Dr. Peter McEwen - M.B.B.S. F.R.A.C.S(Ortho).F.A.Ortho.A.DipModLang - Surgery Knee Dr. Peter McEwen - Surgery Knee: (123) 456789
Urgent Appointments for Knee Ligament Injuries - Dr. Peter McEwen - Surgery of Knee Appointments for ADF Members - Dr. Peter McEwen - Surgery of Knee
 
GP

Which Xrays?

Plain Xrays

There are many xray projections that have differing uses. Ordering the most useful xrays reduces cost, reduces radiation exposure, speeds up processing of referrals and reduces the need for second appointments. Good all around especially for those travelling from outside the Townsville area.

Weightbearing AP: As a generalization weightbearing films are much more useful and unless an acute injury prevents weightbearing all xray series for the knee should include a weightbearing AP.

Rosenberg View: A Rosenberg view is a weightbearing 30 degree cephalocaudad PA with the knees flexed 45 degrees. This by far the most sensitive view for tibiofemoral arthritis and will be positive when even a weightbearing AP is normal. Remember that in most cases arthritis begins at a point and expands radially from that point. The most common pattern of OA is anteromedial OA and a Rosenberg view specifically brings the anteromedial contact point into profile. It is also a very sensitive projection for lateral OA.

Axial Views: Axial views of the PFJ are useful but not sensitive. A simple skyline view done in early flexion is the easiest for the patient to sit through and is as useful as any other axial projection. Certainly with respect to Patellofemoral OA and Patellofemoral Instability the lateral is the most important as the allows categorization of trochlear morphology and assessment of patellar height.

Notch View: A notch view is useful only for OCD and should only be requested if suspected clinically.

Long Leg Weightbearing AP: This view is for assessing tibiofemoral alignment and is useful for surgeical decision making in anyone with arthritis or instability.

As a synthesis of the above the ideal generic set of knee xrays is:

  1. Weightbearing AP
  2. Rosenberg View
  3. Lateral View
  4. Skyline View
  5. Long Leg Weightbearing AP (if has arthritis and is being referred for consideration of surgery).

Ultrasound

Ultrasound has no application with respect to surgical decision making around the knee in the 21st Century. It provides no useful information and often produces completely misleading information with respect to the state of the menisci and collateral ligaments. It is a waste of time and money and despite what the radiology providers would have you believe should not be used. It is not in any way a substitute for either a clinical examination or an MRI. If you believe a patient needs an MRI contact the office to organize one.

CT

CT is useful for defining bony detail. As such it is indicated for fractures around the knee and very little else. It is less sensitive than clinical examination and standing xrays with respect to arthritis and ligament injury and should not be used unless a fracture is suspected. It is not a substitute for an MRI. If you believe a patient needs an MRI contact the office to organize one.

MRI

MRI provides a huge amount of information about the knee and has all but eliminated arthroscopy as a diagnostic tool. MRI will continue to evolve and will provide ever more detailed anatomic and synthetic detail about the knee. An MRI is nearly always useful as it uncovers all the sins that are not seen on Xrays, can help with decision making on the urgency of surgery and saves many people from having unnecessary arthroscopies. One always keep in mind however that much of the pathology identified on MRI is asymptomatic so a positive MRI alone does not indicate the need for surgery. As always, the findings on an MRI need to be matched to history and exam findings. If you believe a patient needs an MRI contact the office to organize one.

Dr. Peter McEwen - Surgery of Knee
Dr. Peter McEwen - Surgery of Knee
Services - Dr. Peter McEwen - Surgery of Knee
ACL Reconstruction - Dr. Peter McEwen - Surgery of Knee
Arthroscopic Surgery - Dr. Peter McEwen - Surgery of Knee
Cartilage Repair - Dr. Peter McEwen - Surgery of Knee
Partial Knee Replacement - Dr. Peter McEwen - Surgery of Knee
Realignment Surgery - Dr. Peter McEwen - Surgery of Knee
Total Knee Replacement - Dr. Peter McEwen - Surgery of Knee
Joint Preserving Surgery - Dr. Peter McEwen - Surgery of Knee
Revision Total Knee Replacement - Dr. Peter McEwen - Surgery of Knee
Patient Forms - Dr. Peter McEwen - Surgery of Knee
Am I a Candidate - Dr. Peter McEwen - Surgery of Knee
Multimedia Patient Education - Dr. Peter McEwen - Surgery of Knee
Arthroscopic Partial Medial Meniscectomy Videos - Dr. Peter McEwen - Surgery of Knee
Arthroscopic Partial Medial Meniscectomy Videos - Dr. Peter McEwen - Surgery of Knee
Australian Orthopaedic Association Royal Australasian College of Surgeons
International Cartilage Repair Society International Society of Arthroscopy, Knee Surgery and Orthopaedic Sports Medicine
Crocodiles Orthopaedic Research Institute of Queensland
 

© North Queensland Orthopaedics

Follow Us Facebook Twitter Linkedin YouTube
Your Practice Online
Bookmark and Share