Plain radiographs underestimate the asymmetry of the posterior condylar offset of the knee compared with MRI knee

Pramod B. Voleti, Jason W. Stephenson, Paul A. Lotke, Gwo Chin Lee

Research output: Contribution to journalArticlepeer-review

26 Scopus citations


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. Questions/purposes: 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. Level of Evidence: Level II, diagnostic study. See Guidelines for Authors for a complete description of levels of evidence.

Original languageEnglish (US)
Pages (from-to)155-161
Number of pages7
JournalClinical orthopaedics and related research
Issue number1
StatePublished - Jan 2014
Externally publishedYes

ASJC Scopus subject areas

  • Surgery
  • Orthopedics and Sports Medicine


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