This corresponds to the definitions that the CMS has applied to the Current Procedural Terminology codes. The American College of Radiology seeks and encourages collaboration with other organizations on the development of the ACR Appropriateness Criteria through society representation on expert panels. Participation by representatives from collaborating societies on the expert panel does not necessarily imply individual or society endorsement of the final document. Reprint requests to: publications@acr.org Acute Trauma to the Knee Discussion of Procedures by Variant Variant 1: Adult or child 5 years of age or older. Fall or acute twisting trauma to the knee. No focal tenderness, no effusion, able to walk. Initial imaging. CT Knee In the absence of focal tenderness and joint effusion in a patient who is able to walk, CT is not used as the initial imaging study for the evaluation of acute trauma to the knee. MR Arthrography Knee MR arthrography is not routinely used as the initial imaging study for the evaluation of acute trauma to the knee. MRA Knee MR angiography (MRA) is not routinely used as the initial imaging study for the evaluation of acute trauma to the knee. MRI Knee MRI is not routinely used as the initial imaging study for the evaluation of acute trauma to the knee. Radiography Knee With no clinical symptoms in the injured knee, including lack of focal tenderness and joint effusion, and with ability to walk, knee radiographs may be indicated if a patient >55 years old per Ottawa rules or >50 years old or <12 years old per Pittsburgh rule criteria [5, 6, 10]. If the patient is between 5 and 12 years, they fall outside the age range for both the Ottawa and Pittsburgh rules and radiographs may be beneficial despite lack of clinical symptoms. Radiographs are commonly performed in the setting of acute knee injuries but have a low yield for showing fractures.
Acute Trauma to the Knee. This corresponds to the definitions that the CMS has applied to the Current Procedural Terminology codes. The American College of Radiology seeks and encourages collaboration with other organizations on the development of the ACR Appropriateness Criteria through society representation on expert panels. Participation by representatives from collaborating societies on the expert panel does not necessarily imply individual or society endorsement of the final document. Reprint requests to: publications@acr.org Acute Trauma to the Knee Discussion of Procedures by Variant Variant 1: Adult or child 5 years of age or older. Fall or acute twisting trauma to the knee. No focal tenderness, no effusion, able to walk. Initial imaging. CT Knee In the absence of focal tenderness and joint effusion in a patient who is able to walk, CT is not used as the initial imaging study for the evaluation of acute trauma to the knee. MR Arthrography Knee MR arthrography is not routinely used as the initial imaging study for the evaluation of acute trauma to the knee. MRA Knee MR angiography (MRA) is not routinely used as the initial imaging study for the evaluation of acute trauma to the knee. MRI Knee MRI is not routinely used as the initial imaging study for the evaluation of acute trauma to the knee. Radiography Knee With no clinical symptoms in the injured knee, including lack of focal tenderness and joint effusion, and with ability to walk, knee radiographs may be indicated if a patient >55 years old per Ottawa rules or >50 years old or <12 years old per Pittsburgh rule criteria [5, 6, 10]. If the patient is between 5 and 12 years, they fall outside the age range for both the Ottawa and Pittsburgh rules and radiographs may be beneficial despite lack of clinical symptoms. Radiographs are commonly performed in the setting of acute knee injuries but have a low yield for showing fractures.