The Cardiovascular
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Ottawa knee rule

Determines need for knee radiography after acute injury.

Ottawa knee rule
Age ≥ 55 years
Tenderness at the head of the fibula
Isolated tenderness of the patella
Unable to flex the knee to 90°
Unable to bear weight 4 steps (immediately and in ED)
ResultNo radiograph needed

No criteria met — clinically significant fracture is very unlikely.

When to use

  • Excluding fracture in acute knee injury to reduce unnecessary radiography.

Formula

Knee x-ray if any of: age ≥ 55, isolated patellar tenderness, fibular-head tenderness, inability to flex to 90°, inability to bear weight for 4 steps.

References

  1. Stiell IG, et al. Ann Emerg Med. 1995;26(4):405-13.