“…In the setting of significant acute trauma to the knee, radiographs should be the first imaging study. It is general agreement that radiographs should be obtained and the clinical decision rule should not be applied for patients with gross deformity [3], a palpable mass [10], a penetrating injury, prosthetic hardware, an unreliable clinical history or physical examination secondary to multiple injuries [3,10], altered mental status (eg, head injury, drug or alcohol use, dementia) [3,10], neuropathy (eg, paraplegia, diabetes) [3,10], or a history suggesting increased risk of fracture. Additionally, in any case scenario, the physician's judgment and common sense should supersede clinical guidelines [3].…”