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The Ottawa knee rules are a set of rules used to help physicians determine whether an x-ray of the knee is needed. [1] They state that an X-ray is required only in patients who have an acute knee injury with one or more of the following: Age 55 years or older; Tenderness at head of fibula; Isolated tenderness of patella
Magnetic resonance imaging (MRI) is a medical imaging technique used in radiology to generate pictures of the anatomy and the physiological processes inside the body. MRI scanners use strong magnetic fields , magnetic field gradients, and radio waves to form images of the organs in the body.
A study found that MRI of just the spine and pelvis would have detected 9% fewer cases of bone involvement than the more extensive skeletal survey which therefore remains the standard method. [2] Skeletal surveys are also used with suspected non-accidental injury in children (CE [3] guidelines state that 19 images of the child are taken.) These ...
Physical examination of the knee begins by observing the person's gait to assess for any abnormalities seen while walking. Gait assessment can be used to differentiate genuine knee pain or pain which referred from hip, lower back or the foot. A person can be asked to perform a duckwalk. This requires the person to squat and walk in that position.
However, from a practical point of view, false positives that lead to negative X-ray tests were the very thing that the knee rules are trying to address. Nonetheless, the Pittsburgh knee rules offer fewer false positives than do the Ottawa knee rules, though the Ottawa knee rules are more commonly used. [2]
Recommended x-ray views are (a) axial, (b) anteroposterior, (c) oblique and (d) views with dorsiflexion and internal rotation of the foot. However, conventional radiography is limited for visualization of calcaneal anatomy, especially at the subtalar joint.
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Additionally, the Ottawa ankle rules indicate whether a foot X-ray series is required. It states that it is indicated if: There is any pain in the midfoot zone; and, Any one of the following: Bone tenderness at the base of the fifth metatarsal (for foot injuries), OR; Bone tenderness at the navicular bone (for foot injuries), OR