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Volume 2016 (2016), Article ID 9786924, 8 pages
Research Article

The Combination of the Tunnel View and Weight-Bearing Anteroposterior Radiographs Improves the Detection of Knee Arthritis

1Center for Hip and Knee Replacement (CHKR), Department of Orthopaedic Surgery, NewYork-Presbyterian Hospital, Columbia University Medical Center, 622 W. 168th Street, PH 1155, New York, NY 10032, USA
2Department of Radiology, NewYork-Presbyterian Hospital, Columbia University Medical Center, 177 Fort Washington Avenue 3-256, New York, NY 10032, USA

Received 13 July 2015; Revised 28 December 2015; Accepted 30 December 2015

Academic Editor: Malcolm Smith

Copyright © 2016 Oladapo M. Babatunde et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


Imaging used for the evaluation of knee pain has historically included weight-bearing anteroposterior (AP), lateral, and sunrise radiographs. We wished to evaluate the utility of adding the weight-bearing (WB) posteroanterior (PA) view of the knee in flexion. We hypothesize that (1) the WB tunnel view can detect radiographic osteoarthritis (OA) not visualized on the WB AP, (2) the combination of the AP and tunnel view increases the radiographic detection of OA, and (3) this may provide additional information to the clinician evaluating knee pain. We retrospectively reviewed the WB AP and tunnel view radiographs of 100 knees (74 patients) presenting with knee pain and analyzed for evidence of arthritis. The combination of the WB tunnel view and WB AP significantly increased the detection of joint space narrowing in the lateral () and medial () compartments over the AP view alone. The combined views significantly improved the identification of medial subchondral cysts (), sclerosis of the lateral tibial plateau (), and moderate-to-large osteophytes in the medial compartment (), intercondylar notch (), and tibial spine (). The WB tunnel view is an effective tool to provide additional information on affected compartments in the painful knee, not provided by the AP image alone.