Optimization of the fixed-flexion knee radiograph

SummaryPurposeTo develop a user-friendly method of achieving optimal radiographs for measurement of joint space width of the knee with minimal radiation exposure. In order to accomplish this the X-ray technologist must (1) be able to identify the anterior and posterior rims of the tibial plateau at a variety of X-ray head angles and (2) be able to choose the direction to adjust the head angle to get a better view based on the criteria for acceptable radiographs.MethodsWe have developed a training manual and materials to instruct investigators and radiology technologists in a method that uses a commercially available Plexiglas positioning frame (Synaflexer™) and standard X-ray equipment to achieve optimal X-rays with regard to tibial plateau alignment of the knee. This should be accomplished with four or fewer radiographs.ResultsOptimized radiographs for joint space width measurements are achieved without the need for fluoroscopy or foot maps.ConclusionsThis method is readily understood and instituted by radiology technologists in the field

New developments in osteoarthritis. Posttraumatic osteoarthritis: pathogenesis and pharmacological treatment options

Joint trauma can lead to a spectrum of acute lesions, including osteochondral fractures, ligament or meniscus tears and damage to the articular cartilage. This is often associated with intraarticular bleeding and causes posttraumatic joint inflammation. Although the acute symptoms resolve and some of the lesions can be surgically repaired, joint injury triggers a chronic remodeling process in cartilage and other joint tissues that ultimately manifests as osteoarthritis in a majority of cases. The objective of the present review is to summarize information on pathogenetic mechanisms involved in the acute and chronic consequences of joint trauma and discuss potential pharmacological interventions. The focus of the review is on the early events that follow joint trauma since therapies for posttraumatic joint inflammation are not available and this represents a unique window of opportunity to limit chronic consequences