Knee, Ankle, and Foot: Normal and Abnormal Features with MRI and Ultrasound Correlation. Disclosures. Outline. Joint Effusion. Suprapatellar recess
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1 Knee, Ankle, and Foot: Normal and Abnormal Features with MRI and Ultrasound Correlation Jon A. Jacobson, M.D. Professor of Radiology Director, Division of Musculoskeletal Radiology University of Michigan Disclosures Consultant: Bioclinica Advisory Board: GE, Philips Book Royalties: Elsevier None are relevant to this talk Note: all images from the textbook Fundamentals of Musculoskeletal Ultrasound are copyrighted by Elsevier Inc. Outline Joint Effusion Suprapatellar recess Superior Prefemoral & quadriceps fat pad separation Distends with partial knee flexion Medial and lateral to patella Distends with knee extension Transducer pressure displaces joint effusion Suprapatellar Recess and Gutters Joint Effusion: sagittal plane Quadriceps * * Sagittal T2w From: Miller PJ et al. Am J Sports Med 2001;29:822. 1
2 Joint Effusion: transverse plane Joint Effusion: knee extension Quad Outline Quadriceps Tendon: tendinosis Short Axis Quadriceps Tendon: Partial Tears Quadriceps Tendon: full-thickness tear RF Vasti P V RF P Rectus Femoris Tear (1 layer) Vasti Tear (2 layers) Sagittal PDw 2
3 r Tendinosis: Jumper s knee Hypoechoic swelling Mucoid degeneration, possible interstitial tearing Hyperemia: neovascularity No inflammatory cells r Tendon: tendinosis Radiology 1996; 200:821 color Doppler power Doppler r Tendon: full-thickness tear r Tendon: full thickness tear Prox Distal Sagittal PDw *Suprapatellar Recess Prepatellar Bursa Deep Infrapatellar Bursa Superficial Infrapatellar Bursa Knee Bursae Baker Cyst Semimembranosus -Tibial Collateral Ligament Bursa Pes Anserinus Bursa Prepatellar Bursa: aseptic fluid Sagittal Axial 3
4 Superficial Infrapatellar Bursa Deep Infrapatellar Bursa Tibia Tibia Tibia Case #1 Case #2 Normal Abnormal Outline Baker Cyst: Semimembranosus-medial gastrocnemius bursa 50% over age of 50 have communication with knee joint Cyst communication to posterior knee between SM-MG tendons required AJR 2001; 176:373 Anatomy: posterior Baker Cyst Medial Gastrocnemius SM From: Netter s Atlas of Human Anatomy Axial Axial T2w 4
5 Baker Cyst Baker Cyst: intraarticular body MG SM MG Sagittal PDw Baker Cyst: rupture Coronal T2w Outline Achilles Tendon: 2 6 cm proximal to insertion Tendinosis Full-thickness tear Calcaneal attachment Tendinosis, tear Haglund Syndrome Paratenonitis: Achilles 5
6 Tendinosis: Achilles Achilles Tendon: partial-thickness tear power Doppler Courtesy of Jon Halperin, San Diego Achilles Tendon: full-thickness tear Full-thickness Tear: Achilles Calcaneus : extended field of view Plantaris Sagittal T2w Short Axis Achilles Tendon: dynamic imaging Achilles Tendon: healing tear Prox Distal 6
7 Outline split: peroneus brevis PL Fibula : proximal CFL PL Calcaneus : distal split: peroneus brevis Peroneal Tendon Subluxation: Abnormal movement may only occur dynamically Predisposes to peroneal tendon tears split of peroneus brevis US: examine with dorsiflexion / eversion 100% accurate diagnosis with US Neustadter et al. AJR 2004; 183:985 Peroneal Retinaculum Superior Peroneal Retinaculum Injury Fib PL/B PL/B Calcaneus Short Axis to Peroneal Tendons Rosenberg et al. AJR 2003; 181:1551 7
8 Peroneal Subluxation: dynamic imaging Dislocation: peroneus brevis & longus Posterior Anterior Anterior Posterior Short axis Intrasheath Subluxation Intrasheath Subluxation Abnormal snapping of peroneal tendons No lateral displacement, intact retinaculum Associations: Convex posterior fibula in 92% Tendon tear in 86% Low lying peroneus brevis muscle in 71% J Bone Joint Surg Am 2008; 90:992 J Foot Ankle Surg 2009; 48:323 Take Home Points effusion: Suprapatellar and medial/lateral recesses Extensor mechanism: dynamic evaluation Baker cyst: must see neck to diagnose Achilles: dynamic imaging Peroneal: dynamic, subluxation Syllabus on line and other educational material: Twitter 8
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