title: Plain radiographs underestimate the asymmetry of the posterior condylar offset of the knee compared with MRI.
abstract: BACKGROUND
  Restoration of posterior condylar offset (PCO) during total knee arthroplasty is essential to maximize range of motion, prevent impingement, and minimize flexion instability. Previously, PCO was determined with lateral radiographs, which could not distinguish the asymmetries between the femoral condyles. MRI can independently measure both medial and lateral PCO.
  
  
  OBJECTIVE
  The purpose of this study is to determine the normal PCO of the knee, to establish the differences in medial and lateral PCO, and to compare PCO measurements obtained from radiographs versus those obtained from MRI.
  
  
  METHODS
  We identified 32 patients without a history of prior knee pathology who had both plain radiographs and MRI scans of the same knee performed. The PCO was measured on lateral radiographs and compared with MRI measurements using a novel three-dimensional protocol.
  
  
  RESULTS
  By MRI, the mean medial PCO was 29 (± 3) mm and the mean lateral PCO was 26 (± 3) mm; both values were greater (p < 0.001 and p = 0.03, respectively) than the mean radiographic PCO of 25 (± 2) mm. The medial PCO, as measured by MRI, was significantly greater than the lateral PCO (p < 0.001).
  
  
  CONCLUSIONS
  Plain radiographs underestimate PCO as well as the asymmetry of the medial and lateral PCO compared with MRI. This discrepancy is the result of both articular cartilage thickness and the anatomic differences between medial and lateral condyles. Designers of knee prostheses and instrumentation should take these differences into account.
authors.affiliation: University of Pennsylvania, 1 Cupp Pavilion, 39th and Market Streets, Philadelphia, PA, 19104, USA.
authors.forename: Pramod B
authors.initials: PB
authors.lastname: Voleti
authors.forename: Jason W
authors.initials: JW
authors.lastname: Stephenson
authors.forename: Paul A
authors.initials: PA
authors.lastname: Lotke
authors.forename: Gwo-Chin
authors.initials: GC
authors.lastname: Lee
mesh_terms: D000328:Adult; D019645:Arthroplasty, Replacement, Knee; D005260:Female; D005269:Femur / Q000000981:diagnostic imaging* / Q000601:surgery; D006801:Humans; D007719:Knee Joint / Q000000981:diagnostic imaging* / Q000601:surgery; D007720:Knee Prosthesis; D008279:Magnetic Resonance Imaging; D008297:Male; D011474:Prosthesis Design; D011859:Radiography
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