Epidemiology
1. Fractures occur in only 6% of knee trauma cases
Efficacy: Accuracy for Acute Knee XRay Indications
1. Pittsburgh Knee Rules (Pittsburgh Decision Rules)
  1. Test Sensitivity: 99%
  2. Test Specificity: 60%
  3. Reduced the use of Knee XRays by 52%
2. Ottawa Knee Rules
  1. Test Sensitivity: 97%
  2. Test Specificity: 27%
  3. Reduced the use of Knee XRays by 28%
Knee XRay Indications: Pittsburgh Knee Rules (acute)
1. Primary criteria (required)
  1. Blunt trauma or fall type injury
2. Secondary criteria (one of the following present)
  1. Age younger than 12 years or over 50 years
  2. Inability to walk four weight bearing steps in ER
Knee XRay Indications: Ottawa Knee Rules (acute)
1. Age over 55 years
2. Isolated patella tenderness
3. Tenderness at head of fibula
4. Inability to flex knee to 90 degrees
5. Inability to bear weight (4 steps)
  1. Immediately at site of accident
  2. Emergency department
6. Rules efficacious down to age 5 years
  1. Bulloch (2003) Ann Emerg Med 42:48
References
1. Stiell (1997) JAMA 278(23):2076
2. Tandeter (1999) Am Fam Physician 60(9):2599

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This page was written by Scott Moses, MD. This page was last revised before 5/10/08, prior to consistent tracking of revision date. This page was last published on 6/1/2008. Please send comments and questions to the editor. Contact information may be found on the page About the Family Practice Notebook. These pages are best viewed with Microsoft Internet Explorer 6.0.