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Knee Ultrasound

Categories
  • Knee
  • Knee Radiology
  • Medical
Tags
  • Knee
  • Knee Radiology
  • Radiology
  • Ultrasound
Knee Anatomy & Examination

Knee Ultrasound

Ultrasonography

Introduction

  • Ultrasound is sound having a frequency above the audible range (> 20 kHz)
  • Frequencies range millions of cycles per second
  • Ultrasound is used in medicine for diagnostic purposes
  • Diagnostic ultrasound uses the principle that ultrasound is reflected by an interface between media of different acoustic impedances
  • The image is produced by the display of the echoes returning to the transducer. The image is composed of pixels varying in light intensity, which depends on the intensity of the reflected echo
  • The reflection depends on the density of the media and subsequently, various structures produce specific images depending on the acoustic mismatching of the reflected sound waves
  • In musculoskeletal imaging, a linear probe is used to assess structures

Human anatomy alignment

Knee Examination
Human anatomy alignment
Knee Examination
Human anatomy alignment

Knee Anatomy: Muscles around the Knee

Knee Muscle Anterior

Anterior

Knee Muscle Posterior

Posterior

Anterior surface anatomy

Anterior surface anatomy

Posterior surface anatomy

Posterior surface anatomy

Muscle and Tendon Attachments around the Knee

Knee muscle
Tendon attachments

Hamstring Ultrasound

Posterior thigh muscles
Probe held longitude

Probe held longitudinally over Hamstring muscle

Longitudinal ultrasound

Longitudinal ultrasound of normal hamstring muscle

Posterior thigh muscles
Probe held transversely

Probe held transversely over Hamstring muscle

Transverse view of Hamstring muscle

Transverse view of normal Hamstring muscle

Hamstring strain

Hamstring strain
Hamstring muscle strain

FIGURE  Hamstring muscle strain

  • L Hamstring muscle strain: Longitudinal ultrasound.
  • A – Acute L Hamstring muscle injury. Anechoic area (Asterix) surrounded by torn muscle tissue.
  • B – Longitudinal R Hamstring muscle normal.

Knee Anatomy: Quadriceps Tendon

Quadriceps Tendon
Quadriceps Tendon
anatomy of proximal Quadriceps
anatomy of proximal Quadriceps

Normal anatomy of proximal Quadriceps

Knee Anatomy: Tendons around the Knee Joint

Quadriceps Tendon
Probe transversely over Quadriceps tendon
Transverse view of Quadriceps tendon

Transverse view of Quadriceps tendon

Quadriceps Tendon Tear

Quadriceps Tendon Tear
Right quadriceps complete tear

Right quadriceps complete tear.

  • A – Longitudinal sonogram of R quadriceps demonstrating complete tear (thick arrows).
    Retracted muscle (thin arrow).
  • B – Surgical exploration: complete tear of ® quadriceps. Free edges of tendon demonstrated by thin arrows.

Meniscus Structure

Meniscus Structure

Extensor Mechanism Infrapatellar Ultrasound

Ultrasound positioning

Patient ultrasound positioning to assess infrapatellar tendon

With seated position, it is easier to assess dynamic real-time ultrasound imaging with knee extension

Longitudinal ultrasound

Longitudinal ultrasound – infrapatellar tendon at patellar insertion, normal.

Longitudinal ultrasound

Longitudinal ultrasound – infrapatellar tendon, at tibial insertion, normal.

Ultrasound of Previous Failed Infrapatellar Tendon Rupture

Tendon Rupture
Chronic infrapatellar tendon rupture

Chronic infrapatellar tendon rupture

Avulsion bone retracted

Avulsion bone retracted

Surgery Reconstruction for Failed Previous Infrapatellar Repair

failed infrapatellar tendon repair

Pre-operation: Previous scar from failed infrapatellar tendon repair

infrapatellar tendon repair

Intra-operative: Area marked from the pre-operative ultrasound that required excision
& then followed by infrapatellar tendon repair

Intra-operative
Intra-operative

Intra-operative: After bone avulsion segment excision, tendon repaired with augmentation of the infrapatellar tendon

Infrapatellar tendinopathy

Infrapatellar tendinopathy
Patellar tendinopathy

FIGURE   Patellar tendinopathy.

  • A – Longitudinal sonogram of the fast bowler with infrapatellar tendinopathy. Thickening of an infrapatellar tendon (white arrow), calcification (arrowhead) demonstrating overuse injury.
  • B – Transverse view of the same athlete, showing calcification ‘ossicle’.
Knee Injury

Osgood Schlatter

Infrapatellar tendinopathy
Osgood Schlatter Disease

FIGURE Osgood – Schlatter Disease:

  • A – Longitudinal sonogram through the distal patella tendon. Sonography shows small avulsions from the apophyseal cartilage (asterix). The avulsions calcify and may grow as separate ossification centres.
  • B – Normal contralateral distal patella tendon. No avulsion injury present at the insertion site (white arrow).

Bipartite Patella

Bipartite Patella
Bipartite patella
Bipartite patella

   Bipartite patella:

  • A – Longitudinal sonogram of patella showing separate patella fragment (b) with joint (J). Inferior bipartite patella represents 5% of bipartite type.
  • B – AP & Lateral X-Ray of the same athlete.

Posterior Knee Structures

Ultrasound posterior knee

Ultrasound posterior knee, transverse view

Ultrasound posterior knee, longitudinal view

Ultrasound posterior knee, longitudinal view

Right Popliteus

Right Popliteus

Posterior knee structures

Posterior knee structures. Popliteus tendon, normal

Lateral Collateral Ligament (LCL)

Lateral Collateral Ligament (LCL)
Ultrasound over LCL area

Ultrasound over LCL area

LCL at femur insertion

Longitudinal view – LCL at femur insertion, normal

LCL at fibular insertion

Longitudinal view – LCL at fibular insertion, normal

Medial & Inferomedial Structures

Medial & Inferomedial Structures
Medial & Inferomedial Structures
Normal MCL at femur insertion

Normal MCL at femur insertion

Normal MCL at mid section

Normal MCL at mid section

Normal MCL at tibia insertion

Normal MCL at tibia insertion

MCL Complete Tear

MCL Complete Tear
Longitudinal view, normal - MCL

Longitudinal view (normal) – MCL

Longitudinal view - complete tear of MCL

Longitudinal view – complete tear of MCL

Pes Anserine Bursitis

Pes Anserine Bursitis
pes tendons down

Follow pes tendons down to insertion medial tibia

Pes anserine bursa swelling

Figure: Pes anserine bursa swelling

Pes Anserine Bursa Injection

Pes Anserine Bursa Injection

Meniscus Tear

MRI is the gold standard for meniscus tear evaluation

Ultrasound limitations

Ultrasound limitations when viewing meniscus:

  • Adequate joint space necessary
  • Deep structure
  • Posterior visualisation difficult
  • Experienced sonographer
tear

Figure: This pic demonstrates features of tear when visualized with ultrasound

Medial Meniscus Tear

Posteromedial meniscus tear

Longitudinal ultrasound: Posteromedial meniscus tear

Medial meniscus tear

Longitudinal ultrasound: Medial meniscus tear

Meniscus Cyst

Longitudinal view medial meniscus showing meniscus cyst

Longitudinal view: medial meniscus showing meniscus cyst

At arthroscopy meniscus cyst confirmed

At arthroscopy meniscus cyst confirmed

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