Ottawa Knee Rules

Execution:

• X-Rays should be requested if one of the following 5 criteria apply:
  1. Patient is 55 or older
  2. Isolated pain or tenderness over the patella
  3. Pain or tenderness over the head of the fibula
  4. Knee flexion <90°
  5. Patient is unable to walk 4 consecutive steps

Study	Reliability	Sn	Sp	LR+	LR-
Bachman et al. (2004)	NA	98.5	48.6	1.92	00.03
Cheung et al. (2013)	ĸ=0.51	86	27	1.17	0.52
Sims et al. (2020)	NA	99	49	1.94	0.02
Comment: Although the study of Cheung et al. (2013) found better accuracy for the Pittsburgh Decision Rule, the meta-analysis by Bachman et al. (2004) has shown almost perfect sensitivity to rule out Knee Fractures.