Radiographic evaluation of knee joint space width using fixed flexion view in knees of Indian adults


  • Ravi Kant Jain Department of Orthopaedics, SAMC & PGI, Indore, Madhya Pradesh, India
  • Abhishek Jain Department of Orthopaedics, SAMC & PGI, Indore, Madhya Pradesh, India
  • Pranav Mahajan Department of Orthopaedics, SAMC & PGI, Indore, Madhya Pradesh, India



Knee, Joint space width, Radiography


Background: The objective of this study is to evaluate the tibiofemoral joint space width in the medial and lateral compartments of the knee using digital radiograph. The measurement of knee joint space width (JSW), in between the femur and the tibia is a way of evaluating the tibio-femoral cartilage thickness. This study is aimed at establishing normal references of joint space width for use in diagnosis and follows up of knee cartilage diseases.

Methods: This study is prospective and carried on 50 subjects at SAMC & PGI, Indore, M.P. One patient refused to sign the consent and was excluded. All subjects were healthy adults with sedentary lifestyle. All subjects underwent x-ray of bilateral knee joints. The joint space width of both medial and lateral compartments of each knee was measured using the scale in the computerized software.

Results: The average age in the study group was 44.59 years with male preponderance.The mean left medial and lateral joint space width was 5.34 mm±1.26 mm and 5.21 mm±1.04 mm and on right side was 5.26±1.11 mm and 5.57±1.57 mm, respectively. No statistically significant difference was found between right and left knee joint space width compartments.

Conclusions: The values obtained after observing the radiographic references showed no significant gender variation in knee joint space width. But, it is seen that there is a decrease in joint space width with increasing age, which progresses towards osteoarthritis of knee.

Author Biographies

Ravi Kant Jain, Department of Orthopaedics, SAMC & PGI, Indore, Madhya Pradesh, India


Abhishek Jain, Department of Orthopaedics, SAMC & PGI, Indore, Madhya Pradesh, India


Pranav Mahajan, Department of Orthopaedics, SAMC & PGI, Indore, Madhya Pradesh, India



Peterfy CG. Imaging of the disease process. Curr Opin Rheumatol. 2002;14:590-6.

Ryan S, Nicholas MM, Eustace S. The knee joint. In: Anatomy For Diagnostic Imaging. London: Elsevier Limited; 2004: 286–289.

Beattie KA, Duryea J, Pui M, O’Neill J, Boulos P, Webber CE, et al. Minimum joint space width and tibial cartilage morphology in the knees of healthy individuals: a cross-sectional study. BMC Musculoskeleton Disorder. 2008;9:119–26.

Lequesne M. Osteoarthritic Disorders. 1st ed. American Academy of Orthopaedic Surgeons; Illinois. Quantitative measurements of joint space during progression of osteoarthritis: “Chondrometry”; 1995: 427

Sharma L, Song J, Felson DT, Cahue S, Shamiyeh MS, Dunlop DD. The role of knee alignment indisease progression and functional decline in knee osteoarthritis. JAMA. 2001;286:188–95.

Hilliquinb P, Pessisc E, Costed J, Maugetc D, Azriab A, Chevrotc A, et al. Quantitative assessment of joint space width with an electronic caliper. Osteoarthr Cartilage. 2002;10:542–6.

Kellgren JH, Lawrence JS. Radiological assessment of Osteo-Arthrosis. Ann Rheum Dis. 1957;16:494–502.

Vignona EF, Conroziera T, Pipernoa M, Richarda S, Carrillon Y, Fantino O. Radiographic assessment of hip and knee osteoarthritis:recommended guidelines. Osteoarthr Cartilage. 1999;7:434–6.

Peterfy C, Li J, Zaim S, Duryea J, Lynch J, Miaux Y, Yu W, Genant HK. Comparison of fixed-flexion positioning with fluoroscopic semi-flexed positioning for quantifying radiographic joint-space width in the knee: test-retest reproducibility. Skeletal Radiol. 2003;32:128-32.

Gensburger D, Arlot M, Sornay-Rendu E, Roux J, Delmas P. Radiologic assessment of age-related knee joint space changes in women: a 4-year longitudinal study. Arthritis Rheum. 2009;61:336–43.

Anas I, Musa TA, Kabiru I, Yisau AA, Kazaure IS, Abbaa SM, Kabira SM, et al. Digital radiographic measurement of normal knee joint space in adults at Kano, Nigeria The Egyptian J Radiol Nuclear Med. 2013;44:253–8.

Sargon MF, Taner D, Altinta K. Examination of joint space by magnetic resonance imaging in anatomically normal knees. ClinAnat. 1998;9:386–90.

Dacre JE, Scott DL, Da Silva JAP, Welsh G, Huskisson EC. Joint space in radiologically normal knees. Rheumatology. 1991;30:426–8.

Duren DL, Sherwood RJ, Chumlea WC, Siervogel RM, Towne B. Radiographic Joint Space of the Knee in Healthy Young Adults. Human Biology. 2006;78(3):353-64.

Lanyon P, O’Reilly S, Jones A, Doherty M. Radiographic assessment of symptomatic knee osteoarthritis in the community: definitions and normal joint space. Ann Rheum Dis. 1998;57:595–601.






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