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The posterior–anterior flexed view is better than the anterior–posterior view for assessing osteoarthritis of the knee

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Abstract

Objective

The aim of this study is to determine whether the posterior–anterior (PA)-flexed view improves the radiographic assessment of patients with knee pain compared with the standard standing anterior–posterior radiograph.

Materials and methods

Three hundred and sixty-five patients with knee pain underwent anterior–posterior (AP), PA flexed, lateral, and Merchant radiographs of the knee. Knees were grouped as mild (Kellgren and Lawrence [K-L] 1–2) or severe (K-L 3–4) osteoarthritis (OA) and either varus (medial compartment), valgus (lateral compartment), or patellofemoral OA.

Results

In knees with mild valgus OA on AP view (K–L 1–2), the PA flexed view was more sensitive than the AP view. The measured lateral minimal joint space width (minJSW) decreased more than 2 mm in 68% of the patients, resulting in an increase in K–L grade (3 or 4). In patients with severe valgus OA and in all patients with varus and patellofemoral OA, there was no difference between AP and PA flexed view with regard to radiographic measurements or KL grade. Based on the Medicare reimbursement rate using the PA flexed view alone instead of both views reduced imaging costs by 47%.

Conclusion

The PA flexed view better classifies the severity of lateral compartment disease in patients with mild valgus OA and provides comparable diagnostic sensitivity for joint space narrowing in varus- and patellofemoral OA. Using the PA flexed view alone was more cost effective than using the combination of AP and PA flexed imaging.

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Authors and Affiliations

  1. Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA

    Kilian Rueckl, Friedrich Boettner, Noor Maza, Armin Runer, Ulrich Bechler & Peter Sculco

  2. Icahn School of Medicine at Mount Sinai, 1468 Madison Avenue, New York, NY, 10029, USA

    Noor Maza

Authors
  1. Kilian Rueckl
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  2. Friedrich Boettner
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  3. Noor Maza
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  4. Armin Runer
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  5. Ulrich Bechler
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  6. Peter Sculco
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Correspondence to Kilian Rueckl.

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Conflicts of interest

Author Friedrich Boettner receives royalties from Smith&Nephew and Orthodevelopment and compensation from Smith&Nephew, Orthodevelopment, and DePuy. All other authors declare that they have no conflicts of interests.

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Rueckl, K., Boettner, F., Maza, N. et al. The posterior–anterior flexed view is better than the anterior–posterior view for assessing osteoarthritis of the knee. Skeletal Radiol 47, 511–517 (2018). https://doi.org/10.1007/s00256-017-2815-2

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  • DOI: https://doi.org/10.1007/s00256-017-2815-2

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