Standardised scanning of the Nemanja Damjanov University of Belgrade Institute of Rheumatology knee Basic pathology
Disclosure Lecturer: Pfizer, Abbvie, Roche, MSD, Boehringer-Ingelheim, Gedeon Richter, Takeda, Investigator: Pfizer, Abbvie, Roche, MSD, Advisor: Pfizer, Abbvie, Roche, MSD, Boehringer- Ingelheim,
Knee anatomy - bones 1 1. Femur 2 2. Patella 3. Tibia 3 4. Fibula 4
Knee anatomy sesamoid bones Sesamoid bones in heads of gastrocnemius muscle 1 Patella 2 Fabellae Sesamoid bone of popliteal muscle
Knee anatomy - joints Femorotibial joint Patellofemoral joint Superior tibiofibular joint Fabellofemoral joint
Knee anatomy large synovial cavities Synovial membrane cavities
Knee anatomy small synovial cavities Prepatellar bursa Superficial infrapatellar bursa Profound infrapatellar bursa Lateral gastrocnemius head bursa
Knee anatomy small synovial cavities
US examination
US examination Anterior longitudinal scan
Suprapatelar longitudinal scan Subcutaneous fat tissue Quadriceps muscle & tendon Suprapatellar fat pad Suprapatellar recess Prefemoral fat pad
Suprapatelar longitudinal scan Subcutaneous fat tissue Quadriceps tendon Suprapatellar fat pad Suprapatellar recess Prefemoral fat pad
Suprapatelar longitudinal scan
Suprapatelar longitudinal scan RA PsA OA Gaut
Suprapatelar transverse scan QT Femur Suprapatellar fat pad Suprapatellar recess Prefemoral fat pad
Suprapatellar transverse scan n.p.
Suprapatellar transverse scan m.f.
Suprapatellar transverse scan m.f. Sonographic signs of cartilaginous changes Normal 1. reduced sharpness of the cartilage superficial margin 2. loss of clarity (transparency) of the cartilage
Suprapatellar transverse scan m.f. Sonographic signs of cartilaginous changes Normal 3. thinning of the cartilaginous layer 4. increased intensity of the deep cartilage margin 5. irregularities of subchondral bone profile.
Sonographic signs of cartilaginous changes 1 Normal 5 2 3 1 1. reduced sharpness of the cartilage superficial margin 2 2. loss of clarity (transparency) of the cartilage 3. thinning of the cartilaginous layer 3 4 4. increased intensity of the deep cartilage margin 5. irregularities of subchondral bone profile. 5 4
Suprapatellar transverse scan m.f. CPPD = calcium pyrophosphate dihydrate deposition
Juxtapatellar scan
Juxtapatellar scan
Juxtapatellar scan
Infrapatellar longitudinal scan
Infrapatellar longitudinal scan
Infrapatellar longitudinal scan Hoffa fat pad Patellar tendon Superficial infrapatellar bursa Profound (deep) infrapatellar bursa
Infrapatellar longitudinal scan Normal patellar tendon
Infrapatellar longitudinal scan Hoffa fat pad
Infrapatellar transvesal scan
Infrapatellar longitudinal scan Jumper s knee
Infrapatellar longitudinal scan Jumper s knee
Sinding Larsen Johansson disease - Chronic traction on the inferior pole of the patella - Small avulsed pieces of cartilage or bone US signs: - fragmented lower pole of the patella - hyperechoic Hoffa's fat - tendinitis with hypervascularity
Osgood-Schlatter disease Tibial tuberosity Tibial tuberosity
Osgood-Schlatter disease Tibial tuberosity
Infrapatellar bursitis PT HF * HF T tibia Deep infrapatellar bursa between the tibia surface and Hoffa s fat pad PT In special conditions like trauma or inflammation it becomes visible on US. T
Parapatellar transverse scan Patella Femur
Knee anatomy - ligaments Anterior knee Medial Colateral Ligament (MCL) Posterior knee Lateral Colateral Ligament (MCL)
Knee anatomy - ligaments Anterior Cruciate Ligament (ACL) LM Medial meniscus LM Anterior knee Posterior Cruciate Ligament (PCL) Posterior knee
Knee anatomy - tendons Quadriceps tendon Patellar Tendon (ligament)
Knee anatomy - tendons Lateral gastrocnemius tendon Popliteus tendon
Knee anatomy - tendons Iliotibial band semitendinosus, gracilis, sartorius tendons
Medial longitudinal scan Medial Collateral Ligament (MCL)
Lateral longitudinal scan Lateral collateral ligament (LCL)
Lateral longitudinal scan Iliotibial band Iateral colateral ligament
Lateral longitudinal scan Iliotibial band syndrome
Lateral longitudinal scan Iliotibial band syndrome
Osteophytes A step-up bony prominence at the end of the normal bone contour, or at the margin of the joint. They usually have a posterior acoustic shadow.
Osteophytes A step-up bony prominence at the end of the normal bone contour, or at the margin of the joint. * * They usually have a posterior acoustic shadow.
Meniscus
Posterior transverse scan Mh Gastrocn. m. Lh Gastrocn. m. IN PV PA
Posterior transverse scan Semimembranosus t. Semitendinosus t. Baker Cist Mh Gastrocnemius m. Tibia Medial condile Ishiadic n. Popliteal vein Popliteal artery
Posterior transverse scan Semimembranosus t. Semitendinosus t. Tibia Medial condile
Posterior medial transverse & longitudinal scan
Posterior medial longitudinal scan
Medial longitudinal scan Meniscus
Medial longitudinal scan Meniscus
Posterior lateral longitudinal scan Parameniscal cyst.
Take home messages Knee is frequently affected joint. US examination is part of the comprehensive clinical approach to the patient. US examination alows fast, reliable dynamic insight in soft tissue pathology. Some structures can not be completely evaluated (meniscus, cruciate ligaments, bones).