Physical examination maneuver

Physical Exam

Ottawa Knee Rule

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Video coming September 2026

How to Perform

In an adult with an acute knee injury, assess the five Ottawa Knee Rule criteria: age 55 years or older; isolated tenderness of the patella (no other bony tenderness of the knee); tenderness at the head of the fibula; inability to flex the knee to 90°; and inability to take four weight-bearing steps both immediately after the injury and at the time of evaluation. The rule is positive if any one of these criteria is present.

How to Interpret

Showing all 1 finding

Knee Fracture

Ottawa knee rule positive in a patient with an acute knee injury
Rule in
Minimally helpfulDerived CI
Rule out
Very helpful
Evidence:Strong

References

  • Bachmann LM, Haberzeth S, Steurer J, ter Riet G. The accuracy of the Ottawa knee rule to rule out knee fractures: a systematic review. Ann Intern Med. 2004;140(2):121-124. PMID: 14734335.
  • Stiell IG, Greenberg GH, Wells GA, et al. Derivation of a decision rule for the use of radiography in acute knee injuries. Ann Emerg Med. 1995;26(4):405-413.

Research last updated September 10, 2026.

Related Diagnoses

Knee Fracture

Related Systems / Regions

Lower ExtremitiesMusculoskeletal

Related Bedside Tests

🎬Video coming Sept 2026
Lower Extremity Inspection and Palpation
Rule in:VHDiabetic Foot Osteomyelitis, VHKnee Osteoarthritis, HAchilles Tendon Rupture +7 more
Rule out:SHAchilles Tendon Rupture, SHDiabetic Foot Osteomyelitis, SHKnee Osteoarthritis +7 more
🎬Video coming Sept 2026
Knee Active Range of Motion
Rule in:IEExtensor Mechanism Disruption, IEKnee Effusion, IEKnee Fracture +2 more
Rule out:IEExtensor Mechanism Disruption, IEKnee Effusion, IEKnee Fracture +2 more
🎬Video coming Sept 2026
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Rule in:VHAnterior Cruciate Ligament Tear
Rule out:VHAnterior Cruciate Ligament Tear
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Knee Passive Range of Motion
Rule in:SHKnee Osteoarthritis, IEKnee Effusion, IELoose Body +2 more
Rule out:HKnee Osteoarthritis, IEKnee Effusion, IELoose Body +2 more
🎬Video coming Sept 2026
Knee Posterior Drawer
Rule in:VHPosterior Cruciate Ligament Tear
Rule out:VHPosterior Cruciate Ligament Tear
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Lachman
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Rule out:VHAnterior Cruciate Ligament Tear