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Message: <blockquote data-quote="amila_90210" data-source="post: 4089300" data-attributes="member: 111009">Initial study for chronic knee problem is X-ray AP/LAT.                                             Grade (X) In AP view - Patella is centrally located. Lateral view - The quadriceps and patella tendons are best seen.  Axial view – This is mandatory to show patellofemoral joint.                            Grade (X)  A.  In Patella dislocation  X ray may show subtle osteochondral fragment in the patella.  B.  In Osgood schalatter,s disease – X ray may show fragmented tibial tubercle  This can be confirmed by US in doubtful cases. Patella tendinosis -  This can be assessed by US.               Grade (Y)  D.  In chondromalacia patellae  -   MRI better assess the articular cartilage.                                                              Grade(Y)   E.  Nonlocalized knee pain with normal X-ray or with evidence of effusion  Next exam should be MRI as it provides more specific information. Apart from joint effusion, It detects communicating synovial cysts, proliferative changes  of synovial membrane, osteophytes, bone marrow edema, fractures and any other lesion.                                    Grade (Y)  F.  When X-ray shows changes of OA • Weight bearing PA X ray standing view better assess the cartilage loss,  Standing X ray with knee flexed shows medial and lateral joint compartment cartilaginous loss than supine X-ray.  • In advanced OA joint narrowing in plain X ray indicates cartilage loss. Then no further work up is needed.  • In early stages of OA plain X ray may not be sensitive. When x ray is normal but clinically suspecting OA, MRI is done for assessment of cartilage as it is important in the management.</blockquote>

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