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Introduction: The Ottawa Knee Rule is a validated clinical decision rule for determining whether knee radiographs should be obtained in the setting of acute knee trauma. The objectives of this study were to assess physician knowledge of, barriers to implementation of, and compliance with the Ottawa Knee Rule in academic emergency departments (EDs), and evaluate whether patient characteristics predict guideline noncompliance.Methods: A 10 question online survey was distributed to all attending ED physicians working at three affiliated academic EDs to assess knowledge, attitudes and self-reported practice behaviors relatedto the Ottawa Knee Rule. We also performed a retrospective ED record review of patients 13 years of age and older who presented with acute knee trauma to the 3 study EDs during the 2009 calendar year, and we analyzed ED records for 19 variables.Results: ED physicians (n = 47) correctly answered 73.2% of questions assessing knowledge of the Ottawa Knee Rule. The most commonly cited barriers to implementation were “patient expectations” and system issues, such as “orthopedics referral requirement.” We retrospectively reviewed 838 records, with 260 eligible for study inclusion. The rate of Ottawa Knee Rule compliance was retrospectively determined to be 63.1%. We observed a statistically significant correlation betweenOttawa Knee Rule compliance and patient age, but not gender, insurance status, or provider type, among others.Conclusion: Compliance with the Ottawa Knee Rule among academic ED healthcare providers is poor, which was predicted by patient age and not other physician or patient variables. Improving compliance will require comprehensive educational and systemic interventions. [West J Emerg Med. 2012;13(4):366-373.]

Meniscal injury is a common cause for presentation to the emergency department or primary care physician's office. Meniscal injuries can be the result of a forceful, twisting event in a young athlete's knee or it can insidiously present in the older patient. Many patients with meniscal pathology appropriately undergo conservative management with a primary care physician while some may need referral to an orthopedist for operative intervention. Arthroscopic surgery to address the menisci is the most frequently performed procedure on the knee and one of the most regularly performed surgeries in orthopedic surgery. The purpose of this paper is to help elucidate the diagnosis and management of meniscal pathology resulting in knee pain. [ABSTRACT FROM AUTHOR]

Anterior Cruciate Ligament (ACL) injury and ACL reconstruction is common in the United States. However, when compared to the standards of other orthopedics procedures today, ACL reconstruction is NOT predictably successful in restoring patients to their pre-injury state. Only 60-70% of reconstructed patients resume their previous level of activity and many patients experience some degree of osteoarthritis. The reasons for such limitations of success are many. A recent renewal of interest in the many variables affecting ACL reconstruction and the understanding of the varying needs of patients with ACL injury holds promise for improving success even today as well as ultimately providing a normal knee for patients after ACL reconstruction. [ABSTRACT FROM AUTHOR]

An introduction is presented in which the editor discusses various articles within the issue on topics including sports medicine, exercise induced rhabdomyolysis, and post-traumatic osteoarthritis after anterior cruciate ligament injury.