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 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 Anterior Axial Sagittal 5 Medial Mensicus: posterior horn Baker Cyst Evaluation: pitfall MG MG SM SM Femur Tibia Sagittal Anterior Cruciate Ligament Posterior Cruciate Ligament Medial Lateral Tibia Femur Axial Sagittal Syllabus on line and other educational material: www.jacobsonmskus.com Twitter handle: @jjacobsn 6.