Ottawa knee rules

Ottawa Knee Rules are a set of guidelines designed to help healthcare professionals determine whether a patient with knee injury should have an X-ray to exclude fractures. Developed in 1995 by Dr. Ian Stiell in Ottawa, Canada, these rules are aimed at reducing the number of unnecessary X-rays, which can save time and resources in emergency departments, and minimize radiation exposure for patients.

Background

Knee injuries are common in both sports and everyday accidents, leading to a significant number of emergency department visits. Before the introduction of the Ottawa Knee Rules, there was a high variability in the use of X-rays for knee injuries, leading to unnecessary radiation exposure for many patients and increased healthcare costs.

The Rules

The Ottawa Knee Rules suggest that an X-ray is only necessary if any of the following criteria are met:

• The patient is 55 years or older.
• There is tenderness at the head of the fibula.
• Isolated tenderness of the patella (that is, no other bone in the knee can be tender).
• Inability to flex the knee to 90 degrees.
• Inability to bear weight both immediately and in the emergency department for four steps, regardless of limping.

Application

The Ottawa Knee Rules have been validated through numerous studies and are recommended for use in adult patients who have acute knee injuries. They are not intended for children (although similar rules, the Pediatric Ottawa Knee Rules, have been developed for this population), or for patients with multiple trauma injuries or those who have been re-injured.

Impact

Since their development, the Ottawa Knee Rules have been widely adopted and have demonstrated a significant reduction in the use of knee X-rays without missing clinically significant fractures. This has led to more efficient use of medical resources and reduced waiting times in emergency departments.

Limitations

While the Ottawa Knee Rules are highly sensitive for detecting fractures that require clinical intervention, they are not 100% foolproof. There may be rare cases where a significant injury is not detected by these criteria. Clinical judgment should always be used in conjunction with these rules.

See Also

• Clinical decision support system
• Radiography in trauma