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Ottawa Knee Rules

The Ottawa Knee Rules, developed by Stiell et al from Ottawa, Canada, are a set of guidelines designed to assist in the decision if a patient with knee pain should be offered x-rays to diagnose a possible fracture.¹

A CIAP full text link of the Ottowa Knee Rules is available here.²

In summary of the guideline, the Ottawa Knee Rules suggest a knee X-ray series is only required for knee injury patients with any of these findings:

1. Age 55 or older
2. Isolated tenderness of the patella (that is, no bone tenderness of the knee other than the patella).
3. Tenderness at the head of the fibula.
4. Inability to flex to 90 degrees.
5. Inability to bear weight both immediately and in the emergency department (4 steps; unable to transfer weight twice onto each lower limb regardless of limping).

In a large trial of the Ottawa Knee Rule which enrolled 3,907 patients with knee injury, there was a reduction in the number of patients requiring an x-ray (78% to 57%) and also a reduction in time spent in the emergency department and reduced medical costs.²

References:

1. 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;275:611-615 (CIAP full text link)
2. 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: 2075-9. (CIAP full text link)

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