Effect of alignment of the medial tibial plateau and X-ray beam on apparent progression of osteoarthritis in the standing anteroposterior knee radiograph

Radiologic assessment of age‐related knee joint space changes in women: A 4‐year longitudinal study

“…The rate of JSL differs according to the radiographic protocol and the quality of alignment of the medial tibial plateau (32). A recent study compared the fixed flexion (16) and Lyon schuss (17) techniques in a 12-month longitudinal study (11).…”

Field test of the reproducibility of the semiflexed metatarsophalangeal view in repeated radiographic examinations of subjects with osteoarthritis of the knee

“…A caution should be issued, however, about the limitations of data on reproducibility of positioning in informing decisions concerning selection of radiographic protocols for longitudinal studies of the progression of knee OA. While reproducible positioning of the knee is necessary for acceptable measurement precision, this is not to say that any radioanatomic position of the joint (aligned or misaligned with the x-ray beam) will, if reproduced in serial radiographs, be sufficient to ensure detection of JSN with high measurement precision (9). The advantages and disadvantages of this and other nonfluoroscopically assisted protocols for standardized knee radiography, relative to fluoroscopically assisted methods, can only be determined by direct longitudinal comparison.…”

“…In the only published report of 1 such method, a posteroanterior (PA) view of the knee in semiflexion with the patella positioned directly above the first metatarsophalangeal (MTP) joint and in contact with the x-ray film cassette, nonfluoroscopically assisted positioning standards resulted in remarkable precision of JSW measurement, but also a very low likelihood (30%) of achieving parallel alignment of the medial tibial plateau and x-ray beam in a given examination (6). In fact, the likelihood of obtaining a semiflexed MTP view exhibiting satisfactory alignment is no greater than that found in the conventional standing anteroposterior (AP) radiograph, in which the knee is positioned in full extension (8,9).…”

Use of the plasma stromelysin (matrix metalloproteinase 3) concentration to predict joint space narrowing in knee osteoarthritis

“…We recently conducted a 30-month randomized, placebo-controlled trial (RCT) of doxycycline in subjects with knee OA, in which the serial radiographs used to measure joint space narrowing (JSN) were obtained using a protocol that ensured highly reproducible alignment of the medial tibial plateau with the central x-ray beam, a criterion that has been shown to yield a more rapid rate of JSN and a lower level of between-subject variability in JSN than positioning protocols that do not afford a high frequency of alignment (10). In that trial, doxycycline significantly slowed the progression of JSN (11) and reduced the frequency of clinically important increases in knee pain (12).…”