Knee (Rosenberg view)

The Rosenberg view of the knees is a specialized projection often used to detect early signs of osteoarthritis. It should be the initial study for any patient with a suspicion of knee osteoarthritis.

Indications

The Rosenberg view is performed for any patient with a suspicion of knee osteoarthritis. It consists of a PA radiograph with weight-bearing and 45° of knee flexion. It is more sensitive than standard weight-bearing radiographs for the detection of joint space narrowing ¹.

Patient position

• the patient is erect facing the upright detector with knees slightly bent at 45°

• femur forms an angle of 25° to the upright detector

• tibia forms an angle of 20° to the upright detector

Technical factors

• posteroanterior projection

• centering point

  • central ray is at the level of the knee joint typically 1.5 cm distal to the apex of the patella, with a 10-20° caudal angle

• collimation (bilateral)

  • superior to include bilateral distal femurs

  • inferior to include the proximal tibiae/fibulae

  • lateral to include skin margin of both knees 

• orientation  

  • landscape

• detector size

  • 35 cm x 30 cm

• exposure

  • 60-65 kVp

  • 4-5 mAs

• SID

  • 100 cm

• grid

  • no

Image technical evaluation

• tibial plateau should be free from any superimposition

• anterior and poster margins of the tibia plateau should be superimposed to demonstrate the knee joint in profile

• femoral condyles should be free from superimposition with the intercondylar fossa in profile, giving the appearance of a 'notch'

Practical points

Patients whom must have this examination performed will have trouble maintaining this position, due to the knee problems they are investigating. Ensure clear demonstrating and instruction is given to the patient before position, and, on completion, the patient is made aware so they can get in a more comfortable position.

An alternate view is the Schuss view, which differs from a flexion angle of 30°.

History and etymology

The Rosenberg view was described by the American orthopedic surgeon Thomas D Rosenberg (fl. 2021), who works in Utah, in 1988 ².