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Ottawa Knee Rules

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Other Names

  • Ottawa Knee Rules


Illustration of the landmarks for the Ottawa Knee Rules
  • To help determine need for radiographs of knee following acute trauma


If one of the following is present, radiographs are indicated:

  • Age >55 years
  • Isolated patellar tenderness without other bone tenderness
  • Tenderness of the fibular head
  • Inability to flex the knee to 90°
  • Inability to bear weight immediately after injury and in the emergency department (4 steps) regardless of limping

Rules Can't be Applied to the Following:

  • Younger then 18 years old
  • Injuries greater then 7 days old
  • Re-evaluation of recent injuries
  • Altered levels of consciousness
  • Paraplegia (an impairment in motor or sensory function) of the lower extremities
  • Multiple injuries or other fractures
  • Pregnancy
  • Isolated injuries of the skin without underlying soft tissue or bone involvement
  • Superficial lacerations or skin injuries
    • Abrasions
    • Puncture wounds
    • Burns
  • Referred from outside the hospital with radiographs



  • Bachmann et al meta-analysis (2004)[1]
    • Sensitivity: 98.5%
    • Specificity: 48.6%

See Also


  1. Bachmann, Lucas M., et al. "The accuracy of the Ottawa knee rule to rule out knee fractures: a systematic review." Annals of internal medicine 140.2 (2004): 121-124.
Created by:
John Kiel on 7 August 2019 14:36:15
Last edited:
22 April 2023 22:49:36