Skip to main content
SpringerLink
Log in

The knee skyline radiograph: its usefulness in the diagnosis of patello-femoral osteoarthritis

  • Original Paper
  • Published:
International Orthopaedics Aims and scope Submit manuscript

Abstract

The aim of this study was to determine the usefulness of the skyline radiograph in the diagnosis of patellofemoral osteoarthritis. Additionally, we wanted to assess the usefulness of patello-femoral crepitus as a clinical sign of this condition. Seventy-seven patients scheduled to undergo knee surgery had standard antero-posterior, lateral and skyline X-rays of their affected knee. The presence of clinical patello-femoral crepitus was also documented preoperatively. At the operation, their patellofemoral joints were graded into two groups according to the presence or absence of osteoarthritis. The lateral and skyline view X-rays as well as patello-femoral crepitus were compared individually against the operative findings. The skyline view had a sensitivity of 79% and a specificity of 80%. The lateral view had a sensitivity of 82% and specificity of 65%. Patello-femoral crepitus as a sign had a sensitivity of 89% and a specificity of 82%. There was no statistically significant difference between the two radiological views in terms of sensitivity and specificity in the diagnosis of patellofemoral osteoarthritis. Hence, we cannot recommend the skyline view as a routine radiological investigation in all cases of suspected patellofemoral osteoarthritis.

Résumé

Le but de cette étude était de déterminer l’utilité des vues axiales de rotule dans le diagnostic de l’arthrose patellofémorale. Le signe du rabot peut également être utile et est un signe clinique habituel dans ce type de lésions. Soixante-dix-sept patients, préparés pour bénéficier d’une prothèse totale du genou ont bénéficié de radios antéropostérieure du genou, de radios de profil et d’une vue axiale de rotule. La présence d’un rabot patello fémoral a également été indiquée en préopératoire. A l’intervention, les lésions patello fémorales ont été classées en deux groupes, en fonction de la présence ou de l’absence de l’arthrose. La vue de profil de la vue axiale de rotule et des lésions fémoro patellaires ont été comparées. La vue axiale de rotule a une sensibilité de 79% et une spécificité de 80%. Le cliché de profil a une sensibilité de 82% et une spécificité de 65%. Le signe du rabot a une sensibilité de 89% et une spécificité de 82%. Il n’y a pas de différences significatives entre tous ces clichés radiologiques en termes de sensibilité et spécificité lors du diagnostic d’une arthrose fémoro patellaire. De ce fait, nous ne recommandons pas de pratiquer une vue axiale de rotule comme bilan de routine dans les cas suspects d’arthrose fémoro patellaires.

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

Similar content being viewed by others

References

  1. Ahlback S (1968) Osteoarthritis of the knee. A radiographic investigation. Acta Radiol [Suppl] 277:1–72

    Google Scholar 

  2. Beaconsfield T, Pintore E, Maffulli N, Petri GJ (1994) Radiological measurements in patellofemoral disorders. Clin Orthop Relat Res 308:18–28

    PubMed  Google Scholar 

  3. Brandt KD, Fife RS, Braunstein EM, Katz B (1991) Radiographic grading of the severity of knee osteoarthritis: relation of the Kellgren and Lawrence grade to a grade based on joint space narrowing, and correlation with arthroscopic evidence of articular cartilage degeneration. Arthritis Rheum 34(11):1381–1386

    Article  PubMed  CAS  Google Scholar 

  4. Brattstrom H (1964) Roentgen examination of the distal femur end and the femoro-patellar joint by so called axial picture. Acta Orthop Scand 68[Suppl]:53–78

    Google Scholar 

  5. Cicuttini FM, Baker J, Hart DJ, Spector TD (1996) Association of pain with radiological changes in different compartments and views of the knee joint. Osteoarthritis Cartilage 4(2):143–147

    Article  PubMed  CAS  Google Scholar 

  6. Cicuttini FM, Baker J, Hart DJ, Spector TD (1996) Choosing the best method for radiological assessment of patellofemoral OA. Ann Rheum Dis 55:134–136

    PubMed  CAS  Google Scholar 

  7. Cooper C, Cushnaghan J, Kirwan JR, Dieppe PA, Rogers J, McAlindon T, McCrae F (1992) Radiographic assessment of the knee joint in osteoarthritis. Ann Rheum Dis 51:80–82

    PubMed  CAS  Google Scholar 

  8. Davies AP, Vince AS, Shepstone L, Donell ST, Glasgow MM (2002) The radiological prevalence of patellofemoral OA. Clin Orthop Relat Res 402:206–212

    Article  PubMed  Google Scholar 

  9. Felson DT, McAlindon TE, Anderson JJ, Naimark A, Weissman BW, Aliabadi P, Evans S, Levy D, LaValley MP (1997) Defining radiographic osteoarthritis for the whole knee. Osteoarthritis Cartilage 5(4):241–250

    Article  PubMed  CAS  Google Scholar 

  10. Fife RS, Brandt KD, Braunstein EM, Katz BP, Shelbourne KD, Kalasinski LA, Ryan S (1991) Relationship between arthroscopic evidence of cartilage damage and radiographic evidence of joint space narrowing in early osteoarthritis of the knee. Ann Rheum Dis 34:377–382

    CAS  Google Scholar 

  11. Jones AC, Ledingham J, McAlindon T, Regan M, Hart D, MacMillan PJ, Doherty M (1993) Radiographic assessment of patellofemoral OA. Ann Rheum Dis 52:655–658

    PubMed  CAS  Google Scholar 

  12. Kellgren JH, Lawrence JS (1957) Radiological assessment of osteoarthrosis. Ann Rheum Dis 16:494–501

    Article  PubMed  CAS  Google Scholar 

  13. Lanyon P, Jones A, Doherty M (1996) Assessing progression of patellofemoral OA: a comparison between two radiographic methods. Ann Rheum Dis 55:875–879

    PubMed  CAS  Google Scholar 

  14. Lanyon P, O'Reilly S, Jones A, Doherty M (1998) Radiographic assessment of symptomatic knee OA in the community: definitions and normal joint space. Ann Rheum Dis 57:595–601

    Article  PubMed  CAS  Google Scholar 

  15. Lequesne M, Brandt K, Bellamy N, Moskowitz R, Menkes CJ, Pelletier J-P (1994) Guidelines for testing slow acting drugs in osteoarthritis. J Rheumatol 21[Suppl 41]:65–73

    Google Scholar 

  16. Merchant AC (2001) Patellofemoral imaging. Clin Orthop Relat Res 389:15–21

    Article  PubMed  Google Scholar 

  17. Merchant AC, Mercer RL, Jacobsen RH, Cool CR (1974) Roentgenographic analysis of patellofemoral congruence. J Bone Joint Surg Am 56 A:1391–1396

    Google Scholar 

  18. Outerbridge RE (1964) The etiology of chondromalacia patellae. J Bone Joint Surg Br 46:752–757

    Google Scholar 

  19. Rosenberg TD, Paulos LE, Parker RD (1988) The 45-degree posteroanterior flexion weight-bearing radiograph of the knee. J Bone Joint Surg Am 70:1479–1483

    PubMed  CAS  Google Scholar 

  20. Spector TD, Hart DJ, Byrne J, Harris PA, Dacre JE, Doyle DV (1993) Definition of osteoarthritis of the knee for epidemiological studies. Ann Rheum Dis 52:790–794

    PubMed  CAS  Google Scholar 

  21. Scott WW Jr, Lethbridge-Cejku M, Reichle R, Wigley FM, Tobin JD, Hochberg MC (1993) Reliability of grading scales for individual radiographic features of osteoarthritis of the knee. The Baltimore longitudinal study of aging atlas of knee osteoarthritis. Invest Radiol 28(6):497–501

    Article  PubMed  Google Scholar 

  22. StataCorp (2001) Stata statistical software: release 7.0. College Station, TX: Stata Corporation

  23. Thomas RH, Resnick D, Alazraki NP, Daniel D, Grenfield R (1975) Compartmental evaluation of osteoarthritis of the knee. Radiology 116:585–594

    PubMed  CAS  Google Scholar 

  24. 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

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

We would like to extend our sincere gratitude to Dr. R. Campbell, Consultant Radiologist at The James Cook University Hospital for arranging to partially fund the project through the radiology department, and to Professor Stothard, Consultant Orthopaedic Surgeon at The James Cook University Hospital, for his support and advice throughout the project.

Author information

Authors and Affiliations

  1. The James Cook University Hospital, Marton Road, Middlesbrough, TS4 3BW, UK

    R. Bhattacharya, V. Kumar, E. Safawi & A. C. Hui

  2. School of Health and Social Care, University of Teesside, Tees Valley, TS1 3BA, Middlesbrough, UK

    P. Finn

  3. 32, Grosvenor Road, Billingham, Cleveland, TS22 5HA, UK

    V. Kumar

Authors
  1. R. Bhattacharya
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. V. Kumar
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. E. Safawi
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. P. Finn
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. A. C. Hui
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to V. Kumar.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Bhattacharya, R., Kumar, V., Safawi, E. et al. The knee skyline radiograph: its usefulness in the diagnosis of patello-femoral osteoarthritis. International Orthopaedics (SICOT) 31, 247–252 (2007). https://doi.org/10.1007/s00264-006-0167-y

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00264-006-0167-y

Keywords

Search

Navigation