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FAST FRIDAY #5 – KNEE INJURY PLAYING FOOTBALL

Updated: Nov 3, 2023

DR LUKE PHILLIPS EMERGENCY PHYSICIAN

PEER REVIEW: DR EANNA MAC SUIBHNE


WELCOME TO FAST FRIDAYS – A CASE-BASED, RAPID REVIEW OF A TOPIC. THE CASES HAVE BEEN ADAPTED FROM REAL PATIENTS BUT HAVE BEEN CHANGED FOR ANONYMITY AND TO EMPHASISE KEY LEARNING POINTS.


THE CASE

23-year-old presents with knee pain and swelling post landing awkwardly on their right knee playing football. They now have pain and swelling to the knee and have difficulty weight bearing. On exam they have a large joint effusion and tenderness to lateral joint line. They can straight leg raise but any other assessment of knee joint integrity is limited by the swelling and pain.


WHICH PATIENTS ACTUALLY NEED A KNEE X-RAY?


Our Canadian friends, led by Stiell et al, have developed the Ottawa Knee Rule to identify low risk patients who may not need a knee X-ray.


 A knee x-ray series is only needed for knee injury patients with any of these findings:

  • Age ≥ 55, OR

  • Isolated tenderness of patella (no bone tenderness of knee other than patella), OR

  • Tenderness of head of fibula, OR

  • Inability to flex to 90°, OR

  • Inability to bear weight both immediately after injury and in the ED for 4 steps (unable to transfer weight twice onto each lower limb regardless of limping.

In an external validation study of the rule, the authors found a relative reduction in knee X-rays of 26.4% and a sensitivity of 100% for detecting knee fractures and a specificity of 48%. 


THE PATIENT MET CRITERIA FOR IMAGING AND X-RAYS WERE PERFORMED

Case courtesy of Dr Luke Phillips, Radiopaedia.org. From the case rID: 99008


WHAT ARE THE KEY FINDINGS ON THESE X-RAYS?