Ultrasound of the Knee: Scanning Protocol

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Ultrasound of the Knee: Sonographic Technique: Scanning Protocol • Focused examination • Complete assessment Jon A. Jacobson, M.D. – Anterior Professor of Radiology – Medial Director, Division of Musculoskeletal Radiology – Lateral University of Michigan – Posterior • Transducers: 5 - 17 MHz linear

Anatomy: anterior Technique: anterior • Quadriceps tendon • Patellar tendon • Suprapatellar recess: joint effusion • Bursa: – Prepatellar, superficial infrapatellar, deep infrapatellar

From: Netter’s Atlas of Human Anatomy

Suprapatellar Recess and Gutters Quadriceps Tendon & Suprapatellar Recess

Patella

Femur Long Axis

From: Miller PJ et al. Am J Sports Med 2001;29:822.

1 Quadriceps Tendon & Suprapatellar Recess Quadriceps Tendon

Patella

Femur

Short Axis Long Axis

Patellar Tendon Retinaculum Joint Effusion Patella • Knee flexion: Medial – Suprapatellar Femur recess Fat Pad – Sagittal plane • Knee extension: – Medial and lateral Pat Short Axis gutters – Axial plane Lateral Femur

Patellar Tendon Articular Cartilage: femur

Long Axis

Femoral Condyle Trochlea Axial Sagittal Patella Tibia

2 Anatomy: medial

Technique: medial • Medial collateral ligament • Medial meniscus – Body – Anterior horn • Pes anserinus

From: Netter’s Atlas of Human Anatomy

MCL and Medial Meniscus Pes Anserinus

1 2 3

Tibia Femur

Longitudinal: distal MCL Longitudinal: Semitendinosus

Long Axis

Anatomy: lateral Technique: lateral • Iliotibial tract • Lateral collateral ligament • Popliteus tendon • Biceps femoris tendon • Common peroneal nerve • Lateral meniscus: body & anterior horn

From: Netter’s Atlas of Human Anatomy

3 Iliotibial Tract Lateral Collateral Ligament

Tibia Femur

Longitudinal

LCL, Popliteus, and Lateral Meniscus Bifurcating Distal Biceps Femoris: • Long axis of fibular collateral ligament • Biceps separates: superficial, deep layers • Surrounds fibular collateral ligament LM Tibia Fibula • May be mistaken as tendinosis or ligament Femur abnormality

Smith, J Ultrasound Med 2011; 30:1156

Longitudinal

Bifurcating Biceps Femoris Tendon Biceps Femoris Tendon

LCL Fibula

Fibula

Longitudinal Femur Fibular Collateral Ligament (long axis)

4 Common Peroneal Nerve

BF LCL Technique: posterior • Baker cyst

Fibula • Menisci: posterior horns • Cruciate ligaments Posterior Anterior Longitudinal Transverse

Anatomy: posterior Technique: Baker cyst • Locate posterior femoral condyle: transverse – Toggle transducer to produce anisotropy – Identify the medial gastrocnemius and semimembranosus • Locate soleus, medial, and lateral gastrocnemius muscles – Follow medial border of medial gastrocnemius muscle – Visualize semimembranosus tendon From: Netter’s Atlas of Human Anatomy AJR 2001; 176:373

No Baker Cyst No Baker Cyst

Posterior ST

MG SM SM Medial

MG Femur

Axial Sagittal

5 Medial Mensicus: posterior horn Baker Cyst Evaluation: pitfall

MG SM SM

Femur Tibia

Sagittal

Anterior Cruciate Ligament Posterior Cruciate Ligament

Medial Lateral

Tibia

Femur Axial Sagittal

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