Ottawa knee rules

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

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

See also