ArticleJournal of experimental orthopaedics2026
Malrotated lateral radiographs do not allow for proper assessment of patellar height using the Caton-Deschamps Index.
Article in Journal of experimental orthopaedics, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Purpose: To compare patellar height measurement (PHM) using the Caton-Deschamps Index (CDI) on malrotated versus properly positioned lateral knee radiographs within the same patients. It was hypothesised that malrotation would significantly alter CDI values. A secondary aim was to establish an anterior-posterior distance (APD) cut-off for malrotation corresponding to a minimally clinically important difference (MCID) of 0.1 in ΔCDI. Methods: This retrospective analysis included patients with lateral knee radiographs between January 2020 and March 2023 at a single academic institution. Patients were included if at least two radiographs were available: one with malrotation (APD ≥ 1 mm) and one properly aligned (APD < 1 mm). Radiographs with tilt, prior osseous surgery, or fractures were excluded. Patellar height was measured using the CDI. Inter and intrarater reliability were assessed via intraclass correlation coefficients (ICC). Paired Results: A total of 126 lateral knee radiographs from 63 patients (57% female) were analysed. Inter and intrarater reliability was excellent (ICC > 0.8 for all comparisons). The mean CDI was 0.96 ± 0.06 on properly aligned and 1.03 ± 0.08 on malrotated radiographs, with a significant mean difference of 0.07 ± 0.05 ( Conclusions: Malrotation significantly alters PHM using the CDI on lateral knee radiographs. A clinically relevant difference of ≥0.1 in ΔCDI occurred in over one-third of patients. Malrotated radiographs should be used with caution, and repeat imaging should be considered when CDI values approach clinical decision thresholds. Level of Evidence: Level III, diagnostic study.
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