Ottawa knee rules

Last revised by Daniel J Bell on 9 Jul 2022

The Ottawa knee rules are a clinical decision-making strategy for determining which patients require radiographic imaging for knee pain following trauma.

A patient with knee pain qualifies for knee radiographs if any of the following apply:

  • 55 years or older
  • point tenderness at the fibular head
  • isolated point tenderness of the patella
  • inability to flex knee to 90°
  • inability to bear weight (inability to take four steps) both immediately following the injury and in the emergency department

The Ottawa knee rules are considered to have a high sensitivity for fracture, while also reducing the overall number of radiographs obtained in an acute setting.

Practical points

  • the use of the Ottawa knee rules was originally validated in adults 1-3

See also

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