Influence of variation in semiflexed knee positioning during image acquisition on separate quantitative radiographic parameters of osteoarthritis, measured by Knee Images Digital Analysis

Kinds, M.B.; Vincken, Koen L.; Hoppinga, T.N.; Bleys, Ronald L. A. W.; Viergever, Max A.; Marijnissen, A.C.; Welsing, Paco M J; Lafeber, Floris P. J. G.

doi:10.1016/j.joca.2012.04.016

Cited by 44 publications

(22 citation statements)

References 32 publications

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“…Rarely (about <1%), severe cartilage damage (grade 4, 5 and 6) which should have resulted in joint space narrowing on radiography was present. The reason for this is unclear, but it could have been affected by positioning/angulation of the knee 14 .…”

Section: Discussionmentioning

confidence: 99%

Pre-radiographic osteoarthritic changes are highly prevalent in the medial patella and medial posterior femur in older persons: Framingham OA study

Hayashi

Felson

Niu

et al. 2014

Osteoarthritis and Cartilage

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Objective To determine which subregions of the knee joint have a high prevalence of pre-radiographic osteoarthritic changes, i.e. cartilage damage and osteophytes that can only be detected by MRI, in radiographically normal knees. Methods Institutional review board approval and written informed consent from all participants was obtained. Data was collected from a community cohort in Framingham, MA, involving people aged 50–79. Participants underwent weight-bearing posteroanterior and lateral knee radiography with the fixed-flexion protocol, and 1.5T MRI. Knees without radiographic osteoarthritis (Kellgren Lawrence grade 0 for the tibiofemoral joint and absence of any osteophytes or joint space narrowing in the patellofemoral joint) were included. The knee joint was divided into 14 subregions for cartilage and 16 subregions for osteophytes, and prevalence and severity of cartilage damage (grade 0–6) and osteophytes (grade 0–7) were semiquantitatively assessed using the Whole Organ Magnetic Resonance Imaging Score. Results The mean age of 696 participants was 62.3±8.4 years, and the mean body mass index was 27.9±5.1 kg/m2. Women comprised 55.2% of the study sample (384/696). Prevalence of cartilage damage (grade ≥2) was 47.7% (332/696) in the medial patellar and 29.9% (208/696) in patellar lateral subregions, and 24.0% (167/696) in femoral medial anterior and 26.5% (184/696) in femoral medial central subregions. Prevalence of osteophytes (grade ≥2) was highest at 60.8% (423/696) in the medial femoral posterior subregion, followed by 34.0% (237/696) in patellar lateral and 24.6% (171/696) in patellar medial subregions. For all other subregions, prevalence of these lesions was lower than the aforementioned percentages. Conclusion MRI-detected cartilage damage and osteophytes are highly prevalent in the medial patellofemoral and medial posterior tibiofemoral joints in radiographically normal knees in persons aged 50–79.

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Section: Discussionmentioning

confidence: 99%

Pre-radiographic osteoarthritic changes are highly prevalent in the medial patella and medial posterior femur in older persons: Framingham OA study

Hayashi

Felson

Niu

et al. 2014

Osteoarthritis and Cartilage

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“…With regard to the first hypothesis that FTA correlated with knee rotation angle, the results showed that FTA positively correlated with knee rotation angle at 0° flexion position and negatively correlated with knee rotation angle at 45° knee flexion position. Previous studies have highlighted the effect of knee positioning during radiograph acquisition on measurement accuracy while investigating joint space narrowing [16, 21], lower limb alignment [9], osteoarthritis (OA) grading [4, 12], and while performing ligament reconstructions using surgical guides [1]. In this 3D CT model study, FTA measurement was significantly influenced by malrotation of the knee leading to incorrect results.…”

Section: Discussionmentioning

confidence: 99%

Knee rotation influences the femoral tunnel angle measurement after anterior cruciate ligament reconstruction: a 3-dimensional computed tomography model study

Tang

Thorhauer

Marsh

et al. 2013

Knee Surg Sports Traumatol Arthrosc

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Purpose Femoral tunnel angle (FTA) has been proposed as a metric for evaluating whether ACL reconstruction was performed anatomically. In clinic, radiographic images are typically acquired with an uncertain amount of internal/external knee rotation. The extent to which knee rotation will influence FTA measurement is unclear. Furthermore, differences in FTA measurement between the two common positions (0° and 45° knee flexion) have not been established. The purpose of this study was to investigate the influence of knee rotation on FTA measurement after ACL reconstruction. Methods Knee CT data from 16 subjects were segmented to produce 3D bone models. Central axes of tunnels were identified. The 0° and 45° flexion angles were simulated. Knee internal/external rotations were simulated in a range of ±20°. FTA was defined as the angle between the tunnel axis and femoral shaft axis, orthogonally projected into the coronal plane. Results Femoral tunnel angle was positively/negatively correlated with knee rotation angle at 0°/45° knee flexion. At 0° knee flexion, FTA for anterio-medial (AM) tunnels was significantly decreased at 20° of external knee rotation. At 45° knee flexion, more than 16° external or 19° internal rotation significantly altered FTA measurements for single-bundle tunnels; smaller rotations (±9° for AM, ±5° for PL) created significant errors in FTA measurements after double-bundle reconstruction. Conclusion Femoral tunnel angle measurements were correlated with knee rotation. Relatively small imaging malalignment introduced significant errors with knee flexed 45°. This study supports using the 0° flexion position for knee radiographs to reduce errors in FTA measurement due to knee internal/external rotation. Level of evidence Case–control study, Level III.

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“…Variations in knee positioning significantly influence assessment of most radiographic characteristics of OA. This seems to be relevant for semi-quantitative as well as quantitative evaluation, as shown in an exemplary fashion in the Dutch CHECK cohort in which systematic variation in semi-flexed knee joint positioning during image acquisition influenced the measurement of several radiographic parameters including joint space width, which may lead to false-positive or false–negative misclassification in regard to joint space narrowing as shown in Figure 2 15 .…”

Section: Why Radiography Is Insufficientmentioning

confidence: 96%

The role of radiography and MRI for eligibility assessment in DMOAD trials of knee OA

et al. 2018

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Currently no disease-modifying drugs for osteoarthritis have been approved. There are several reasons for failure of clinical trials in the past, including the commonly applied definition of structural eligibility based on radiographic assessment. In the context of precision medicine it will be of increasing relevance to find the appropriate patient for a specific treatment approach. Phenotypical stratification by imaging at eligibility will be paramount in the future and cannot be achieved using radiography alone. Furthermore, joints at high risk for faster progression need to be identified, as these may allow a more efficient DMOAD trial design. In addition, joints at high risk for collapse need to be excluded at screening. MRI may be able to offer solutions in this context, and commonly perceived hurdles in the application of MRI at eligibility assessment are being addressed as a result of technological advances and simplified image assessment.

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Influence of variation in semiflexed knee positioning during image acquisition on separate quantitative radiographic parameters of osteoarthritis, measured by Knee Images Digital Analysis

Cited by 44 publications

References 32 publications

Pre-radiographic osteoarthritic changes are highly prevalent in the medial patella and medial posterior femur in older persons: Framingham OA study

Pre-radiographic osteoarthritic changes are highly prevalent in the medial patella and medial posterior femur in older persons: Framingham OA study

Knee rotation influences the femoral tunnel angle measurement after anterior cruciate ligament reconstruction: a 3-dimensional computed tomography model study

The role of radiography and MRI for eligibility assessment in DMOAD trials of knee OA

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