Skip to main content
SpringerLink
Log in

Upright CT of the knee: the effect of weight-bearing on joint alignment

  • Musculoskeletal
  • Published:
European Radiology Aims and scope Submit manuscript

Abstract

Objectives

To prospectively compare patellofemoral and femorotibial alignment in supine non-weight-bearing computed tomography (NWBCT) and upright weight-bearing CT (WBCT) and assess the differences in joint alignment.

Methods

NWBCT and WBCT images of the knee were obtained in 26 patients (mean age, 57.0 ± 15.9 years; range, 21-81) using multiple detector CT for NWBCT and cone-beam extremity CT for WBCT. Two musculoskeletal radiologists independently quantified joint alignment by measuring femorotibial rotation, tibial tuberosity-trochlear groove distance (TTTG), lateral patellar tilt angle, lateral patellar shift, and medial and lateral femorotibial joint space widths. Significant differences between NWBCT and WBCT were sought using Wilcoxon signed-rank test (P-value < 0.05).

Results

Significant differences were found for femorotibial rotation (the NWBCT mean changed from 2.7° ± 5.1 (reader 1)/2.6° ± 5.6 (reader 2) external rotation to WBCT 0.4° ± 7.7/0.2° ± 7.5 internal rotation; P = 0.009/P = 0.004), TTTG (decrease from NWBCT (13.8 mm ± 5.1/13.9 mm ± 3.9) to WBCT (10.5 mm ± 5.0/10.9 mm ± 5.2; P = 0.008/P = 0.002), lateral patellar tilt angle (decrease from NWBCT (15.6° ± 6.7/16.9° ± 7.4) to WBCT (12.5° ± 7.7/15.0° ± 6.2; P = 0.011/P = 0.188). The medial femorotibial joint space decreased from NWBCT (3.9 mm ± 1.4/4.5 mm ± 1.3) to WBCT (2.9 mm ± 2.2/3.5 mm ± 2.2; P = 0.003/P = 0.004). Inter-reader agreement ranged from 0.52-0.97.

Conclusion

Knee joint alignment changes significantly in the upright weight-bearing position using CT when compared to supine non-weight-bearing CT.

Key Points

• Cone-beam extremity CT offers upright weight-bearing examinations of the lower extremities.

• Knee alignment changes significantly in an upright position compared to supine position.

• Tibial tuberosity-trochlear groove distance (TTTG) is less pronounced in a weight-bearing position.

• The weight-bearing position leads to a decrease of the lateral patellar tilt angle.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6

Similar content being viewed by others

References

  1. Draper CE, Besier TF, Fredericson M et al (2011) Differences in patellofemoral kinematics between weight-bearing and non-weight-bearing conditions in patients with patellofemoral pain. J Orthop Res 29:312–317

    Article  PubMed  Google Scholar 

  2. Powers CM, Ward SR, Fredericson M, Guillet M, Shellock FG (2003) Patellofemoral kinematics during weight-bearing and non-weight-bearing knee extension in persons with lateral subluxation of the patella: a preliminary study. J Orthop Sports Phys Ther 33:677–685

    Article  PubMed  Google Scholar 

  3. Souza RB, Draper CE, Fredericson M, Powers CM (2010) Femur rotation and patellofemoral joint kinematics: a weight-bearing magnetic resonance imaging analysis. J Orthop Sports Phys Ther 40:277–285

    Article  PubMed  Google Scholar 

  4. Ward SR, Terk MR, Powers CM (2007) Patella alta: association with patellofemoral alignment and changes in contact area during weight-bearing. J Bone Joint Surg Am 89:1749–1755

    Article  PubMed  Google Scholar 

  5. Pal S, Besier TF, Beaupre GS, Fredericson M, Delp SL, Gold GE (2013) Patellar maltracking is prevalent among patellofemoral pain subjects with patella alta: an upright, weightbearing MRI study. J Orthop Res 31:448–457

    Article  PubMed Central  PubMed  Google Scholar 

  6. Gold GE, Besier TF, Draper CE, Asakawa DS, Delp SL, Beaupre GS (2004) Weight-bearing MRI of patellofemoral joint cartilage contact area. J Magn Reson Imaging 20:526–530

    Article  PubMed  Google Scholar 

  7. Powers CM, Shellock FG, Pfaff M (1998) Quantification of patellar tracking using kinematic MRI. J Magn Reson Imaging 8:724–732

    Article  CAS  PubMed  Google Scholar 

  8. Doucette SA, Child DD (1996) The effect of open and closed chain exercise and knee joint position on patellar tracking in lateral patellar compression syndrome. J Orthop Sports Phys Ther 23:104–110

    Article  CAS  PubMed  Google Scholar 

  9. Tennant S, Williams A, Vedi V, Kinmont C, Gedroyc W, Hunt DM (2001) Patello-femoral tracking in the weight-bearing knee: a study of asymptomatic volunteers utilising dynamic magnetic resonance imaging: a preliminary report. Knee Surg Sports Traumatol Arthrosc 9:155–162

    Article  CAS  PubMed  Google Scholar 

  10. Izadpanah K, Weitzel E, Vicari M, et al (2014) Influence of knee flexion angle and weight bearing on the Tibial Tuberosity-Trochlear Groove (TTTG) distance for evaluation of patellofemoral alignment. Knee Surg Sports Traumatol Arthrosc 22(11):2655-2661

  11. Tuominen EK, Kankare J, Koskinen SK, Mattila KT (2013) Weight-bearing CT imaging of the lower extremity. AJR Am J Roentgenol 200:146–148

    Article  PubMed  Google Scholar 

  12. Demehri S, Muhit A, Zbijewski W, et al. (2015) Assessment of image quality in soft tissue and bone visualization tasks for a dedicated extremity cone-beam CT system. Eur Radiol. doi:10.1007/s00330-014-3546-6

  13. Lin YF, Jan MH, Lin DH, Cheng CK (2008) Different effects of femoral and tibial rotation on the different measurements of patella tilting: an axial computed tomography study. J Orthop Surg Res 3:5

    Article  PubMed Central  PubMed  Google Scholar 

  14. Pfirrmann CW, Zanetti M, Romero J, Hodler J (2000) Femoral trochlear dysplasia: MR findings. Radiology 216:858–864

    Article  CAS  PubMed  Google Scholar 

  15. Schoettle PB, Zanetti M, Seifert B, Pfirrmann CW, Fucentese SF, Romero J (2006) The tibial tuberosity-trochlear groove distance; a comparative study between CT and MRI scanning. Knee 13:26–31

    Article  PubMed  Google Scholar 

  16. Sasaki T, Yagi T (1986) Subluxation of the patella. Investigation by computerized tomography. Int Orthop 10:115–120

    Article  CAS  PubMed  Google Scholar 

  17. Urch SE, Tritle BA, Shelbourne KD, Gray T (2009) Axial linear patellar displacement: a new measurement of patellofemoral congruence. Am J Sports Med 37:970–973

    Article  PubMed  Google Scholar 

  18. Rosner B. Fundamentals of biostatistics, 7th ed. Boston: Brooks/Cole, Cengage Learning, 2011:xvii, 859 p.

  19. Dupuy DE, Hangen DH, Zachazewski JE, Boland AL, Palmer W (1997) Kinematic CT of the patellofemoral joint. AJR Am J Roentgenol 169:211–215

    Article  CAS  PubMed  Google Scholar 

  20. Hirschmann A, Pfirrmann CW, Klammer G, Espinosa N, Buck FM (2014) Upright cone CT of the hindfoot: comparison of the non-weight-bearing with the upright weight-bearing position. Eur Radiol 24:553–558

    Article  PubMed  Google Scholar 

  21. van Kampen A, Huiskes R (1990) The three-dimensional tracking pattern of the human patella. J Orthop Res 8:372–382

    Article  PubMed  Google Scholar 

  22. Camp CL, Stuart MJ, Krych AJ et al (2013) CT and MRI measurements of tibial tubercle-trochlear groove distances are not equivalent in patients with patellar instability. Am J Sports Med 41:1835–1840

    Article  PubMed  Google Scholar 

  23. Dietrich TJ, Betz M, Pfirrmann CW, Koch PP, Fucentese SF (2014) End-stage extension of the knee and its influence on tibial tuberosity-trochlear groove distance (TTTG) in asymptomatic volunteers. Knee Surg Sports Traumatol Arthrosc 22:214–218

    Article  PubMed  Google Scholar 

  24. Dejour H, Walch G, Nove-Josserand L, Guier C (1994) Factors of patellar instability: an anatomic radiographic study. Knee Surg Sports Traumatol Arthrosc 2:19–26

    Article  CAS  PubMed  Google Scholar 

  25. Koeter S, Diks MJ, Anderson PG, Wymenga AB (2007) A modified tibial tubercle osteotomy for patellar maltracking: results at two years. J Bone Joint Surg (Br) 89:180–185

    Article  CAS  Google Scholar 

Download references

Acknowledgments

The scientific guarantor of this publication is Anna Hirschmann, MD. The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article. The authors state that this work has not received any funding. One of the authors has significant statistical expertise; however, no complex statistical methods were necessary for this paper. Institutional Review Board approval was obtained. Written informed consent was obtained from all patients in this study. Methodology: prospective, diagnostic study performed at one institution

Author information

Authors and Affiliations

  1. Department of Radiology, Orthopedic University Hospital Balgrist, University of Zurich, Forchstrasse 340, 8008, Zurich, Switzerland

    Anna Hirschmann, Florian M. Buck & Christian W. A. Pfirrmann

  2. Orthopedic Surgery, Orthopedic University Hospital Balgrist, University of Zurich, Forchstrasse 340, 8008, Zurich, Switzerland

    Sandro F. Fucentese

  3. Clinic of Radiology and Nuclear Medicine, University of Basel Hospital, Petersgraben 4, 4031, Basel, Switzerland

    Anna Hirschmann

Authors
  1. Anna Hirschmann
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Florian M. Buck
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Sandro F. Fucentese
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Christian W. A. Pfirrmann
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Anna Hirschmann.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Hirschmann, A., Buck, F.M., Fucentese, S.F. et al. Upright CT of the knee: the effect of weight-bearing on joint alignment. Eur Radiol 25, 3398–3404 (2015). https://doi.org/10.1007/s00330-015-3756-6

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00330-015-3756-6

Keywords

Search

Navigation