ACR Appropriateness Criteria® Acute Trauma to the Knee

Taljanovic, Mihra S.; Chang, Eric Y.; Ha, Alice S.; Bartolotta, Roger J.; Bucknor, Matthew; Chen, Karen C.; Gorbachova, Tetyana; Khurana, Bharti; Klitzke, Alan; Lee, Kenneth S.; Mooar, Pekka A.; Nguyen, Jie C.; Ross, Andrew B.; Shih, Richard D.; Singer, Adam D.; Smith, Stacy E.; Thomas, Jonelle M.; Yost, William J.; Kransdorf, Mark J.

doi:10.1016/j.jacr.2020.01.041

Cited by 13 publications

(9 citation statements)

References 61 publications

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“…Compared to nonoperative treatment followed by delayed surgery, immediate surgery provides an incremental cost‐effectiveness ratio of $17,000 per QALY in adolescents [37]. Thus, all patients with patellar dislocations should receive MRI to ensure that additional soft tissue injuries and loose bodies are not missed [59].…”

Section: Discussionmentioning

confidence: 99%

“…Treatment for a first‐time patellar dislocation is often a trial of non‐surgical management provided no concomitant pathologies are present [26]. Additional imaging is thus indicated to detect possible additional pathologies, such as OCF, that may require surgical intervention [59]. In practice, such definitive guidelines regarding optimal imaging modalities to evaluate traumatic patellar dislocations are lacking.…”

Section: Introductionmentioning

confidence: 99%

“…As medical imaging advances to better assess and manage injuries, resource stewardship becomes increasingly relevant. Typically, plain radiography is utilised as a first‐line imaging modality for patellar dislocation [59]. However, different imaging modalities enable physicians to optimise treatment plans and identify additional complications.…”

Section: Introductionmentioning

confidence: 99%

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MRI as the optimal imaging modality for assessment and management of osteochondral fractures and loose bodies following traumatic patellar dislocation: a systematic review

Qiu

Fitzpatrick

Cohen

et al. 2022

Knee Surg Sports Traumatol Arthrosc

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PurposeTo assess the imaging modalities used for diagnosis, as well as the management decisions of patients with osteochondral fractures (OCF) and loose bodies following traumatic patellar dislocation. MethodsAccording to the Preferred Reporting Items for Systematic Review and Meta‐analyses (PRISMA), MEDLINE, EMBASE, Web of Science, and PubMed were searched for results from January 1, 2000, to May 18, 2021, in two subsequent searches for English language studies that presented data on traumatic patellar dislocation. Quality of selected papers was assessed using the Methodological Index for Non‐Randomised Studies (MINORS) and the Risk of Bias (RoB) 2.0 protocol. Results were qualitatively synthesised, and descriptive statistics were calculated. ResultsForty studies totalling 3074 patients (1407 females) were included for the analysis. The mean age was 18.9 years (range 0–69). The population included 2446 first‐time dislocations. The imaging modalities used were: 71.1% MRI, 52.6% plain radiography, 12.1% CT, and 0.68% ultrasound. In the 25 studies that reported the number of OCF, a total of 38.3% of patients were found to have OCF. 43.3% of patients with a first‐time dislocation, and 34.7% of patients with previous dislocations, had at least one OCF. In the included paediatric studies (maximum age ≤ 18), the presence of OCF was detected by plain radiography in 10.1% of patients, MRI in 76.6% of patients, and CT in 89.5% of patients. For management of an OCF, the surgical options include fixation for larger pieces, excision for smaller pieces, and conservative management on a case‐by‐case basis. ConclusionsBased on the current available evidence, assessment and management of patellar dislocations and subsequent OCFs vary, with radiography and MRI as the main imaging modalities on presentation and particular benefit for MRI in the paediatric population. Findings from this study suggest the highest rate of OCF detection with MRI, and thus, surgeons should consider routinely ordering an MRI in patients with first‐time patellar dislocation. Regarding management of OCFs, the main indication for fixation was large fragments, while smaller and poor‐quality fragments are excised. Few studies choose conservative management of OCFs due to later requirements for surgical management. Future work should focus on large, high‐quality studies, and implementation of randomised control trials to form guidelines for imaging patellar dislocations and management of OCFs. Level of evidenceLevel IV.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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MRI as the optimal imaging modality for assessment and management of osteochondral fractures and loose bodies following traumatic patellar dislocation: a systematic review

Qiu

Fitzpatrick

Cohen

et al. 2022

Knee Surg Sports Traumatol Arthrosc

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“…1,2 As per the American College of Radiology Appropriateness Criteria, plain radiography is the standard diagnostic tool for establishing bony injury. 3 The Ottawa Knee Rule (OKR) was derived in 1995 to provide a clinical decision aid for emergency referrers in ruling out knee fractures. 2 The rule assesses five criteria: age 55 years or older, tenderness of fibular head, isolated tenderness of patella, inability to flex to 90 degrees and inability to weight bear for 4 steps immediately after injury and in the emergency department (ED).…”

Section: Introductionmentioning

confidence: 99%

Validation of the Ottawa knee rule in adults: A single centre study

Sims

Chau

Davies

2020

J of Medical Radiation Sci

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Introduction This clinical audit aimed to evaluate performance of the Ottawa Knee Rule (OKR) and degree of compliance by emergency referrers for acute knee injuries in adults. Methods Knee radiography requests were analysed retrospectively for eligibility. Data were extracted from eligible requests under headings describing the OKR criteria, patient history, diagnosis and referrer profession. Sensitivity, specificity, negative likelihood ratio and positive likelihood ratio were calculated with 95% CI for the entire sample and each profession (consultant doctors, resident medical officers [RMO], physiotherapists and triage nurses) individually. The frequency of each OKR criterion and correlation with fracture, referrer compliance to the rule and the relative reduction in radiography were also calculated. Results Of 713 patients identified, 149 were enrolled by the eligibility criteria. The overall sensitivity, specificity, negative likelihood ratio and positive likelihood ratio of the OKR for knee fracture were 71% (95%CI, 49‐87%), 46% (95%CI, 37‐55%), 0.64 (95%CI, 0.33‐1.22) and 1.3 (95%CI, 0.96‐1.76), respectively. Physiotherapists and triage nurses demonstrated better rule performance than consultant doctors and RMOs, with a sensitivity of 100% and negative likelihood ratio of 0.0. Physiotherapists were most compliant at 73% (19/26). Only 85 requests were OKR positive and, when abiding by the rule, this would have reduced radiography by 43% (64/149). Conclusions In this first Australian study, moderate OKR performance and variable compliance by emergency referrers were observed. This led to unnecessary irradiation of patients without a fracture. The findings suggest emergency referrers could benefit from education on applying and documenting the OKR on radiography requests.

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“…T13. ACUTE KNEE TRAUMA 9,10,21,35,46,49 1. In patients with acute knee trauma who meet the criteria in the Ottawa Knee Rule, 64 we recommend XR* as the initial imaging modality (↑↑).…”

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confidence: 99%

Canadian Association of Radiologists Trauma Diagnostic Imaging Referral Guideline

Hamel,

Abdeen,

Avard

et al. 2023

Can Assoc Radiol J

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The Canadian Association of Radiologists (CAR) Trauma Expert Panel consists of adult and pediatric emergency and trauma radiologists, emergency physicians, a family physician, a patient advisor, and an epidemiologist/guideline methodologist. After developing a list of 21 clinical/diagnostic scenarios, a systematic rapid scoping review was undertaken to identify systematically produced referral guidelines that provide recommendations for 1 or more of these clinical/diagnostic scenarios. Recommendations from 49 guidelines and contextualization criteria in the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) for guidelines framework were used to develop 50 recommendation statements across the 21 scenarios related to the evaluation of traumatic injuries. This guideline presents the methods of development and the recommendations for head, face, neck, spine, hip/pelvis, arms, legs, superficial soft tissue injury foreign body, chest, abdomen, and non-accidental trauma.

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ACR Appropriateness Criteria® Acute Trauma to the Knee

Cited by 13 publications

References 61 publications

MRI as the optimal imaging modality for assessment and management of osteochondral fractures and loose bodies following traumatic patellar dislocation: a systematic review

MRI as the optimal imaging modality for assessment and management of osteochondral fractures and loose bodies following traumatic patellar dislocation: a systematic review

Validation of the Ottawa knee rule in adults: A single centre study

Canadian Association of Radiologists Trauma Diagnostic Imaging Referral Guideline

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