UMEM Educational Pearls

Title: Knee Injuries are Radiographs Needed

Keywords: Ottawa, Knee, Pittsburgh (PubMed Search)

Posted: 3/30/2013 by Michael Bond, MD
Click here to contact Michael Bond, MD

Knee Pain Injuries are Radiographs needed?

Many people know that the folks in Ottawa have come up with a rule to determine whether radiographs are needed in patients complaining of knee pain. The Ottawa Knee rules that that radiographs are only required for knee injuries with any of the following:
   •   Age 55 years or older
   •   isolated tenderness of patella
   •   tenderness at head of fibula
   •   inability to flex to 90'
   •   inability to bear weight both immediately and in the emergency department (4 steps)

Well another group in Pittsburgh have their own set of rules that were recently shown to be more specific with equal sensitivity. The Pittsburgh decision rules state that radiographs are only needed if

There is a history of fall or blunt trauma AND ( Patient is < 12 or > 50 years old OR Patient is unable to walk for weight bearing steps in the ED. )

So consider using the Pittsburgh or Ottawa Knee rules the next time you have a patient with knee pain to determine if those radiographs are really needed.

The full article can be found at http://www.ajemjournal.com/article/S0735-6757%2812%2900566-9/abstract

References

Cheung TC, Tank Y, Breederveld RS, Tuinebreijer WE, de Lange-de Klerk ESM, MD RJD. Diagnostic accuracy and reproducibility of the Ottawa Knee Rule vs the Pittsburgh Decision Rule. Am J Emerg Med. Elsevier Inc; 2013 Feb 1;:1–5.