Skyline Projections of

knee joint
PRESENTED BY,
RAJABHARATHI.R
206061105068
INTERN
Skyline projection
The skyline projection can be used to:
 Assess the retro-patellar joint space for degenerative disease.
 Determine the degree of any lateral subluxation of the patella with ligament
laxity.
 Diagnose chondromalacia patellae.
 Confirm the presence of a vertical patella fracture in acute trauma
The optimum retro-patellar joint spacing occurs when the knee is flexed
approximately 30-45°. Further flexion pulls the patella into the intercondylar
notch, reducing the joint spacing; as flexion increases, the patella tracks over
the lateral femoral condyle. The patella moves a distance of 2 cm from full
extension to full flexion.
Three Methods to Achieve Skyline
Projection
 SUPERO-INFERIOR (BEAM DIRECTED DOWNWARDS)
 CONVENTIONAL INFERO-SUPERIOR
 INFERO-SUPERIOR (PATIENT PRONE)
Supero-inferior
Position of Patient and Image Receptor
 The patient sits on the x-ray table,
with the affected knee flexed over
the side.
 Ideally the leg should be flexed to
45° to reflect a similar knee position
to the conventional skyline
projection.
 The receptor is supported
horizontally on a stool at the level of
the inferior tibial tuberosity border.
Direction and Location of X-ray Beam
 The collimated vertical central beam is centered over the posterior aspect of
the proximal border of the patella.
 The central ray should be parallel to the long axis of the patella.
 The beam is collimated to the patella and femoral condyles.
Infero-superior
Position of Patient and Image Receptor
 The patient sits on the x-ray table, with the knee flexed 30-45° and
supported on a pad placed below the knee.
 The image receptor is held by the patient against the anterior distal femur
and supported using a non-opaque pad, which rests on the anterior aspect of
the thigh.
Direction and Location of X-ray Beam
 The x-ray tube is lowered into the horizontal orientation. Avoiding the feet,
the central ray is directed cranially to pass through the apex of patella
parallel to the long axis. This may require 5-10° cranial angle from horizontal.
 The beam should be closely collimated to the patella and femoral condyles to
limit scattered radiation to the trunk and head.
Infero-superior (Patient Prone)
Position of Patient and Image Receptor
 The patient lies prone on the x-ray
table, with the image receptor
placed under the knee joint and the
knee flexed through 90°.
 A bandage placed around the ankle
and either tethered to a vertical
support or held by the patient may
prevent unnecessary movement.
 The patient flexes the knee a further
5°, to remove any chance of
superimposition of the tibia or foot
on the patella-femoral joint space.
Direction and Location of X-ray Beam
 The collimated vertical central beam is centered behind the patella, with the
vertical central ray angled approximately 15° towards the knee, avoiding the
toes.
References:
CLARK’S POSITIONING IN RADIOGRAPHY 13RD
EDITION
STEWART WHITLEY, GAIL JEFFERSON, KEN
HOLMES, CHARLES SLOANE, CRAIG ANDERSON,
GRAHAM HOADLEY