Rosenberg view

If the meniscus and/or articular cartilage are deficient on one side, the weight going through the joint will decrease the gap between tibia and femur on that side. This may not be evident in a non-weight-bearing film.

How is the patient positioned for a Rosenberg View?

An arthritic patient may find it difficult to maintain this position, in which case a Schuss view may be applicable, where the angle of flexion is reduced to 30 degrees.

Once the surgeon has reviewed the films, any signs of osteoarthritis present will allow the arthritis stage to be graded (eg Kellgren-Lawrence Classification). This is similar to the Outerbridge grading that is possible during arthroscopy.

Quotes from peer-reviewed papers:

• "Without these weight-bearing or flexed knee views, there is difficulty in the ability to detect and grade possible radiographic osteoarthritis."

  Citation: Babatunde OM, Danoff JR, Patrick DA Jr, Lee JH, Kazam JK, Macaulay W. The Combination of the Tunnel View and Weight-Bearing Anteroposterior Radiographs Improves the Detection of Knee Arthritis. Arthritis. 2016;2016:9786924. doi: 10.1155/2016/9786924. Epub 2016 Jan 26. PMID: 26925264; PMCID: PMC4746274.

• "MRi is not suited for diagnosing bone-on-bone and endstage OA in the medial knee compartment...it should be discouraged when bone-on-bone can be assessed sufficiently with a cheap and straightforward radiographic image such as the Rosenberg view..."

  Citation: Mortensen JF, Mongelard KBG, Radev DI, Kappel A, Rasmussen LE, Østgaard SE, Odgaard A. MRi of the knee compared to specialized radiography for measurements of articular cartilage height in knees with osteoarthritis. J Orthop. 2021 May 12;25:191-198. doi: 10.1016/j.jor.2021.05.014. PMID: 34045822; PMCID: PMC8141415.

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What will the radiologist be looking for?

The Rosenberg view may offer information about narrowing of the normal joint space which is not available in a straight-leg X-ray.

There may also be evidence of bone spurs and cysts, and irregular bone density.

The information gained will allow the surgeon to follow the progression of any bony arthritic changes over time.

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Original reference

Rosenberg TD, Paulos LE, Parker RD, Coward DB, Scott SM. The forty-five-degree posteroanterior flexion weight-bearing radiograph of the knee. J Bone Joint Surg Am. 1988 Dec;70(10):1479-83. PMID: 3198672.