorithm for Fractures in Children

Yao, K., & Haque, T. (2012). The Ottawa knee rules: A useful clinical decision tool. Australian family physician, 41(4), 223-224.

Cheung, T. C., Tank, Y., Breederveld, R. S., Tuinebreijer, W. E., de Lange-de Klerk, E. S., & Derksen, R. J. (2013). Diagnostic accuracy and reproducibility of the Ottawa Knee Rule vs the Pittsburgh Decision Rule. The American Journal of Emergency Medicine, 31(4), 641-645.

Stiell, I. G., Greenberg, G. H., Wells, G. A., McKnight, R. D., Cwinn, A. A., Cacciotti, T., … & Smith, N. A. (1995). Derivation of a decision rule for the use of radiography in acute knee injuries. Annals of emergency medicine, 26(4), 405-413.