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Lyon Schuss Radiographic View of the Knee. Utility of Fluoroscopy for the Quality of Tibial Plateau Alignment
THIERRY CONROZIER, PIERRE MATHIEU, MURIEL PIPERNO, DIEGO PROVVEDINI, ALAIN TACCOEN, FREDERIC COLSON, JEAN-PIERRE DUIVON, ROBERT DUSAN, HUGUETTE FAVRET, and ERIC VIGNON
ABSTRACT. Objective. The "Lyon schuss" (LS) view is a fluoroscopically assisted radiographic technique of the knee in flexion. The quality of medial tibial plateau (MTP) alignment is a key element for accuracy and sensitivity to change of knee radiography. We collected data on the geometry of the osteoarthritic (OA) knee when positioned under fluoroscopy according to the LS protocol, then applied the results to develop an angulation standard for a nonfluoroscopically guided examination, and evaluated the performance of fluoroscopic and nonfluoroscopic alternatives for good alignment of the MTP. Methods. 1. For 50 patients with knee pain (100 knee radiographs): Standardized radiographic procedure under fluoroscopy (LS view and lateral weight-bearing radiograph of the 2 knees); measurement of the tibial plateau inclination with the horizontal (TPI-h); evaluation of the quality of MTP alignment; assessment of the mean x-ray beam angle to obtain satisfactory MTP alignment. 2. For 30 patients with knee OA: LS radiograph of the knee performed without fluoroscopy, using a fixed 11° downward x-ray beam angle (mean value of the angle obtained in the first part of the study) and standardized procedure; then assessment of the quality of MTP alignment. Results. With the fluoroscopically assisted protocol, MTP alignment was satisfactory in 88% of cases. The mean x-ray beam angle was 11.2° downward (SD 3.3°, range 4–22°) and was unrelated to sex, height, weight, body mass index, and joint space width. The mean TPI-h was 19.6° (SD 6.9°, range 3–35°). Beam angle and TPI-h were correlated only in the satisfactorily aligned radiographs. In the 30 knees radiographed using a standardized procedure without fluoroscopy, the MTP alignment was satisfactory in 60% of cases. Conclusion. Fluoroscopy is useful to obtain satisfactory MTP alignment in LS radiographs because of large interindividual variations in anatomy of the knee. (J Rheumatol 2004;31:584-90) Key Indexing Terms:
OSTEOARTHRITIS
From the Service de Rhumatologie, Centre Hospitalier Lyon-Sud, Pierre Bénite, France; Laboratoire d'Exploration et de Morphométrie Articulaire (LEMA), Lyon, France; NEGMA-LERADS, Toussus-le-Noble, France; and the Centre de Rhumatologie Lyon-Presqu'île, Lyon, France. Supported by an unrestricted grant from NEGMA-LERADS, Toussus-le-Noble, France. T. Conrozier, MD; M. Piperno, MD; E. Vignon, MD, Professor of Rheumatology, Service de Rhumatologie, Centre Hospitalier Lyon-Sud; P. Mathieu, MD; H. Favret, MD, Laboratoire d'Exploration et de Morphométrie Articulaire; D. Provvedini, MD; A. Taccoen, MD, NEGMA-LERADS; F. Colson, MD; J-P. Duivon, MD; R. Dusan, MD, Centre de Rhumatologie Lyon-Presqu'île. Address reprint requests to Dr. T. Conrozier, Department of Rheumatology, University Hospital Lyon-Sud, F69495 Pierre Bénite cedex, France. E-mail: thierry.conrozier@chu-lyon.fr Submitted February 24, 2003; revision accepted September 15, 2003. |