title: ACR Appropriateness Criteria Acute Trauma to the Knee.
abstract: More than 500,000 visits to the emergency room occur annually in the United States, for acute knee trauma. Many of these are twisting injuries in young patients who can walk and bear weight, and emergent radiographs are not required. Several clinical decision rules have been devised that can considerably reduce the number of radiographs ordered without missing a clinically significant fracture. Although a fracture is seen on only 5% of emergency department knee radiographs, 86% of knee fractures result from blunt trauma. In patients with a fall or twisting injury who have focal tenderness, effusion, or inability to bear weight, radiographs should be the first imaging study obtained. If the radiograph shows no fracture, MRI is best for evaluating for a suspected meniscus or ligament tear, or the injuries from a reduced patellar dislocation. Patients with a knee dislocation should undergo radiographs and an MRI, as well as an angiographic study such as a fluoroscopic, CT, or MR angiogram. The ACR Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed every three years by a multidisciplinary expert panel. The guideline development and review include an extensive analysis of current medical literature from peer-reviewed journals and the application of a well-established consensus methodology (modified Delphi) to rate the appropriateness of imaging and treatment procedures, by the panel. In those instances in which evidence is lacking or not definitive, expert opinion may be used to recommend imaging or treatment.
authors.affiliation: University of Wisconsin Hospital, Madison, Wisconsin. Electronic address: mtuite@uwhealth.org.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Tuite
authors.affiliation: Mayo Clinic, Phoenix, Arizona.
authors.forename: Mark J
authors.initials: MJ
authors.lastname: Kransdorf
authors.affiliation: University of Kentucky, Lexington, Kentucky.
authors.forename: Francesca D
authors.initials: FD
authors.lastname: Beaman
authors.affiliation: New York University Center for Musculoskeletal Care, New York, New York.
authors.forename: Ronald S
authors.initials: RS
authors.lastname: Adler
authors.affiliation: University of Texas MD Anderson Cancer Center, Houston, Texas.
authors.forename: Behrang
authors.initials: B
authors.lastname: Amini
authors.affiliation: James J. Peters VA Medical Center, Bronx, New York, American Academy of Orthopaedic Surgeons.
authors.forename: Marc
authors.initials: M
authors.lastname: Appel
authors.affiliation: Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania.
authors.forename: Stephanie A
authors.initials: SA
authors.lastname: Bernard
authors.affiliation: Texas Scottish Rite Hospital, Dallas, Texas.
authors.forename: Molly E
authors.initials: ME
authors.lastname: Dempsey
authors.affiliation: Bone, Spine and Hand Surgery, Chartered, Brick, New Jersey.
authors.forename: Ian Blair
authors.initials: IB
authors.lastname: Fries
authors.affiliation: Medical College of Georgia at Georgia Regents University, Augusta, Georgia.
authors.forename: Bennett S
authors.initials: BS
authors.lastname: Greenspan
authors.affiliation: Brigham & Women's Hospital, Boston, Massachusetts.
authors.forename: Bharti
authors.initials: B
authors.lastname: Khurana
authors.affiliation: Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania.
authors.forename: Timothy J
authors.initials: TJ
authors.lastname: Mosher
authors.affiliation: Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania.
authors.forename: Eric A
authors.initials: EA
authors.lastname: Walker
authors.affiliation: Tufts Medical Center, Boston, Massachusetts.
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Ward
authors.affiliation: Mayo Clinic, Jacksonville, Florida.
authors.forename: Daniel E
authors.initials: DE
authors.lastname: Wessell
authors.affiliation: Brigham & Women's Hospital, Boston, Massachusetts.
authors.forename: Barbara N
authors.initials: BN
authors.lastname: Weissman
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000367:Age Factors; D002648:Child; D003952:Diagnostic Imaging / Q000592:standards* / Q000706:statistics & numerical data*; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D015601:Injury Severity Score; D007718:Knee Injuries / Q000175:diagnosis* / Q000628:therapy; D008279:Magnetic Resonance Imaging / Q000592:standards / Q000706:statistics & numerical data; D008297:Male; D017410:Practice Guidelines as Topic / Q000592:standards*; D011829:Radiation Dosage; D011835:Radiation Protection; D018570:Risk Assessment; D012955:Societies, Medical / Q000592:standards; D014057:Tomography, X-Ray Computed / Q000592:standards / Q000706:statistics & numerical data; D018608:Ultrasonography, Doppler / Q000706:statistics & numerical data; D014481:United States
keywords: Appropriateness criteria; CT; MRI; diagnostic imaging; knee injury; radiograph