Ultrasonographic Examination of Joints in Horses

Total Page:16

File Type:pdf, Size:1020Kb

Ultrasonographic Examination of Joints in Horses Reprinted in the IVIS website with the permission of AAEP Close window to return to IVIS IN DEPTH: ULTRASONOGRAPHY OF JOINTS Ultrasonographic Examination of Joints in Horses J.-M. Denoix, DVM, PhD, Agre´ge´; F. Audigie´, DVM, PhD The diagnosis of lesions can be made with ultrasonography in many painful joints with no abnormal radiographic findings. These lesions include ligament, capsule, synovial, and meniscal injuries as well as periarticular injuries. When abnormal radiographic findings are present, complementary ultrasonographic evaluation provides more information concerning the soft tissues and joint surfaces; therefore, a more complete assessment of the joint is achieved. In every clinical case, the ability to diagnose injuries and the reliability of the diagnosis are largely improved when two symmetrical areas are examined; therefore, the homologoid joints of both limbs should always be examined. A systematic approach to every aspect of each joint is necessary to avoid false negative diagnosis. Au- thors’ address: CIRALE–IPC, Ecole Nationale Ve´te´rinaire d’Alfort, Goustranville RN 175, 14 430 Dozule´, France. © 2001 AAEP. 1. Introduction 2. Anatomical Basis Ultrasonography has become an essential procedure for diagnosing joint injuries.1–5 With this tech- Distal Interphalangeal Joint (DIPJ) nique and the new equipment available, noninva- This joint presents five ligaments that can be imaged sive assessment of most of the soft tissues of every ultrasonographically (Figs. 1 and 2): two short and joint in the limbs, back, and pelvis is possible. Ul- long collateral ligaments between the middle phalanx trasonography also provides useful information for (P2) and the distal phalanx (P3), two long and oblique many lesions of the articular surfaces. collateral sesamoidean ligaments between the distal The objectives of this presentation are to de- sesamoid bone (DSB) and P2 as well as the proximal scribe the most interesting anatomical structures phalanx (P1), and a short and wide distal impar sesa- that are frequently injured or that present clinical moidean ligament between the DSB and P3. applications in the field of diagnostic ultrasonog- The DIPJ presents two main recesses that are raphy; to provide reference anatomical figures to accessible with ultrasonography: a dorsal recess aid in the identification of the most important between the dorsal digital extensor tendon and P2 anatomical structures seen during ultrasono- and a proximopalmar recess located proximal to the graphic examination of joints; and to present DSB. The dorsal articular margins of P2 and the the main ultrasonographic abnormal findings of extensor process of P3 can be seen with a dorsal the different joint structures, which will allow the approach to the joint. With a palmaroproximal ap- diagnosis and documentation of many joint proach, the palmar margin of P2 and the proximal conditions. border of the DSB can be imaged. NOTES 366 2001 ր Vol. 47 ր AAEP PROCEEDINGS Proceedings of the Annual Convention of the AAEP 2001 Reprinted in the IVIS website with the permission of AAEP Close window to return to IVIS IN DEPTH: ULTRASONOGRAPHY OF JOINTS limb. The distal aspect of this articular surface can be examined on the flexed fetlock. The articular cartilage is thicker dorsally (ϳ1 mm) than it is dis- tally (ϳ0.5 mm). Shoulder Joint The scapulohumeral joint is closed by a thin articu- lar capsule and does not present any ligament (Fig. 5). This capsule is better seen with lateral and caudolateral approaches than it is with a cranial approach to the joint. It is covered by the supraspi- natus, infraspinatus, and deltoid muscles (Figs. 5 and 6). There is very little synovial fluid in the articular cavity in sound joints. When present, this fluid is seen on a caudolateral approach below the margin of the humeral head. The articular margins are also more easily imaged with lateral and caudolateral approaches: the glenoid cavity has a sharp articu- lar margin on longitudinal sections whereas the hu- meral head has very smooth caudolateral articular margins. The articular surface of the scapula cannot be imaged ultrasonographically. The lateral and cau- dal parts of the humeral head are the only articular surfaces accessible with this technique. The ex- posed surface can be expended when the limb is protracted and adducted. Hock Joint The crurotarsal joint has two strong and complex collateral ligaments (CL). Each of them presents a long and single CL as well as a short CL (Figs. 7–9) Fig. 1. Dissected specimen showing the dorsal aspect of the with a calcanean and a talean part. The talean interphalangeal joints. The two collateral ligaments of the dis- part of the medial CL is divided into superficial and tal interphalangeal joint are symmetrically placed on the dorso- deep fasciculi. These different ligaments do not lateral and dorsomedial aspects of the joint. Middle phalanx (1), have the same orientation (Figs. 8 and 9). There- distal phalanx (2), collateral ligament of the distal interphalan- fore, examination of each of them in longitudinal geal joint (3), collateral ligament of the proximal interphalangeal and transverse sections requires specific orientation joint (4). of the probe. The articular capsule can easily be imaged at the medial and dorsal aspects of the joint. The normal crurotarsal joint has a wide dorsome- Fetlock Joint dial recess that is imaged below the medial malleo- The fetlock joint has a thick dorsal articular capsule lus of the tibia. The normal synovial fluid is totally (Fig. 3). This joint presents two symmetrical anechogenic and the synovial membrane presents collateral ligaments (Fig. 4) with two layers: a distinct villi floating in the synovial fluid. In nor- superficial and long as well as a short and oblique mal horses, there is very little fluid dorsally and layer—except for the suspensory apparatus (third laterally between the talus and the articular capsule interosseus muscle, proximal sesamoid bones and or in the plantarolateral and plantaromedial re- palmar ligament, sesamoidean ligaments). This cesses of the tarsocrural joint. The articular mar- joint presents two main recesses: a dorsal recess gins of the medial malleolus and the medial aspect of with little synovial fluid in normal joints and a fi- the talus are imaged with a medial approach. brous proximodorsal synovial fold, and a proximo- The dorsal aspect of the articular surface of the palmar recess with numerous and high synovial talus is widely exposed, which allows easy imaging villi. of the medial and lateral trochlea ridges of this The dorsal and collateral articular margins are bone. On the flexed hock, the caudoproximal part easily accessible and smooth in normal joints. The of the talus trochlea can also be examined. articular cartilage and subchondral bone surface of The distal tarsus is surrounded by strong liga- the dorsal aspect of the metacarpal (metatarsal) ments made of the distal part of the CL laterally condyle can be imaged on the weight-bearing and medially (Figs. 7–9), the talometatarsal liga- AAEP PROCEEDINGS ր Vol. 47 ր 2001 367 Proceedings of the Annual Convention of the AAEP 2001 Reprinted in the IVIS website with the permission of AAEP Close window to return to IVIS IN DEPTH: ULTRASONOGRAPHY OF JOINTS Fig. 2. Transverse section of the distal interphalangeal joint. The two collateral ligaments of the distal interphalangeal joint are symmetrically placed on the dorsolateral and dorsomedial aspects of the joint. Middle phalanx (1), distal sesamoid bone (2), collateral ligament of the distal interphalangeal joint (3), ungular cartilage (4), proximal aspect of the hoof wall (5). ment dorsally, and the distal plantar ligament cau- The distal articular margin of the patella is dally. Very little synovial fluid can be seen at the smooth. The articular surface of the femoral medial aspect of the distal intertarsal joint or at trochlea is widely exposed on the weight-bearing the plantarolateral aspect of the tarsometatarsal limb. The medial trochlea ridge is thick and pre- joint. The articular margins of these two joints are sents thin articular cartilage (1–2 mm thick), the regular and sharp; the joint spaces with the articu- lateral trochlea ridge is sharp and covered by thick lar cartilage are imaged as an anechogenic gap in articular cartilage (2–4 mm thick), and the femoral the hyperechogenic profile of the distal tarsal bones. trochlea groove often presents an irregular subchon- Stifle Joint dral bone surface. The femorotibial joints present two menisci (Figs. The three patellar ligaments (PL) of the femoropa- 11 and 12), the body and horns of which can be tellar joint (Fig. 10) can be imaged on the longitudi- examined on the weight-bearing limb. On longitu- nal and transverses sections. On transverse sections, the medial PL is triangular, the interme- dinal section, the medial meniscus presents a trian- diate PL is round, and the lateral PL is flat and wide gular radial section with a concave proximal border and is molted over the lateral ridge of the femoral molted over the medial femoral condyle. The body trochlea in its proximal part (Fig. 10). The distal of the lateral meniscus has a trapezoidal shape but part of these ligaments is extra-articular because its cranial and caudal horns have a triangular radial the infrapatellar fat pad is between them and the section. The cranial attachment of each meniscus synovial membrane. can be imaged on longitudinal and transverse sec- On sound stifles, the femoropatellar joints present tions on the flexed limb (Fig. 12). The medial col- two recesses with synovial fluid: one medial, cau- lateral ligament is attached to the medial meniscus dal to the medial PL, and one lateral, caudal to the (Fig. 10) whereas the lateral collateral ligament is lateral PL. High and thick synovial villi are separated from the lateral meniscus by the proximal present in the medial femoropatellar recess. tendon of the popliteus muscle (Fig.
Recommended publications
  • Adipose Tissue As Pain Generator in the Lower Back and Lower Extremity
    Lee et al. HCA Healthcare Journal of Medicine (2020) 1:5 https://doi.org/10.36518/2689-0216.1102 Clinical Review Adipose Tissue as Pain Generator in the Lower Back and Lower Extremity: Application in Author affiliations are listed Musculoskeletal Medicine at the end of this article. Se Won Lee, MD ,1 Craig Van Dien, MD ,2 Sun Jae Won, MD, PhD3 Correspondence to: Se Won Lee, MD Abstract Department of Physical Medicine and Rehabilitation Description MoutainView Medical Adipose tissue (AT) has diverse and important functions in body insulation, mechanical protection, energy metabolism and the endocrine system. Despite its relative abundance in Center the human body, the clinical significance of AT in musculoskeletal (MSK) medicine, partic- 2880 N Tenaya Way, 2nd Fl, ularly its role in painful MSK conditions, is under-recognized. Pain associated with AT can Las Vegas, NV 89128 be divided into intrinsic (AT as a primary pain generator), extrinsic (AT as a secondary pain ([email protected]) generator) or mixed origin. Understanding AT as an MSK pain generator, both by mechanism and its specific role in pain generation by body region, enhances the clinical decision-making process and guides therapeutic strategies in patients with AT-related MSK disorders. This article reviews the existing literature of AT in the context of pain generation in the lower back and lower extremity to increase clinician awareness and stimulate further investigation into AT in MSK medicine. Keywords adipose tissue; fat pad; musculoskeletal pain; connective tissue; lipodystrophy; lipoma; obe- sity; lipedema; pain generator Introduction lower extremity, focusing on its pathogenic role Mounting evidence supports the various func- as a pain generator as well as practical diagno- tions of adipose tissue (AT), most notably its sis and management.
    [Show full text]
  • High Lateral Portal for Sparing the Infrapatellar Fat-Pad During ACL Reconstruction
    Orthopaedics & Traumatology: Surgery & Research (2011) 97, 870—873 Available online at www.sciencedirect.com TECHNICAL NOTE High lateral portal for sparing the infrapatellar fat-pad during ACL reconstruction B. Sonnery-Cottet ∗, P. Archbold, R. Zayni, M. Thaunat, J. Bortolletto, J.-M. Fayard, P. Chambat Paul-Santy orthopaedic center, 24, avenue Paul-Santy, 69008 Lyon, France Accepted: 23 August 2011 KEYWORDS Summary During arthroscopic ACL reconstruction, intra-articular visualization can be com- Infrapatellar Fat Pad; promised by the interposition of the infrapatellar fat pad (IPFP) between the scope and the Anterior cruciate notch. In this technical note, we describe our technique of using lateral higher arthroscopic ligament portal, starting arthroscopy with the resection of the ligamentum mucosum and performing the reconstruction; tibial tunnel in 40◦ of knee flexion to optimise the intra-articular view without IPFP debride- Arthroscopy; ment. This technique was performed in 112 consecutive arthroscopic ACL reconstructions and Ligamentum compared to that in the previous 112 cases in which a conventional method was used. The use mucosum; of this technique was associated with a shorter operative time and no increase in the difficulty Arthroscopic portal in performing associated meniscal procedures. © 2011 Elsevier Masson SAS. All rights reserved. Introduction can influence patellar and knee kinematics [4]. Scarring of the anterior interval changes the mechanics of the anterior During arthroscopic ACL reconstruction, intra-articular visu- structures of the knee and may lead to refractory anterior alization can be compromised by the interposition of the knee pain [1]. Some studies have shown that the excessive infrapatellar fat pad (IPFP) between the scope and the resection of IPFP can have negative consequences on the notch.
    [Show full text]
  • Infrapatellar Fat Pad Gene Expression and Protein Production in Patients with and Without Osteoarthritis
    International Journal of Molecular Sciences Article Infrapatellar Fat Pad Gene Expression and Protein Production in Patients with and without Osteoarthritis 1, 2,3, 4,5 Elisa Belluzzi y , Veronica Macchi y , Chiara Giulia Fontanella , Emanuele Luigi Carniel 5,6, Eleonora Olivotto 7 , Giuseppe Filardo 8, Gloria Sarasin 2, Andrea Porzionato 2,3, Marnie Granzotto 9, Assunta Pozzuoli 1 , Antonio Berizzi 10, Manuela Scioni 11, Raffaele De Caro 2,3, Pietro Ruggieri 10 , Roberto Vettor 9, Roberta Ramonda 12, Marco Rossato 9,* and Marta Favero 12,13 1 Musculoskeletal Pathology and Oncology Laboratory, Orthopedic and Traumatologic Clinic, Department of Surgery, Oncology and Gastroenterology (DISCOG), University of Padova, 35128 Padova, Italy; [email protected] (E.B.); [email protected] (A.P.) 2 Institute of Human Anatomy, Department of Neurosciences, University of Padova, 35121 Padova, Italy; [email protected] (V.M.); [email protected] (G.S.); [email protected] (A.P.); raff[email protected] (R.D.C.) 3 L.i.f.e. L.a.b. Program, Consorzio per la Ricerca Sanitaria (CORIS), Veneto Region, 35128 Padova, Italy 4 Department of Civil, Environmental and Architectural Engineering, University of Padova, 35131 Padova, Italy; [email protected] 5 Centre for Mechanics of Biological Materials, University of Padova, 35131 Padova, Italy; [email protected] 6 Department of Industrial Engineering, University of Padova, 35131 Padova, Italy 7 RAMSES Laboratory, RIT Department, IRCCS Istituto Ortopedico
    [Show full text]
  • Inflammatory and Metabolic Alterations of Kager's Fat Pad in Chronic Achilles Tendinopathy
    RESEARCH ARTICLE Inflammatory and Metabolic Alterations of Kager's Fat Pad in Chronic Achilles Tendinopathy Jessica Pingel1☯, M. Christine H. Petersen2,3☯, Ulrich Fredberg4,Søren G. Kjær4, Bjørn Quistorff3, Henning Langberg5, Jacob B. Hansen2* 1 Department of Exercise and Nutrition, University of Copenhagen, Copenhagen, Denmark, 2 Department of Biology, University of Copenhagen, Copenhagen, Denmark, 3 Department of Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark, 4 Diagnostic Centre, Silkeborg Regional Hospital, Silkeborg, Denmark, 5 CopenRehab, Department of Public Health, University of Copenhagen, Copenhagen, Denmark ☯ These authors contributed equally to this work. * [email protected] Abstract OPEN ACCESS Background Citation: Pingel J, Petersen MCH, Fredberg U, Kjær Achilles tendinopathy is a painful inflammatory condition characterized by swelling, stiffness SG, Quistorff B, Langberg H, et al. (2015) and reduced function of the Achilles tendon. Kager’s fat pad is an adipose tissue located in Inflammatory and Metabolic Alterations of Kager's Fat Pad in Chronic Achilles Tendinopathy. PLoS ONE 10 the area anterior to the Achilles tendon. Observations reveal a close physical interplay be- (5): e0127811. doi:10.1371/journal.pone.0127811 tween Kager’s fat pad and its surrounding structures during movement of the ankle, sug- ’ Academic Editor: Hazel RC Screen, Queen Mary gesting that Kager s fat pad may stabilize and protect the mechanical function of the ankle University of London, UNITED KINGDOM joint. Received: January 19, 2015 Accepted: April 18, 2015 Aim Published: May 21, 2015 The aim of this study was to characterize whether Achilles tendinopathy was accompanied by changes in expression of inflammatory markers and metabolic enzymes in Kager’sfat Copyright: © 2015 Pingel et al.
    [Show full text]
  • The Infrapatellar Fat Pad from Diseased Joints Inhibits Chondrogenesis of Mesenchymal Stem Cells W
    EuropeanW Wei et Cellsal. and Materials Vol. 30 2015 (pages 303-314) DOI: 10.22203/eCM.v030a21 Anti-chondrogenic effect ofISSN IPFP 1473-2262 on MSCs THE INFRAPATELLAR FAT PAD FROM DISEASED JOINTS INHIBITS CHONDROGENESIS OF MESENCHYMAL STEM CELLS W. Wei1, R. Rudjito1, N. Fahy2, J.A.N. Verhaar1, S. Clockaerts1, Y.M. Bastiaansen-Jenniskens1,§ and G.J.V.M. van Osch1,3,§,* 1Department of Orthopaedics, Erasmus MC University Medical Center, Rotterdam, The Netherlands 2Regenerative Medicine Institute, National University of Ireland, Galway, Ireland 3Department of Otorhinolaryngology, Erasmus MC University Medical Center, Rotterdam, The Netherlands §Both authors contributed equally Abstract Introduction Cartilage repair by bone marrow derived mesenchymal Articular cartilage has limited self-healing capabilities stem cells (MSCs) can be influenced by inflammation and surgical intervention using bone marrow stimulation in the knee. Next to synovium, the infrapatellar fat pad techniques, such as the microfracture procedure, can be (IPFP) has been described as a source for inflammatory used to activate mesenchymal stem cells (MSCs) from factors. Here, we investigated whether factors secreted the underlying bone marrow to repair the defect (Shapiro by the IPFP affect chondrogenesis of MSCs and whether et al., 1993; Steadman et al., 2003). However, instead of this is influenced by different joint pathologies or obesity. a normal hyaline cartilage matrix, a fibrocartilaginous Furthermore, we examined the role of IPFP resident cartilage matrix fills up the defect (Frisbie et al., 2003; macrophages. First, we made conditioned medium from Kaul et al., 2012; Shapiro et al., 1993). An explanation IPFP obtained from osteoarthritic joints, IPFP from why hyaline cartilage production is inhibited could be traumatically injured joints during anterior cruciate that the cartilage defect is located in a post-traumatic ligament reconstruction, and subcutaneous adipose inflammatory environment (Irie et al., 2003).
    [Show full text]
  • Magnetic Resonance Imaging of Variants of the Knee Snoeckx A, Vanhoenacker F M, Gielen J L, Van Dyck P, Parizel P M
    Pictorial Essay Singapore Med J 2008; 49(9) : 734 CME Article Magnetic resonance imaging of variants of the knee Snoeckx A, Vanhoenacker F M, Gielen J L, Van Dyck P, Parizel P M ABSTRACT 1a Magnetic resonance imaging has become the imaging modality of choice for evaluation of internal derangements of the knee. Anatomical variants are often an incidental finding on these examinations. Knowledge and recognition of variants is important, not only to avoid misdiagnosis but also to avoid additional imaging and over-treatment. This pictorial essay provides an overview of variants encountered during a review of 1,873 magnetic resonance imaging examinations of the knee. Emphasis is laid on these variants that are clinically important. Keywords: knee anatomy, knee imaging, knee variants, magnetic resonance imaging Singapore Med J 2008; 49(9): 734-744 INTRODUCTION Magnetic resonance (MR) imaging has become the imaging modality of choice for evaluation of internal derangements of the knee. Normal variants are often encountered as incidental finding on MR images. Department of Knowledge and recognition of variants is important for Radiology, Antwerp University accurate analysis of MR images. Incorrect interpretation Fig. 1 Sagittal SE T1-W MR image of the right knee in a 20- Hospital, may lead to unnecessary additional imaging and over- year-old woman shows residual islands of red bone marrow in University of the distal femur. There are no signal changes in the epiphysis or Antwerp, treatment. Initially, we performed a review of the literature patella, which contain fatty yellow marrow. Wilrijkstraat 10, B-2650 Edegem, on normal variants of the knee.
    [Show full text]
  • Function of the Infrapatellar Fat Pad and Advanced Hoffa's Disease with Ossification
    Arch Rheumatol 2014;29(2):134-137 doi: 10.5606/ArchRheumatol.2014.3499 CASE REPORT Function of the Infrapatellar Fat Pad and Advanced Hoffa's Disease With Ossification Murat KARKUCAK,1 Erhan ÇAPKIN,1 İpek CAN,1 Avni Mustafa ÖNDER,2 Ali KÜPELİ3 1Department of Physical Medicine and Rehabilitation, Medical Faculty of Karadeniz Technical University, Division of Rheumatology, Trabzon, Turkey 2Department of Orthopedics and Traumatology, Medical Faculty of Karadeniz Technical University, Trabzon, Turkey 3Department of Radiology, Medical Faculty of Karadeniz Technical University, Trabzon, Turkey Being one of the conditions presenting with patellar pain, Hoffa’s syndrome is characterized with inflammation of the fat tissue in the patellar region. In advanced stage, this may lead to transformation of the fibrocartilage tissue and ossification of the infrapatellar fat pad. Some cases can be associated with tumors or tumor-like conditions. In this article, we describe a 72-year-old female case suffering from knee pain for a long time and discuss the end-stage Hoffa's disease and function of the infrapatellar fat pad in the light of literature. Keywords: Hoffa’s syndrome; infrapatellar fat pad; ossification. Hoffa’s disease (or Hoffa’s fat pad syndrome) is Recurrent acute traumas, micro-traumas and a clinical condition, which develops as a result surgical procedures on the knee joint may cause of impingement of the infrapatellar fat pad hypertrophy following inflammation of the IFP. In (IFP) between the femorotibial and femoropatellar chronic phase, this may lead to transformation of spaces after inflammation and edema, and may the fibrocartilage tissue and ossification of the IFP cause knee pain.1 It generally begins with trauma (imitating enchondroma).5-7 at early ages.
    [Show full text]
  • Infrapatellar Plica Injury: Magnetic Resonance Imaging Review of a Neglected Cause of Anterior Knee Pain
    SA Journal of Radiology ISSN: (Online) 2078-6778, (Print) 1027-202X Page 1 of 8 Pictorial Review Infrapatellar plica injury: Magnetic resonance imaging review of a neglected cause of anterior knee pain Authors: Synovial plicae are normal remnants of synovial membranes within the knee joint cavity and 1 Dharmendra K. Singh are usually asymptomatic. Pathological infrapatellar plica, which is mostly due to plica injury, Heena Rajani1 Mukul Sinha1 may be a potential cause of anterior knee pain, but is often overlooked and under-reported on Amit Katyan1 magnetic resonance imaging (MRI). This pictorial review illustrates the MRI findings of Saurabh Suman1 infrapatellar plica injury and associated knee injuries, with emphasis on its differentiation 1 Aayushi Mishra from the mimics of plica injury. Bibhu K. Nayak2 Keywords: MR imaging; knee; synovial plica; infrapatellar plica injury; anterior knee pain. Affiliations: 1Department of Radiology, Vardhman Mahavir Medical College, Safdarjung Hospital, Introduction New Delhi, India Synovial plicae are normal folds of synovial tissue within a joint cavity, which represent normal 2Department of Sport’s remnants of synovial membranes during embryological development of the knee joint. There are Medicine, Vardhman Mahavir four main plicae in the knee joint, namely infrapatellar plica (IPP) or ligamentum mucosum, Medical College, Safdarjung suprapatellar plica, medio-patellar plica and lateral patellar plica, in decreasing order of Hospital, New Delhi, India occurrence.1 These may become symptomatic because of plica syndrome or injury. Although IPP Corresponding author: is the most commonly encountered plica, present in about 65% of patients, traditionally, it is Heena Rajani, considered least likely to be symptomatic.2,3 [email protected] Dates: This review illustrates a series of cases where patients presented to the Radiology department Received: 29 Aug.
    [Show full text]
  • Infrapatellar Fat Pad Syndrome : a Review of Anatomy, Function, Treatment and Dynamics
    Acta Orthop. Belg., 2016, 82, 94-101 ORIGINAL STUDY Infrapatellar fat pad syndrome : a review of anatomy, function, treatment and dynamics Mr James MACE, Prof Waqar BHATTI, Mr Sanjay ANAND From the Department of Trauma and Orthopaedics, Stepping Hill hospital NHS Foundation Trust, Cheshire, UK The infrapatellar (Hoffa’s) fatpad is an important small case series (3,14,15,17,19-21,26,29,35,38,39,43,46, structure within the knee, whose function and role 47). We present an overview of information pertain- are both poorly understood. This review explores the ing to the Infrapatellar fat pad and the role it may anatomy, neural innervation, vascularity, role in bio- play in pathology and pain around the knee. mechanics, pathology, imaging (stressing the impor- tance of dynamic ultrasound assessment) and treat- Anatomy ment of disorders presenting within this structure. Keywords : infrapatellar fatpad ; Hoffa’s fatpad ; ultra- The infrapatellar fat pad is one of three fat pads sound ; fatpad impingement. located in the anterior aspect of the knee (24). Its macroscopic, arthroscopic and radiographic ana- tomic boundaries are all well described (7,11,21,24,32, INTRODUCTION 37,43,49,50). Gallagher et al detail cadaveric anato- my, finding it to be a constant structure bounded In 1904, Albert Hoffa first attributed impinge- superiorly by the inferior pole of the patella, inferi- ment of the Infrapatellar fat pad to symptoms of orly by the anterior tibia, intermeniscal ligament, knee pain. He described inflammatory fibrous hy- meniscal horns and infrapatellar bursa, anteriorly by perplasia of the infrapatellar fat pad at excision, a the patellar tendon and posteriorly by the femoral procedure resulting in symptomatic relief in his se- ries of 21 patients (29).
    [Show full text]
  • Variant Attachments of the Anterior Horn of the Medial Meniscus
    Folia Morphol. Vol. 62, No. 3, pp. 291–292 Copyright © 2003 Via Medica S H O R T C O M M U N I C A T I O N ISSN 0015–5659 www.fm.viamedica.pl Variant attachments of the anterior horn of the medial meniscus Marian Jakubowicz, Wojciech Ratajczak, Andrzej Pytel Department of Anatomy, University of Medical Sciences, Poznań, Poland [Received 6 January 2003; Accepted 20 May 2003] The purpose of this study was to analyse the occurrence of variants of anoma- lous insertions of the anterior horn of the medial meniscus in human knee joints. The study was carried out on 78 human lower limbs of both sexes (42 males and 36 females). Out of 78 knee joints, 10 knee joints (12.82%) presented atypical attachments of the anterior horn of the medial meniscus. In 9 cases we found that the anterior horn of the medial meniscus was attached to the transverse ligament of the knee and in 1 case it was attached to the coronary ligament. In the remaining cases the anterior horn of the medial meniscus was attached to the anterior intercondylar area of the tibia. key words: knee joint, transverse ligament, coronary ligament INTRODUCTION left). Our anatomical findings were classified into the The anterior horn of the medial meniscus (AHMM) following categories, with reference to the criteria is attached, through the meniscal insertional liga- described by Ikeuchi [2]: the transverse ligament type, ments, to the anterior intercondylar area of the tibia where the AHMM was attached to the transverse anteriorly to the attachment of the anterior cruciate ligament of the knee, and the coronary ligament type, ligament (ACL).
    [Show full text]
  • Fat Pads As a Cause of Adolescent Anterior Knee Pain
    Current Concept Review Fat Pads as a Cause of Adolescent Anterior Knee Pain Mitchell G. Foster, BS1; Jerry Dwek, MD2; James D. Bomar, MPH2; Andrew T. Pennock, MD2 1University of California, San Diego, Department of Orthopedic Surgery, San Diego, CA; 2Rady Children’s Hospital, San Diego, Department of Orthopedic Surgery, San Diego, CA Abstract: Anterior knee pain is one of the most frequently encountered symptoms in pediatric sports medicine. The fat pad is a structure with mounting evidence supporting its dynamic involvement in many pathological states in the anterior knee. There are three peripatellar fat pads that occupy much of the extrasynovial space of the knee. This review explores the anatomy, innervation, vasculature, function, imaging, and pathology of these fat pads. Fat pad pathology is likely underestimated given the limited literature on such disease in the pediatric population. In particular, the prefemoral fat pad is the least described of the fat pads with only a few reports detailing chronic pathological pro- cesses. To highlight the relevance of the fat pad, particularly in the pediatric population, we describe an atypical case of a self-limiting acute prefemoral fat pad impingement due to a hyperextension injury in a young athlete. Key Concepts: • The three peripatellar fat pads of the anterior knee, although often overlooked, are important nociceptive struc- tures with robust vasculature that undergo dynamic changes in many pathological states. • Fat pad impingement is often described as a chronic process predominantly involving the infrapatellar fat pad; however, acute impingement is also clinically significant and all three of the fat pads may be implicated in disease.
    [Show full text]
  • Synovial Joints • Typically Found at the Ends of Long Bones • Examples of Diarthroses • Shoulder Joint • Elbow Joint • Hip Joint • Knee Joint
    Chapter 8 The Skeletal System Articulations Lecture Presentation by Steven Bassett Southeast Community College © 2015 Pearson Education, Inc. Introduction • Bones are designed for support and mobility • Movements are restricted to joints • Joints (articulations) exist wherever two or more bones meet • Bones may be in direct contact or separated by: • Fibrous tissue, cartilage, or fluid © 2015 Pearson Education, Inc. Introduction • Joints are classified based on: • Function • Range of motion • Structure • Makeup of the joint © 2015 Pearson Education, Inc. Classification of Joints • Joints can be classified based on their range of motion (function) • Synarthrosis • Immovable • Amphiarthrosis • Slightly movable • Diarthrosis • Freely movable © 2015 Pearson Education, Inc. Classification of Joints • Synarthrosis (Immovable Joint) • Sutures (joints found only in the skull) • Bones are interlocked together • Gomphosis (joint between teeth and jaw bones) • Periodontal ligaments of the teeth • Synchondrosis (joint within epiphysis of bone) • Binds the diaphysis to the epiphysis • Synostosis (joint between two fused bones) • Fusion of the three coxal bones © 2015 Pearson Education, Inc. Figure 6.3c The Adult Skull Major Sutures of the Skull Frontal bone Coronal suture Parietal bone Superior temporal line Inferior temporal line Squamous suture Supra-orbital foramen Frontonasal suture Sphenoid Nasal bone Temporal Lambdoid suture bone Lacrimal groove of lacrimal bone Ethmoid Infra-orbital foramen Occipital bone Maxilla External acoustic Zygomatic
    [Show full text]