Semi-automated digital image analysis of patellofemoral joint space width from lateral knee radiographs

Objective: To design a semi-automated program to measure minimum patellofemoral joint space width (JSW) using standing lateral view radiographs. Design: Lateral patellofemoral knee radiographs were obtained from 35 asymptomatic subjects. The radiographs were analyzed to report both the repeatability of the image analysis program and the reproducibility of JSW measurements within a 2 week period. The results were also compared with manual measurements done by an experienced musculoskeletal radiologist. Results: The image analysis program was shown to have an excellent coefficient of repeatability of 0.18 and 0.23 mm for intra- and inter-observer measurements respectively. The manual method measured a greater minimum JSW than the automated method. Reproducibility between days was comparable to other published results, but was less satisfactory for both manual and semi-automated measurements. The image analysis program had an inter-day coefficient of repeatability of 1.24 mm, which was lower than 1.66 mm for the manual method. Conclusions: A repeatable semi-automated method for measurement of the patellofemoral JSW from radiographs has been developed. The method is more accurate than manual measurements. However, the between-day reproducibility is higher than the intra-day reproducibility. Further investigation of the protocol for obtaining sequential lateral knee radiographs is needed in order to reduce the between-day variability.