Abstract
There has been a debate amongst orthopaedic surgeons about which plain radiographs are required in common knee conditions and this is a 5-year review assessing the influence of recent publications on the use of radiographs. A postal survey of all members of the British Orthopaedic Association was performed. The response rate was 60% (990/1,650). There was a broad agreement on the use of anteroposterior and lateral radiographs. The use of the posteroanterior (PA) weight-bearing radiograph has increased from 82 to 86%. The use of skyline view for suspected arthritis and after knee replacement has increased from 23 to 41%. There is still disparity amongst orthopaedic surgeons regarding the knee flexion angle for skyline and weight-bearing views. After review of the literature we recommend that a single skyline view in 30° flexion is adequate and should be a standard investigation in knee disorders. We also stress the importance of weight-bearing PA radiograph in 30° knee flexion for adequate assessment in all patients with suspected arthritis.
Résumé
But: Il y a un débat parmi les orthopédistes au sujet des radiographies nécessaires pour un bilan de genou. Ce travail est une revue sur 5 ans étudiant l’influence des publications récentes sur ce problème. Méthode: envoi d’un questionnaire par voie postale à tous les membres de la British Orthopaedic Association. Résultats: Taux de réponse de 60%. Il y a un large agrément pour l’utilisation des radiographies antéro-postérieures et latérales. L’utilisation des radiographies postéro-antérieures en charge s’est accru de 82 à 86%. L’utilisation des incidences tangentielles pour la suspicion d’arthrose ou après remplacement prothétique a augmenté de 23 à 41%. Il persiste des disparités entre les orthopédistes pour l’angle de flexion des incidences tangentielles et dans les clichés en charge. Discussion: après une revue de la littérature nous pensons que le cliché tangentiel à 30° de flexion doit être une incidence standard et nous insistons sur l’importance des clichés postéro-antérieurs en charge à 30° de flexion dans les suspicions d’arthrose.
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References
Ahlback S (1968) Osteoarthrosis of the knee: a radiographic investigation. Acta Radiol Scand Suppl 277:7–22
Rosenberg TD, Paulos LE, Parker RD, Coward D, Scott S (1988) The forty-five-degree posteroanterior flexion weight-bearing radiograph of the knee. J Bone Joint Surg Am 70:1479–1483
Davies AP, Calder DA, Marshall T, Glasgow MMS (1999) Plain radiography in the degenerate knee: a case for change. J Bone Joint Surg Br 81:632–635
McAlindon TE, Snow S, Cooper C, Dieppe PA (1992) Radiographic patterns of osteoarthritis of the knee joint in the community: the importance of the patellofemoral joint. Ann Rheum Dis 51:844–849
Berry DJ, Rand JA (1993) Isolated patellar component revision in total knee arthroplasty. Clin Orthop 286:110–114
Bindelglass DF, Cohen JL, Dorr LD (1993) Patellar tilt and subluxation in total knee arthroplasty. Relationship to pain, fixation and design. Clin Orthop 286:103–109
Merchant AC, Mercer RL, Jacobsen RH, Cool CR (1974) Roentgenographic analysis of patellofemoral congruence. J Bone Joint Surg Am 56:1391–1396
Laurin CA, Dussault R, Levesque HP (1979) The tangential X-ray investigation of the patellofemoral joint. Clin Orthop 144:16–26
Ficat RP, Philippe J, Hungerford DS (1979) Chondromalacia patellae: a system of classification. Clin Orthop 144:55–62
Resnick D, Vint V (1980) The tunnel view in assessment of cartilage loss in osteoarthritis of the knee. Radiology 137:547–548
Davies AP, Bayer J, Owen-Johnson S, Shepstone L, Darrah C, Glasgow MM, Donell ST (2004) The optimum knee flexion angle for skyline radiography is thirty degrees. Clin Orthop Relat Res 423:166–171
Vignon E, Piperno M, Le Graverand MP, Mazzuca SA, Brandt KD, Mathieu P, Favret H, Vignon M, Merle-Vincent F, Conrozier T (2003) Measurement of radiographic joint space width in the tibiofemoral compartment of the osteoarthritic knee: comparison of standing anteroposterior and Lyon schuss views. Arthritis Rheum 48(2):378–384
Jones AC, Ledingham J, McAlindon T, Regan M, Hart D, MacMillan PJ, Doherty M (1993) Radiographic assessment of patellofemoral osteoarthritis. Ann Rheum Dis 52(9):655–658
Cicuttini FM, Baker J, Hart DJ, Spector TD (1996) Choosing the best method for radiological assessment of patellofemoral osteoarthritis. Ann Rheum Dis 55(2):134–136
Vince AS, Singhania AK, Glasgow MMS (2000) What knee X-rays do we need? A survey of orthopaedic surgeons in the United Kingdom. The Knee 7:101–104
Deep K, Norris M, Senior C (2003) Radiographic measurement of joint space height in non-osteoarthritic tibiofemoral joints. A comparison of weight-bearing extension and 30 degrees flexion views. J Bone Joint Surg Br 85(7):980–982
Acknowledgement
We would like to thank all the members of the British Orthopaedic Association who were kind enough to complete the questionnaire and enable this survey to take place.
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Bhatnagar, S., Carey-Smith, R., Darrah, C. et al. Evidence-based practice in the utilization of knee radiographs—A survey of all members of the British Orthopaedic Association. International Orthopaedics (SICOT) 30, 409–411 (2006). https://doi.org/10.1007/s00264-006-0099-6
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DOI: https://doi.org/10.1007/s00264-006-0099-6