Article Text

Download PDFPDF
Head-to-head comparison of the Lyon Schuss and fixed flexion radiographic techniques. Long-term reproducibility in normal knees and sensitivity to change in osteoarthritic knees
  1. M-P Hellio Le Graverand1,
  2. E P Vignon2,
  3. K D Brandt3,
  4. S A Mazzuca4,
  5. M Piperno2,
  6. R Buck1,
  7. H C Charles5,
  8. D J Hunter6,
  9. C G Jackson7,
  10. V Byers Kraus8,
  11. T M Link9,
  12. T J Schnitzer10,
  13. A Vaz11,
  14. B Wyman1
  1. 1
    Pfizer GRD, Ann Arbor, Michigan, USA
  2. 2
    Universite Claude Bernard, Lyon, France
  3. 3
    Kansas University Medical Center, Kansas City, Kansas, USA
  4. 4
    Indiana University School of Medicine, Indianapolis, Indiana, USA
  5. 5
    Duke Image Analysis Laboratory, Durham, North Cordina, USA
  6. 6
    Boston University Clinical Epidemiology Research and Training Unit, Arthritis Center, and Boston Medical Center, Boston, Massachusetts, USA
  7. 7
    University of Utah School of Medicine, Salt Lake City, Utah, USA
  8. 8
    Department of Medicine, Duke University, Durham, North Cordina, USA
  9. 9
    Department of Radiology, University of California, San Francisco, California, USA
  10. 10
    Northwestern University, Chicago, Illinois, USA
  11. 11
    University of Arizona, College of Medicine, Tucson, Arizona, USA
  1. Marie-Pierre Hellio Le Graverand, Pfizer Global Research & Development, 2800 Plymouth Road, Ann Arbor, 48105 MI, USA; helliomp{at}


Objective: The Lyon Schuss (LS) and fixed flexion (FF) views of the knee are superior to a conventional standing anteroposterior view in evaluating joint space narrowing (JSN) in osteoarthritis (OA). Both position the knee identically but only the LS aligns the medial tibial plateau (MTP) with the x-ray beam fluoroscopically. The present study provides the first head-to-head comparison of the LS and FF views.

Methods: At baseline and 12 months, 62 OA and 99 control knees were imaged twice on the same day with LS and FF views. Minimum joint space width (mJSW) was measured by computer and MTP alignment was assessed from the distance between anterior and posterior margins of the MTP (intermargin distance, IMD). Reproducibility of measurements of mJSW and sensitivity to change were evaluated.

Results: In normal knees, JSW did not vary over 12 months with either view. In OA knees, 12-month mJSN was 0.22 (0.43) mm with the LS view and −0.01 (0.46) mm with the FF view (p = 0.0002 and p = 0.92, respectively). Mean IMD was only half as large in LS as in FF views (0.9 (0.5) mm vs 1.9 (1.2) mm, p<0.0001).

Conclusions: LS and FF radiographs offer similar reproducibility in JSW measurement. However, presumably due to its superiority in aligning the MTP, the LS view is much more sensitive to JSN in OA knees.

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.


  • Funding: Pfizer Global Research & Development.

  • Competing interests: None of the authors has a competing interest with regard to publication of the study, because no organisation may gain or lose financially from the results of conclusions published here. M-PHLeG is employed by Pfizer Inc. EV receives grant support from Pfizer. KDB provides consulting services to Pfizer. MP receives grant support from Pfizer. RJB is employed by Pfizer Inc. HCC receives contract support from Pfizer. DH receives grant support from Pfizer, Merck and DonJoy. CJ receives research grants from Pfizer. VBK receives research grants from Pfizer. TML receives research grants from Pfizer, GlaxoSmithKline and Merck. SAM receives grant support from, and provides consulting services to Pfizer. TJS receives research grants from Pfizer. AV receives research grants from Pfizer. BW is employed by Pfizer Inc.

  • Ethics approval: The study was conducted in compliance with the ethical principles derived from the Declaration of Helsinki and in compliance with local Institutional Review Board, informed consent regulations, and International Conference on Harmonisation Good Clinical Practices Guidelines.