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OBJECTIVES: Posterior tibial slope (PTS) is an important anatomic parameter of the knee related to anteroposterior instability. Biplanar stereoradiography allows for simultaneous low-dose acquisition of anteroposterior and lateral views with 3D capability, enabling separate lateral and medial plateau analyses. We aimed to evaluate the possibility and compare the reproducibility of measuring medial and lateral PTS on EOS® images with two different patient positionings and compare it with CT of the knees as the gold standard. METHODS: This is a retrospective study including volunteers who underwent lower limb stereoradiography and knee CT from 01/08/2016 to 07/31/2019. Sixty legs from 30 patients were studied. PTS were measured using stereoradiography and CT by two radiologists. Intraclass correlation was used to calculate intrarater and interrater reproducibilities. Pearson's correlation coefficients were used to calculate the correlation between stereoradiography and CT. We also compared the reproducibility of the stereoradiography of volunteers with 2 different positionings. RESULTS: The mean stereoradiography PTS values for right and left knees were as follows: lateral, 12.2° (SD: 4.1) and 10.1° (SD: 3.5); medial,12.2° (SD: 4.4) and 11.6° (SD: 3.9). CT PTS mean values for right and left knee are as follows: lateral, 10.3° (SD:2.5) and 10.6° (SD: 2.8); medial: 8.7° (SD: 3.7) and 10.4° (SD: 3.5). Agreement between CT and EOS for angles between lateral and medial PTS was good (right, 0.874; left, 0.871). Regarding patient positioning on stereoradiography, interrater and intrarater reproducibilities were greater for patients with nonparallel feet (0.738-0.883 and 0.870-0.975). CONCLUSIONS: Stereoradiography allows for appropriate delineation of tibial plateaus, especially in patients with nonparallel feet, for the purpose of measuring PTS. The main advantage is lower radiation doses compared to radiography and CT.

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OBJECTIVE: The purpose of this study is to establish the prevalence bone marrow edema of the phalanges of the feet and hands before and during the COVID-19 pandemic on MRI studies and correlate with clinically chilblain skin lesions and epidemiological data. METHODS: This observational retrospective study. In patients with confirmed bone marrow edema of the phalanges, epidemiological data and clinical findings were collected, including the history of current or remote COVID-19 infection and vaccination status. The two-proportion test was used to compare the frequency of bone marrow edema in the phalanges before and during the pandemic, and the comparison between the categories variables was performed using the one-proportion test. RESULTS: Of the total of 7215 patients, only 20 presented isolated bone marrow edema of the digits in MRI studies; 2 (0.05%) were found two years before the pandemic's beginning, and 18 (0.64%) after the pandemic's onset, demonstrating an increase of 13-fold in this period. 16 were women with a mean age of 40.3 years and 4 were men with a mean age of 53.5 years. The most frequently reported clinical symptoms by the patients were pain (85.0%), and erythema of the skin (45.0%). Of the 18 patients found after the pandemic's onset, only 27.8% had COVID-19 infections confirmed by RT-PCR before the imaging study, and all cases were mild. CONCLUSION: This study demonstrated a significant increase in the prevalence of bone marrow edema of the phalanges after the onset of the COVID-19 pandemic, particularly in middle-aged and younger women.

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Imaging-guided tendon procedures aim to reduce pain and increase function by controlling inflammation and stimulating healing. Ultrasound is the preferable guiding modality due to its high resolution and real-time demonstration of the tendinous anatomy and needle positioning. The technique includes appropriate patient positioning, which varies depending on the targeted tendon, as well as sterile and proper draping. For most procedures, we prefer the "in-plane" approach, which demonstrates the entire needle as it advances through different tissue layers. Upper limb injections commonly use corticosteroids and anesthetics with different reported short- and long-term results depending on the tendon treated; better results are obtained in the treatment of tenosynovitis (sliding tendons such as trigger finger and De Quervain's tenosynovitis). Shoulder and elbow tendinopathies (anchor tendons) may also benefit from injections containing irritants or healing stimulants such as dextrose (prolotherapy) and platelet-rich plasma or by the stimulation of healing via tendon perforations (fenestration). The hyaluronic acid injection has also been used in the treatment of both tenosynovitis and tendinopathies. For tendons passing through osteofibrous tunnels, an additional release may be performed, and the techniques are discussed in this review. Therefore, this article provides practicing musculoskeletal radiologists and trainees with a comprehensive review of tendon injection musculoskeletal image-guided procedures.

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BACKGROUND: Chronic nonbacterial osteomyelitis (CNO), also known as chronic recurrent multifocal osteomyelitis, is a noninfectious autoinflammatory disorder that occurs primarily in children and adolescents and is characterized by episodic musculoskeletal pain with a protracted course. MAIN BODY: Traditionally, the diagnosis of CNO is made by exclusion and commonly requires bone biopsy to rule out infection and malignancy. However, bone biopsy may be avoided when imaging and clinical characteristic features are present, such as multifocal bone lesions at typical sites, no constitutional symptoms and no signs of infection in laboratory test results. Whole-body magnetic resonance imaging (WB-MRI) can assess signs of acute and chronic inflammation and enables the detection of CNO typical patterns of lesion location and distribution, thereby helping to exclude differential diagnosis. The goal of the present study paper is to review the main clinical and imaging aspects of the disease with emphasis on the role of WB-MRI in the diagnosis, assessment of disease burden and follow-up monitoring. CONCLUSION: Radiologists need to be familiar with the imaging features to suggest the diagnosis as the early therapy may help to avoid irreversible secondary damage of skeletal system.

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The sacroiliac joint (SIJ) is an amphiarthrosis composed of a posterior syndesmosis and an anterior cartilaginous portion, with limited yet present mobility. Its main function is to transmit the load from the axial skeleton to the lower limbs and vice-versa; it is susceptible to early mechanical and degenerative changes which are much more common than inflammatory sacroiliitis. Magnetic resonance imaging (MRI) has increasingly been used to evaluate these changes, and while subchondral bone marrow edema (BME) is a common finding related to both, care must be taken when applying the ASAS research MRI definition for sacroiliitis without considering lesion BME topography, size and depth, concomitant structural damage and, of course, the clinical picture. In this review, we will discuss the anatomy and biomechanics of the SIJ, the noninflammatory causes of SIJ subchondral BME, and how these concepts combined can be used to increase our diagnostic confidence.

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INTRODUCTION: Osteitis pubis is a common inflammatory disease of the pubic symphysis, defined as a chronic pain syndrome caused by repetitive microtrauma. Since adaptative changes are necessary in the pelvis to adjust the equilibrium of the myotendinous structures, the aim of this study was to evaluate the correlation between pelvic incidence and osteitis pubis among professional soccer players. MATERIALS AND METHODS: An observational, cross-sectional study was performed with professional soccer players from five teams during pre-season. Athletes with previous congenital pelvic abnormalities or a history of surgery were excluded. Radiographs of the pelvis were analyzed by two radiologists and assessed for findings consistent with osteitis pubis, and the following parameters were measured: pelvic incidence (PI), sacral inclination (SI), and pelvic version (PV). RESULTS: A total of 107 subjects were included in the study, with a mean age of 25.6 ± 3.1 years. Findings compatible with osteitis pubis were present in 74.8% of the subjects (80/107). There was no statistical correlation between osteitis pubis and PI (52.3°±12.7° vs. 48.4°±10.8°; p=0.156), SI (43.1°±9.8° vs. 39.9°±10.1°; p=0.146), or PV (9.2°± 6.3° vs 8.6°± 7.5°; p=0.649). Agreement between readers was excellent (p<0.0001). CONCLUSION: There was no significant correlation between pelvic parameters and radiographic diagnosis of osteitis pubis. Leve of Evidence II; Diagnostic study.

Introdução. A osteíte púbica é uma doença inflamatória comum da sínfise púbica, definida como síndrome de dor crônica causada por microtraumas de repetição. Uma vez que são necessárias mudanças adaptativas na pelve para adequar o equilíbrio das estruturas miotendíneas, o objetivo deste estudo foi avaliar a correlação entre e a incidência pélvica e a osteíte púbica em jogadores profissionais de futebol. Materiais e Métodos. Estudo transversal, observacional, conduzido com jogadores profissionais de futebol de cinco times profissionais durante a pré-temporada. Foram excluídos do estudo atletas com anormalidades congênitas prévias ou com história de cirurgia. As radiografias de pelve foram avaliadas por dois médicos radiologistas quanto aos achados compatíveis com osteíte púbica, e os seguintes parâmetros foram medidos: incidência pélvica (PI), inclinação sacral (SI) e versão pélvica (PV). Resultados. Foram incluídos 107 participantes, com média de idade de 25,6 ± 3,1 anos. Achados compatíveis com osteíte púbica estavam presentes em 74,8% dos indivíduos (80/107). Não houve correlação estatística entre osteíte púbica e PI (52,3°± 12,7° vs. 48,4° ± 10,8°; p = 0,156), SI (43,1° ± 9,8° vs. 39,9° ± 10,1°; p = 0,146) ou PV (9,2° ± 6,3° vs. 8,6° ± 7,5°; p = 0,649). A concordância entre os médicos radiologistas foi excelente (p < 0,0001). Conclusões. Não houve correlação significativa entre os parâmetros pélvicos e o diagnóstico radiográfico de osteíte púbica. Nível de Evidência II; Estudo diagnóstico.

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As deformidades dos membros inferiores são uma condição comum e podem levar a alterações da marcha e afetar a função e longevidade das articulações do quadril, do joelho e da coluna. Uma abordagem diagnóstica sistemática é essencial para definir o tratamento e alcançar o resultado terapêutico desejado com a menor taxa de complicações. A radiografia panorâmica é frequentemente utilizada para caracterizar as deformidades dos membros inferiores por meio de medidas de comprimento e desvios angulares dos eixos, além de se tratar de um método de baixo custo e alta disponibilidade. No entanto, como é frequente a combinação de deformidades em dois ou três planos ortogonais dos membros, a avaliação radiográfica perde acurácia por se tratar de um método de imagem bidimensional. Nesse sentido, deformidades em valgo/varo avaliadas radiograficamente no plano coronal apresentarão variações crescentes nas medidas dependendo do grau de flexão/recurvatum, torções ósseas anômalas ou, não menos importante, um posicionamento inadequado. A estereorradiografia biplanar de baixa dose, por meio de modelos tridimensionais, permite obter medidas mais acuradas de vários parâmetros usados na avaliação das deformidades dos membros inferiores, incluindo comprimentos, eixos e as torções tibial e femoral, antes disponíveis apenas pela tomografia computadorizada, com a vantagem de ser realizada em posição funcional com carga. Além disso, por permitir uma avaliação global da cabeça aos pés, abre uma nova perspectiva de compreender a inter-relação das deformidades dos membros com o posicionamento da bacia e com as deformidades da coluna.

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Resumo As deformidades dos membros inferiores são uma condição comum e podem levar a alterações da marcha e afetar a função e longevidade das articulações do quadril, do joelho e da coluna. Uma abordagem diagnóstica sistemática é essencial para definir o tratamento e alcançar o resultado terapêutico desejado com a menor taxa de complicações. A radiografia panorâmica é frequentemente utilizada para caracterizar as deformidades dos membros inferiores por meio de medidas de comprimento e desvios angulares dos eixos, além de se tratar de um método de baixo custo e alta disponibilidade. No entanto, como é frequente a combinação de deformidades em dois ou três planos ortogonais dos membros, a avaliação radiográfica perde acurácia por se tratar de um método de imagem bidimensional. Nesse sentido, deformidades em valgo/varo avaliadas radiograficamente no plano coronal apresentarão variações crescentes nas medidas dependendo do grau de flexão/recurvatum, torções ósseas anômalas ou, não menos importante, um posicionamento inadequado. A estereorradiografia biplanar de baixa dose, por meio de modelos tridimensionais, permite obter medidas mais acuradas de vários parâmetros usados na avaliação das deformidades dos membros inferiores, incluindo comprimentos, eixos e as torções tibial e femoral, antes disponíveis apenas pela tomografia computadorizada, com a vantagem de ser realizada em posição funcional com carga. Além disso, por permitir uma avaliação global da cabeça aos pés, abre uma nova perspectiva de compreender a inter-relação das deformidades dos membros com o posicionamento da bacia e com as deformidades da coluna.

Abstract Deformities of the lower limbs are a common condition and can lead to changes in gait, as well as affecting the function and longevity of the hips, knees, and spine. A systematic approach is essential to achieve the desired therapeutic result with the lowest rate of complications. Panoramic radiography is a widely available, low-cost method that is commonly used in order to assess the length and angular deformities of the lower limbs, by measuring the length and angular deviations of the axes. However, because the combination of lower limb deformities in two or three orthogonal planes is common, conventional radiography lacks accuracy because it is a two-dimensional imaging method. Therefore, the measurements of valgus/varus deformities on X-rays restricted to the coronal plane will present increasing variations in measurements depending on the degree of flexion/recurvatum alignment, anomalous bone torsions, or, last but not least, inappropriate patient positioning. Low-dose biplanar stereoradiography using three-dimensional models increases the accuracy of the measurement of several parameters used in the evaluation of lower limb alignment, including lengths, axes, and tibial/femoral torsions, parameters that could previously be evaluated only by computed tomography. Stereoradiography also makes it possible to perform a head-to-toe evaluation, as well as to evaluate the interactions among the lower limbs, pelvis, and spine.

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Objective To compare magnetic resonance imaging (MRI) using a body coil with computed tomography (CT) in measuring the tibial tubercle-trochlear groove distance (TT-TG) and the patellar tendon-cartilaginous trochlear groove (PT-CTG) distances, and evaluate interrater reliability. Methods The study group consisted of 34 knees from 17 asymptomatic subjects with no history of knee pathology, trauma or surgery. A low-dose CT scan and an axial T1-weighted MRI sequence of the knees were performed with rigorous standardization of the positioning with full extension of the knees and parallel feet. Two musculoskeletal radiologists performed the measurements independently. The reliability of the TT-TG and PT-CTG distances on CT (17.1 ± 4.2 mm and 17.3 ± 4.2 mm) and of MRI (16.2 ± 3.7 mm and 16.5 ± 4.1 mm) was assessed by intraclass correlation coefficient (ICC [2,1]) and Bland-Altman graphs, as well as the interrater reliability for both methods. Results Good reliability and agreement was observed between CT and MRI measurements for TT-TG and PT-CTG, with an ICC of 0.774 ( p < 0.001) and 0.743 ( p < 0.001), respectively, and no systematic bias was observed. The interrater reliability was excellent for all measurements on both imaging methods. Conclusion This was the first study that compared MRI using a body coil with CT in measuring the TT-TG distance, with the potential clinical implication that the CT in this clinical setting could be avoided.

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Abstract Objective To compare magnetic resonance imaging (MRI) using a body coil with computed tomography (CT) in measuring the tibial tubercle-trochlear groove distance (TT-TG) and the patellar tendon-cartilaginous trochlear groove (PT-CTG) distances, and evaluate interrater reliability. Methods The study group consisted of 34 knees from 17 asymptomatic subjects with no history of knee pathology, trauma or surgery. A low-dose CT scan and an axial T1-weighted MRI sequence of the knees were performed with rigorous standardization of the positioning with full extension of the knees and parallel feet. Two musculoskeletal radiologists performed the measurements independently. The reliability of the TT-TG and PT-CTG distances on CT (17.1 ± 4.2 mm and 17.3 ± 4.2 mm) and of MRI (16.2 ± 3.7 mm and 16.5 ± 4.1 mm) was assessed by intraclass correlation coefficient (ICC [2,1]) and Bland-Altman graphs, as well as the interrater reliability for both methods. Results Good reliability and agreement was observed between CT and MRI measurements for TT-TG and PT-CTG, with an ICC of 0.774 (p< 0.001) and 0.743 (p< 0.001), respectively, and no systematic bias was observed. The interrater reliability was excellent for all measurements on both imaging methods. Conclusion This was the first study that compared MRI using a body coil with CT in measuring the TT-TG distance, with the potential clinical implication that the CT in this clinical setting could be avoided.

Resumo Objetivo Comparar a ressonância magnética (RM) usando uma bobina corporal e tomografia computadorizada (TC) na medição da distância tubérculo tibial-sulco troclear (TT-ST) e as distâncias tendão patelar-sulco troclear cartilaginoso (TP-STC), e avaliar a confiabilidade interavaliador. Métodos O grupo de estudo consistiu em 34 joelhos de 17 indivíduos assintomáticos sem história de patologia, trauma ou cirurgia no joelho. Uma tomografia computadorizada (TC) de baixa dose e uma sequência axial de RM ponderada em T1 dos joelhos foram realizadas com padronização rigorosa do posicionamento com extensão total dos joelhos e pés paralelos. Dois radiologistas musculoesqueléticos realizaram as medidas de forma independente. A confiabilidade das distâncias TT-ST e TP-STC na TC (17,1 ± 4,2 mm e 17,3 ± 4,2 mm) e RM (16,2 ± 3,7 mm e 16,5 ± 4,1 mm), foi avaliada pelo coeficiente de correlação intraclasse (CCI [2,1)]) e gráficos Bland-Altman, bem como a confiabilidade entre avaliadores para ambos os métodos. Resultados Boa confiabilidade e concordância foram observadas entre as medidas de TC e RM para TT-ST e TP-STC com um CCI de 0,774 (p< 0,001) e 0,743 (p< 0,001), respectivamente, e nenhum viés sistemático foi observado. A confiabilidade entre avaliadores foi excelente para todas as medições em ambos os métodos de imagem. Conclusão Este foi o primeiro estudo que comparou a RM usando bobina de corpo com a TC na medição da distância TT-ST, com a implicação clínica potencial de que a TC neste cenário clínico poderia ser evitada.

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ABSTRACT Introduction. Osteitis pubis is a common inflammatory disease of the pubic symphysis, defined as a chronic pain syndrome caused by repetitive microtrauma. Since adaptative changes are necessary in the pelvis to adjust the equilibrium of the myotendinous structures, the aim of this study was to evaluate the correlation between pelvic incidence and osteitis pubis among professional soccer players. Materials and Methods. An observational, cross-sectional study was performed with professional soccer players from five teams during pre-season. Athletes with previous congenital pelvic abnormalities or a history of surgery were excluded. Radiographs of the pelvis were analyzed by two radiologists and assessed for findings consistent with osteitis pubis, and the following parameters were measured: pelvic incidence (PI), sacral inclination (SI), and pelvic version (PV). Results. A total of 107 subjects were included in the study, with a mean age of 25.6 ± 3.1 years. Findings compatible with osteitis pubis were present in 74.8% of the subjects (80/107). There was no statistical correlation between osteitis pubis and PI (52.3°±12.7° vs. 48.4°±10.8°; p=0.156), SI (43.1°±9.8° vs. 39.9°±10.1°; p=0.146), or PV (9.2°± 6.3° vs 8.6°± 7.5°; p=0.649). Agreement between readers was excellent (p<0.0001). Conclusion. There was no significant correlation between pelvic parameters and radiographic diagnosis of osteitis pubis. Leve of Evidence II; Diagnostic study.

RESUMO Introdução. A osteíte púbica é uma doença inflamatória comum da sínfise púbica, definida como síndrome de dor crônica causada por microtraumas de repetição. Uma vez que são necessárias mudanças adaptativas na pelve para adequar o equilíbrio das estruturas miotendíneas, o objetivo deste estudo foi avaliar a correlação entre e a incidência pélvica e a osteíte púbica em jogadores profissionais de futebol. Materiais e Métodos. Estudo transversal, observacional, conduzido com jogadores profissionais de futebol de cinco times profissionais durante a pré-temporada. Foram excluídos do estudo atletas com anormalidades congênitas prévias ou com história de cirurgia. As radiografias de pelve foram avaliadas por dois médicos radiologistas quanto aos achados compatíveis com osteíte púbica, e os seguintes parâmetros foram medidos: incidência pélvica (PI), inclinação sacral (SI) e versão pélvica (PV). Resultados. Foram incluídos 107 participantes, com média de idade de 25,6 ± 3,1 anos. Achados compatíveis com osteíte púbica estavam presentes em 74,8% dos indivíduos (80/107). Não houve correlação estatística entre osteíte púbica e PI (52,3°± 12,7° vs. 48,4° ± 10,8°; p = 0,156), SI (43,1° ± 9,8° vs. 39,9° ± 10,1°; p = 0,146) ou PV (9,2° ± 6,3° vs. 8,6° ± 7,5°; p = 0,649). A concordância entre os médicos radiologistas foi excelente (p < 0,0001). Conclusões. Não houve correlação significativa entre os parâmetros pélvicos e o diagnóstico radiográfico de osteíte púbica. Nível de Evidência II; Estudo diagnóstico.

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Osteochondral lesions (OCLs) of the talar dome consist of a multifactorial pathology of the articular cartilage and subchondral bone and can result in persistent ankle pain and osteoarthritis (OA). Along with a physical examination and clinical history, an imaging evaluation plays a pivotal role in the diagnosis of these lesions and is fundamental for making treatment decisions and determining prognosis by providing information regarding the size, location, and cartilage and subchondral bone statuses as well as associated lesions and degenerative changes. Multiple surgical techniques for OCLs of the talar dome have been developed in recent decades, including cartilage repair, regeneration, and replacement strategies, and radiologists should be acquainted with their specific expected and abnormal postoperative imaging findings to better monitor the results and predict poor outcomes. The present article proposes a thorough review of the ankle joint anatomy and biomechanics, physiopathology, diagnosis, and treatment of OCLs of the talar dome, highlighting the radiological approach and imaging findings in both pre- and postoperative scenarios.

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BACKGROUND: Trunk pelvic dissociation is fundamental to the compensatory mechanism for muscle weakness during body bending. We carried out an early investigation of gait changes in a sample of community-dwelling women ≥60 years without gait complaints. The primary objective was to correlate spine and pelvic angles with performance tests and accelerometry parameters. The secondary objective was to correlate performance tests with accelerometry. METHODS: In this cross-sectional study, 54 community-dwelling women ≥60 years were subjected to Falls Efficacy Scale-International (FES-I), performance tests (Berg Balance Scale, Timed Up and Go, and Gait analysis), and radiographic analysis of sagittal alignment (Thoracic and Lumbar Cobb, Pelvic Incidence, Sacral Slope, and Pelvic Tilt angles). Gait speed was assessed in a 10-m comfortable walk, and accelerometry parameters were obtained in a 30-m walk distance. RESULTS: The sample, aged 72 ± 6 years, exhibited moderate correlation between Sacral Slope and Step Length (+ 0.615). Sacral Slope weakly correlated with FES-I (- 0.339), Berg Balance Scale (+ 0.367), and with further accelerometry data in the AP plane: RMS, (+ 0.439) and Stride Regularity (+ 0.475), p < 0.05, all. Lumbar Cobb weakly correlated with the following accelerometry data in the AP plane: Step Length (+ 0.405), RMS, (+ 0.392), and Stride Regularity (+ 0.345), p < 0.05, all. Additionally, Stride Regularity in AP moderately correlated with FES-I (0,561, p < 0.05), among other weak correlations between performance tests and accelerometry data in AP. CONCLUSIONS: Early alterations in Sacral Slope and gait abnormalities in the AP plane may provide understanding of the early gait changes in robust older women.

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Abstract Background: Trunk pelvic dissociation is fundamental to the compensatory mechanism for muscle weakness during body bending. We carried out an early investigation of gait changes in a sample of community-dwelling women ≥60 years without gait complaints. The primary objective was to correlate spine and pelvic angles with performance tests and accelerometry parameters. The secondary objective was to correlate performance tests with accelerometry. Methods: In this cross-sectional study, 54 community-dwelling women ≥60years were subjected to Falls Efficacy Scale-International (FES-I), performance tests (Berg Balance Scale, Timed Up and Go, and Gait analysis), and radiographic analysis of sagittal alignment (Thoracic and Lumbar Cobb, Pelvic Incidence, Sacral Slope, and Pelvic Tilt angles). Gait speed was assessed in a 10-m comfortable walk, and accelerometry parameters were obtained in a 30m walk distance. Results: The sample, aged 72 ±6 years, exhibited moderate correlation between Sacral Slope and Step Length (+ 0.615). Sacral Slope weakly correlated with FES-I (- 0.339), Berg Balance Scale (+0.367), and with further accelerometry data in the AP plane: RMS, (+ 0.439) and Stride Regularity (+ 0.475), p < 0.05, all. Lumbar Cobb weakly correlated with the following accelerometry data in the AP plane: Step Length (+0.405), RMS, (+0.392), and Stride Regularity (+ 0.345), p < 0.05, all. Additionally, Stride Regularity in AP moderately correlated with FES-I (0,561, p < 0.05), among other weak correlations between performance tests and accelerometry data in AP. Conclusions: Early alterations in Sacral Slope and gait abnormalities in the AP plane may provide understanding of the early gait changes in robust older women.

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OBJETIVO: Analisar os métodos mais comuns de medida da altura patelar e o impacto da experiência do observador na correlação com os outros avaliadores utilizando a radiografia digital. MÉTODOS: Sessenta radiografias digitais do joelho na incidência em perfil foram analisadas por quatro observadores, sendo um médico residente do segundo ano de ortopedia (R2), um médico residente do terceiro ano de ortopedia (R3), um ortopedista especialista em joelho (EJ) e um radiologista especialista na área musculoesquelética (ER). Os índices estudados foram: Insall-Salvati (IS), Blackburne-Peel (BP), Caton-Deschamps (CD) e Insall-Salvati modificado (ISM). Foi calculada a concordância interobservadores por meio do coeficiente de concordância Kappa (κ). RESULTADOS: Os maiores coeficientes de correlação foram obtidos com o método de IS seguido pelo método de CD. A pior correlação foi observada no método de ISM. A maior concordância interobservadores foi obtida entre o ortopedista especialista em joelho e o radiologista especializado na área musculoesquelética nos quatro métodos de aferição utilizados. CONCLUSÃO: Utilizando a radiografia digital, os índices de Insall-Salvati e Caton-Deschamps apresentaram maior concordância interobservadores, sendo esta também influenciada positivamente pela experiência do observador.

OBJECTIVE: To analyze the most common methods for measuring patellar height and the impact of observer experience in correlations with the other observers using digital radiography. METHODS: Sixty digital radiographs of the knee in lateral view were analyzed by four observers: a physician in the second year of medical residence in orthopedics (R2); a physician in the third year of medical residence in orthopedics (R3); an orthopedic surgeon who was a specialist in knee surgery (SK); and a radiologist who was a specialist in musculoskeletal radiology (SR). The indices used were: Insall-Salvati (IS), Blackburne-Peel (BP), Caton-Deschamps (CD) and modified Insall-Salvati (ISM). The interobserver agreement was calculated using the kappa coefficient (k). RESULTS: The highest correlation coefficients were found when using the IS method followed by the CD method. The worst correlation was observed in the ISM method. The highest interobserver agreement was found between the orthopedic surgeon specializing in knee surgery and the radiologist specializing in musculoskeletal radiology, for the four measurement methods used. CONCLUSION: Using digital radiography, the Insall-Salvati and Caton-Deschamps indexes presented the highest interobserver agreement, and this was also positively influenced by the observer's level of experience.

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OBJECTIVE: To analyze the most common methods for measuring patellar height and the impact of observer experience in correlations with the other observers using digital radiography. METHODS: Sixty digital radiographs of the knee in lateral view were analyzed by four observers: a physician in the second year of medical residence in orthopedics (R2); a physician in the third year of medical residence in orthopedics (R3); an orthopedic surgeon who was a specialist in knee surgery (SK); and a radiologist who was a specialist in musculoskeletal radiology (SR). The indices used were: Insall-Salvati (IS), Blackburne-Peel (BP), Caton-Deschamps (CD) and modified Insall-Salvati (ISM). The interobserver agreement was calculated using the kappa coefficient (κ). RESULTS: The highest correlation coefficients were found when using the IS method followed by the CD method. The worst correlation was observed in the ISM method. The highest interobserver agreement was found between the orthopedic surgeon specializing in knee surgery and the radiologist specializing in musculoskeletal radiology, for the four measurement methods used. CONCLUSION: Using digital radiography, the Insall-Salvati and Caton-Deschamps indexes presented the highest interobserver agreement, and this was also positively influenced by the observer's level of experience.

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