Ultrasound of the knee

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Ultrasound of the knee can be a useful imaging modality for evaluation, allowing high resolution imaging of superficial knee anatomy while simultaneously allowing dynamic evaluation of some of the tendons and ligaments. Knee ultrasound is somewhat limited compared with ultrasound examinations of other joints because the cruciate ligaments and the entirety of the meniscus is usually difficult to visualize.

Approach

There are multiple possible approaches to imaging the knee with ultrasound. A typical overall protocol is as follows 1:

Anterior knee

Knee is flexed 20-30 degrees (flexion of the knee tightens the extensor tendons, decreasing the change of anisotropy occuring in a lax tendon):

  1. Transverse and longitudinal images of the quadriceps tendon from its myotendinous junctions to its attachment on the superior patella (rectus femoris myotendinous junction is more cranial than the vastus junctions.
  2. Evaluate the suprapatellar and parapatellar joint recesses.
  3. Evaluate the femoral trochlea
    • best examined in full knee flexion
    • useful for examination of the trochlear cartilage
  4. Evaluate the patellar retincula
  5. Evaluate the medial patellar articular facet (lateral facet not visible on ultrasound)
  6. Evaluate the patellar tendon and patellar bursa
    • prepatellar bursa normally not visible
    • infrapatellar bursa
      • small amount of fluid in the deep infrapatellar bursa is normal
      • normally no fluid in the superficial infrapatellar bursa
Lateral knee

Knee is flexed 20-30 degrees:

  1. Evaluate the distal iliotibial band in long axis (located between anterior and middle third of the lateral knee).
  2. Evaluate the lateral collateral ligament in long axis.
    • may detect para-articular ganglia
  3. May see lateral meniscal pathology (e.g. meniscal cyst)
    • extreme knee flexion may bring out a meniscal abnormality
Medial knee

Knee is flexed 20-30 degrees, with external rotation:

  1. Evaluate medial collateral ligament and pes anserinus tendons in long axis
    • valgus stress may be useful to examine the ligament
Posterior knee

Often examined with patient prone and knee extended:

  1. Evaluate the medial tendons in short axis (medial to lateral):
    • sartorius
    • gracilis
    • semitendinosis
  2. Moving even more medially, evaluate the semimembranosus-gastrocnemius bursa in short axis
  3. Evaluate the popliteal neurovascular bundle and intercondylar fossa in short axis.
  4. Evaluate the posterolateral corner and biceps femoris in short and long axis.
  5. Evaluate the peroneal nerve
    • start with the common peroneal nerve branching off the sciatic nerve above the knee
    • follow it around the fibular head

Pathology

A number of knee abnormalities can be identified on ultrasound, including:

  • -<p><strong>Ultrasound of the knee</strong> can be a useful imaging modality for evaluation, allowing high resolution imaging of superficial knee anatomy while simultaneously allowing dynamic evaluation of some of the tendons and ligaments. Knee ultrasound is somewhat limited compared with ultrasound examinations of other joints because the cruciate ligaments and the entirety of the meniscus is usually difficult to visualize.</p><h4>Approach</h4><p>There are multiple possible approaches to imaging the knee with ultrasound. A typical overall protocol is as follows <sup>1</sup>:</p><h6>Anterior knee</h6><p>Knee is flexed 20-30 degrees (flexion of the knee tightens the extensor tendons, decreasing the change of <a title="Anisotropy" href="/articles/anisotropy">anisotropy</a> occuring in a lax tendon):</p><ol>
  • +<p><strong>Ultrasound of the knee</strong> can be a useful imaging modality for evaluation, allowing high resolution imaging of superficial knee anatomy while simultaneously allowing dynamic evaluation of some of the tendons and ligaments. Knee ultrasound is somewhat limited compared with ultrasound examinations of other joints because the cruciate ligaments and the entirety of the meniscus is usually difficult to visualize.</p><h4>Approach</h4><p>There are multiple possible approaches to imaging the knee with ultrasound. A typical overall protocol is as follows <sup>1</sup>:</p><h6>Anterior knee</h6><p>Knee is flexed 20-30 degrees (flexion of the knee tightens the extensor tendons, decreasing the change of <a href="/articles/anisotropy">anisotropy</a> occuring in a lax tendon):</p><ol>
  • -<li><a title="suprapatellar fat pad" href="/articles/suprapatellar-fat-pad">suprapatellar fat pad</a></li>
  • -<li><a title="prefemoral fat pad" href="/articles/prefemoral-fat-pad">prefemoral fat pad</a></li>
  • +<li><a href="/articles/suprapatellar-fat-pad">suprapatellar fat pad</a></li>
  • +<li><a href="/articles/prefemoral-fat-pad">prefemoral fat pad</a></li>
  • -<li>Evaluate the <a title="femoral trochlea" href="/articles/femoral-trochlea">femoral trochlea</a><ul>
  • +<li>Evaluate the <a href="/articles/femoral-trochlea">femoral trochlea</a><ul>
  • -<li>Evaluate the <a title="Patella" href="/articles/patella">patellar retincula</a>
  • +<li>Evaluate the <a href="/articles/patella">patellar retincula</a>
  • -<li>Evaluate the <a title="patella articular facet" href="/articles/patella">medial patellar articular facet</a> (lateral facet not visible on ultrasound)</li>
  • +<li>Evaluate the <a href="/articles/patella">medial patellar articular facet</a> (lateral facet not visible on ultrasound)</li>
  • -<li>Evaluate the <a title="Lateral collateral ligament of the knee" href="/articles/lateral-collateral-ligament-of-the-knee">lateral collateral ligament</a> in long axis.<ul><li>may detect para-articular ganglia</li></ul>
  • +<li>Evaluate the <a href="/articles/lateral-collateral-ligament-of-the-knee">lateral collateral ligament</a> in long axis.<ul><li>may detect para-articular ganglia</li></ul>
  • -</ol><h6>Medial knee</h6><p>Knee is flexed 20-30 degrees, with external rotation:</p><ol><li>Evaluate <a title="Medial collateral ligament of the knee" href="/articles/medial-collateral-ligament-of-the-knee">medial collateral ligament</a> and <a title="Pes anserinus" href="/articles/pes-anserinus">pes anserinus</a> tendons in long axis<ul><li>valgus stress may be useful to examine the ligament</li></ul>
  • +</ol><h6>Medial knee</h6><p>Knee is flexed 20-30 degrees, with external rotation:</p><ol><li>Evaluate <a href="/articles/medial-collateral-ligament-of-the-knee">medial collateral ligament</a> and <a href="/articles/pes-anserinus">pes anserinus</a> tendons in long axis<ul><li>valgus stress may be useful to examine the ligament</li></ul>
  • -<li>Moving even more medially, evaluate the semimembranosus-gastrocnemius bursa in short axis<ul><li>a <a title="Popliteal cyst" href="/articles/baker-cyst-1">popliteal cyst (Baker's cyst)</a> arises between these tendons</li></ul>
  • +<li>Moving even more medially, evaluate the semimembranosus-gastrocnemius bursa in short axis<ul><li>a <a href="/articles/baker-cyst-1">popliteal cyst (Baker's cyst)</a> arises between these tendons</li></ul>
  • -<li>patellar tendinosis / <a title="Patellar tendon rupture" href="/articles/patellar-tendon-rupture">patellar tendon tear</a>
  • +<li>patellar tendinosis / <a href="/articles/patellar-tendon-rupture">patellar tendon tear</a>
  • -<li><a title="Rupture of the quadriceps tendon" href="/articles/quadriceps-tendon-rupture">quadriceps tendon tear</a></li>
  • -<li><a title="prepatellar bursitis" href="/articles/prepatellar-bursitis">prepatellar bursitis</a></li>
  • -<li><a title="Infrapatellar bursitis" href="/articles/infrapatellar-bursitis">infrapatellar bursitis</a></li>
  • -<li><a title="Popliteal cyst" href="/articles/baker-cyst-1">popliteal cyst (Baker's cyst)</a></li>
  • +<li><a href="/articles/quadriceps-tendon-rupture">quadriceps tendon tear</a></li>
  • +<li><a href="/articles/prepatellar-bursitis">prepatellar bursitis</a></li>
  • +<li><a href="/articles/infrapatellar-bursitis">infrapatellar bursitis</a></li>
  • +<li><a href="/articles/baker-cyst-1">popliteal cyst (Baker's cyst)</a></li>

References changed:

  • 1. Martinoli C. Musculoskeletal ultrasound: technical guidelines. Insights Imaging. 2010;1 (3): 99-141. <a href="http://dx.doi.org/10.1007/s13244-010-0032-9">doi:10.1007/s13244-010-0032-9</a> - <a href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3481034">Free text at pubmed</a> - <a href="http://www.ncbi.nlm.nih.gov/pubmed/23100193">Pubmed citation</a><span class="auto"></span>
  • 2. Jacobson JA. Fundamentals of Musculoskeletal Ultrasound: Expert Consult-Online and Print, 2e (Fundamentals of Radiology). Saunders. ISBN:1455738182. <a href="http://books.google.com/books?vid=ISBN1455738182">Read it at Google Books</a> - <a href="http://www.amazon.com/gp/product/1455738182">Find it at Amazon</a><span class="auto"></span>

Tags changed:

  • musculoskeletal
  • musculoskeletal sonography
  • knee

Sections changed:

  • Approach

Systems changed:

  • Musculoskeletal
Images Changes:

Image 1 Ultrasound ( create )

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