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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
International Knee Documentation Committee (IKDC) system [10] Grade Findings A No joint space narrowing, defined in this system as at least 4 mm joint space B At least 4 mm joint space, but small osteophytes, slight sclerosis, or femoral condyle flattening C 2–4 mm joint space D < 2 mm joint space
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]
X-ray of the knee of a 12-year-old male, showing knee effusion of medium severity, marked by black arrows. It displaces the patella anteriorly and extends into the suprapatellar bursa. An X-ray is useful to verify that there is no break or dislocation when there is a history of trauma. May show signs of osteoarthritis.
A Settegast is a standard medical x-ray projection that presents a tangential view of the patella. To acquire such an image the patient is placed in a prone position with the knee flexed at least 90 degrees and the field of view centered on the patellofemoral joint space.
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A knee X-ray and/or blood test – this can assist to exclude certain types of arthritis or inflammation. Magnetic Resonance Imaging – to observe cartilage condition and assess deterioration; Arthroscopy – a low invasive approach to image the inside of the knee joint by inserting an endoscope into the knee joint. [16]
However, in SONK, often just one side of the knee joint is afflicted, so unicompartmental knee arthroplasty (UKA) can be considered as an alternative that leads to a shorter recovery time. [3] A meta-analysis concluded that UKA was "an excellent alternative to TKA" with few complications and good survivorship.
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