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SAN FRANCISCO — Physicians who are treating patients with knee injury or possible arthritis may initially be inclined to order anterior-posterior and lateral views—or sunrise views—of the knee and occasionally even an MRI. But in most cases, the resulting films are not particularly useful and can actually be misleading, Dr. W. Dilworth Cannon said at a conference on sports medicine sponsored by the University of California, San Francisco.
Dr. Cannon, of the department of orthopaedic surgery at UCSF, said he regards the supine anterior-posterior (AP) view of the knee to be “pretty worthless unless the patient can't stand. … Someone could have severe advanced degenerative arthritis, and if you just look at the AP, you may miss it.”
Although the supine lateral is worth ordering, a posterior-anterior (PA) bent-knee standing film is better than the supine AP. The patient faces away from the x-ray tube, with knees placed against the cassette and bent at least 25 degrees; the x-ray beam is aimed 10 degrees caudally, which provides a more useful view of the joint.
Dr. Cannon specifies a 30-degree or 45-degree patellofemoral axial view.
Dr. Cannon also suggested that physicians not order MRIs and instead, leave them to the orthopedic surgeon. He said many of the MRIs that come into his office from primary care physicians are of relatively poor quality.
SAN FRANCISCO — Physicians who are treating patients with knee injury or possible arthritis may initially be inclined to order anterior-posterior and lateral views—or sunrise views—of the knee and occasionally even an MRI. But in most cases, the resulting films are not particularly useful and can actually be misleading, Dr. W. Dilworth Cannon said at a conference on sports medicine sponsored by the University of California, San Francisco.
Dr. Cannon, of the department of orthopaedic surgery at UCSF, said he regards the supine anterior-posterior (AP) view of the knee to be “pretty worthless unless the patient can't stand. … Someone could have severe advanced degenerative arthritis, and if you just look at the AP, you may miss it.”
Although the supine lateral is worth ordering, a posterior-anterior (PA) bent-knee standing film is better than the supine AP. The patient faces away from the x-ray tube, with knees placed against the cassette and bent at least 25 degrees; the x-ray beam is aimed 10 degrees caudally, which provides a more useful view of the joint.
Dr. Cannon specifies a 30-degree or 45-degree patellofemoral axial view.
Dr. Cannon also suggested that physicians not order MRIs and instead, leave them to the orthopedic surgeon. He said many of the MRIs that come into his office from primary care physicians are of relatively poor quality.
SAN FRANCISCO — Physicians who are treating patients with knee injury or possible arthritis may initially be inclined to order anterior-posterior and lateral views—or sunrise views—of the knee and occasionally even an MRI. But in most cases, the resulting films are not particularly useful and can actually be misleading, Dr. W. Dilworth Cannon said at a conference on sports medicine sponsored by the University of California, San Francisco.
Dr. Cannon, of the department of orthopaedic surgery at UCSF, said he regards the supine anterior-posterior (AP) view of the knee to be “pretty worthless unless the patient can't stand. … Someone could have severe advanced degenerative arthritis, and if you just look at the AP, you may miss it.”
Although the supine lateral is worth ordering, a posterior-anterior (PA) bent-knee standing film is better than the supine AP. The patient faces away from the x-ray tube, with knees placed against the cassette and bent at least 25 degrees; the x-ray beam is aimed 10 degrees caudally, which provides a more useful view of the joint.
Dr. Cannon specifies a 30-degree or 45-degree patellofemoral axial view.
Dr. Cannon also suggested that physicians not order MRIs and instead, leave them to the orthopedic surgeon. He said many of the MRIs that come into his office from primary care physicians are of relatively poor quality.