Special Imaging Considerations Knee radiographs should include at least one frontal projection of one or both knees (anteroposterior, Rosenberg, or tunnel), a tangential patellar view, and a lateral view of the affected knee [2,9]. Standing radiographs more accurately reflect medial and lateral compartment cartilage loss than supine radiographs with the posteromedial and posterolateral joint compartments more accurately assessed using a weight-bearing flexion posteroanterior radiograph [9,10]. Discussion of Procedures by Variant Variant 1: Adult or child greater than or equal to 5 years of age. Chronic knee pain. Initial imaging. Radiography Knee Radiographs should be the initial imaging study for chronic knee pain. In elderly patients, the most common source of chronic knee pain is osteoarthritis. Conventional radiographic diagnosis of osteoarthritis includes joint space narrowing, osteophytes, subchondral cysts, and subarticular sclerosis [11]. Articular cartilage is evaluated Reprint requests to: publications@acr.org Chronic Knee Pain Radiography Hip An ipsilateral hip radiograph is usually not indicated as a first imaging examination. CT Knee CT is usually not indicated as a first imaging examination. CT Arthrography Knee CT arthrography is usually not indicated as a first imaging examination. MRI Knee MRI is usually not indicated as a first imaging examination. To avoid unnecessary MRI, assessment of current radiographs (within the prior year) is required [2]. MR Arthrography Knee MR arthrography is usually not indicated as a first imaging examination. US Knee Ultrasound (US) is usually not indicated as a first imaging examination. Bone Scan Knee Radionuclide bone scan is usually not indicated as a first imaging examination. Image-Guided Aspiration Knee Joint aspiration is usually not indicated as a first imaging examination. Variant 2: Adult or child greater than or equal to 5 years of age. Chronic knee pain. Initial knee radiograph negative or demonstrates joint effusion.
Chronic Knee Pain. Special Imaging Considerations Knee radiographs should include at least one frontal projection of one or both knees (anteroposterior, Rosenberg, or tunnel), a tangential patellar view, and a lateral view of the affected knee [2,9]. Standing radiographs more accurately reflect medial and lateral compartment cartilage loss than supine radiographs with the posteromedial and posterolateral joint compartments more accurately assessed using a weight-bearing flexion posteroanterior radiograph [9,10]. Discussion of Procedures by Variant Variant 1: Adult or child greater than or equal to 5 years of age. Chronic knee pain. Initial imaging. Radiography Knee Radiographs should be the initial imaging study for chronic knee pain. In elderly patients, the most common source of chronic knee pain is osteoarthritis. Conventional radiographic diagnosis of osteoarthritis includes joint space narrowing, osteophytes, subchondral cysts, and subarticular sclerosis [11]. Articular cartilage is evaluated Reprint requests to: publications@acr.org Chronic Knee Pain Radiography Hip An ipsilateral hip radiograph is usually not indicated as a first imaging examination. CT Knee CT is usually not indicated as a first imaging examination. CT Arthrography Knee CT arthrography is usually not indicated as a first imaging examination. MRI Knee MRI is usually not indicated as a first imaging examination. To avoid unnecessary MRI, assessment of current radiographs (within the prior year) is required [2]. MR Arthrography Knee MR arthrography is usually not indicated as a first imaging examination. US Knee Ultrasound (US) is usually not indicated as a first imaging examination. Bone Scan Knee Radionuclide bone scan is usually not indicated as a first imaging examination. Image-Guided Aspiration Knee Joint aspiration is usually not indicated as a first imaging examination. Variant 2: Adult or child greater than or equal to 5 years of age. Chronic knee pain. Initial knee radiograph negative or demonstrates joint effusion.