Optimization of the fixed-flexion knee radiograph.

Osteoarthritis and Cartilage (Impact Factor: 4.66). 12/2007; 15(11):1221-4. DOI: 10.1016/j.joca.2007.05.012
Source: PubMed

ABSTRACT To develop a user-friendly method of achieving optimal radiographs for measurement of joint space width of the knee with minimal radiation exposure. In order to accomplish this the X-ray technologist must (1) be able to identify the anterior and posterior rims of the tibial plateau at a variety of X-ray head angles and (2) be able to choose the direction to adjust the head angle to get a better view based on the criteria for acceptable radiographs.
We have developed a training manual and materials to instruct investigators and radiology technologists in a method that uses a commercially available Plexiglas positioning frame (Synaflexer) and standard X-ray equipment to achieve optimal X-rays with regard to tibial plateau alignment of the knee. This should be accomplished with four or fewer radiographs.
Optimized radiographs for joint space width measurements are achieved without the need for fluoroscopy or foot maps.
This method is readily understood and instituted by radiology technologists in the field.

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    ABSTRACT: Women are at a greater risk for knee osteoarthritis (OA), but reasons for this greater risk in women are not well understood. It may be possible that differences in cartilage composition and walking mechanics are related to greater OA risk in women. (1) Do women have higher knee cartilage and meniscus T1ρ than men in young healthy, middle-aged non-OA and OA populations? (2) Do women exhibit greater static and dynamic (during walking) knee loading than men in young healthy, middle-aged non-OA and OA populations? Data were collected from three cohorts: (1) young active (< 35 years) (20 men, 13 women); (2) middle-aged (≥ 35 years) without OA (Kellgren-Lawrence [KL] grade < 2) (43 men, 65 women); and (3) middle-aged with OA (KL > 1) (18 men, 25 women). T1ρ and T2 relaxation times for cartilage in the medial knee, lateral knee, and patellofemoral compartments and medial and lateral menisci were quantified with 3.0-T MRI. A subset of the participants underwent three-dimensional motion capture during walking for calculation of peak knee flexion and adduction moments, flexion and adduction impulses, and peak adduction angle. Differences in MR, radiograph, and gait parameters between men and women were compared in the three groups separately using multivariate analysis of variance. Women had higher lateral articular cartilage T1ρ (men = 40.5 [95% confidence interval {CI}, 38.8-42.3] ms; women = 43.3 [95% CI, 41.9-44.7] ms; p = 0.017) and patellofemoral T1ρ (men = 44.4 [95% CI, 42.6-46.3] ms; women = 48.4 [95% CI, 46.9-50.0] ms; p = 0.002) in the OA group; and higher lateral meniscus T1ρ in the young group (men = 15.3 [95% CI, 14.7-16.0] ms; women = 16.4 [95% CI, 15.6-17.2] ms; p = 0.045). The peak adduction moment in the second half of stance was lower in women in the middle-aged (men = 2.05 [95% CI, 1.76-2.34] %BW*Ht; women = 1.66 [95% CI, 1.44-1.89] %BW*Ht; p = 0.037) and OA (men = 2.34 [95% CI, 1.76-2.91] %BW*Ht; women = 1.42 [95% CI, 0.89-1.94] %BW*Ht; p = 0.022) groups. Static varus from radiographs was lower in women in the middle-aged (men = 178° [95% CI, 177°-179°]; women = 180° [95% CI, 179°-181°]; p = 0.002) and OA (men = 176° [95% CI, 175°-178°]; women = 180° [95% CI, 179°-181°]; p < 0.001) groups. Women had lower varus during walking in all three groups (young: men = 4° [95% CI, 3°-6°]; women = 2° [95% CI, 0°-3°]; p = 0.013; middle-aged: men = 2° [95% CI, 1°-3°]; women = 0° [95% CI, -1° to 1°]; p = 0.015; OA: men = 4° [95% CI, 2°-6°]; women = 0° [95% CI, -2° to 2°]; p = 0.011). Women had a higher knee flexion moment (men = 4.24 [95% CI, 3.58-4.91] %BW*Ht; women 5.40 [95% CI, 4.58-6.21] %BW*Ht; p = 0.032) in the young group. These data demonstrate differences in cartilage composition and gait mechanics between men and women in young healthy, middle-aged healthy, and OA cohorts. Considering the cross-sectional nature of the study, longitudinal research is needed to investigate if these differences in cartilage composition and walking mechanics are associated with a greater risk of lateral tibiofemoral or patellofemoral OA in women. Future studies should also investigate the relative risk of lateral versus medial patellofemoral cartilage degeneration risk in women compared with men. Level III, retrospective study.
    Clinical Orthopaedics and Related Research 02/2015; DOI:10.1007/s11999-015-4212-2 · 2.79 Impact Factor
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    ABSTRACT: Osteoarthritis is observed with a much higher incidence in the military than comparable civilian populations. The diagnosis is often made at a younger age in military members. Anterior cruciate ligament (ACL) ruptures are endemic injuries to the young, active military athlete population. Posttraumatic osteoarthritis (PTOA) occurs commonly in the post-ACL-injured knee. Recent efforts by national organizations have brought attention to the unique opportunity to study PTOA in its earliest, molecular stages in knees sustaining traumatic injuries to the ACL. The search for surrogate biomarkers of PTOA in the military population offers opportunity to advance understanding of this significant disease.
    Clinics in Sports Medicine 10/2014; 33(4):633–640. DOI:10.1016/j.csm.2014.06.008 · 2.58 Impact Factor