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Ultrasound - Knee

From SonoSite MSK Ultrasound Course, Pacific Medical, Tracy CA, February 2012

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Ultrasound - Knee

  1. 1. Ultrasound of the Knee Alan M. Hirahara, M.D., FRCS(C) Board Certified in Orthopaedic Surgery & Orthopaedic Sports Medicine Specializing in arthroscopic shoulder surgery Medical Director Team Physician ConsultantSacramento State Athletics Sacramento River Cats Oakland A’s MiLB - AAA
  2. 2. Ultrasound Technique - Anterior • Quadriceps tendon • Patellar tendon • Patella • Trochlea • Femoral condyles • ACL
  3. 3. Quadriceps Tendon - Longitudinal• Leg position: 30o Flexion with bolster• Tip: Superior to patella• MRI equivalent: Sagittal plane
  4. 4. Quadriceps Tendon - Transverse• Leg position: 30o Flexion with bolster• Tip: Find longitudinal view and turn probe 90o• MRI equivalent: Axial plane
  5. 5. Quadriceps – Poor Technique• Leg position: Extension• Problem: Concave tendon & false positive for tendon tear• Solutions: Angle transducer perpendicular to tendon Bend knee to 30o
  6. 6. Patellar Tendon - Longitudinal• Leg position: 30o Flexion with bolster• Tip: Superior to patella• MRI equivalent: Sagittal plane
  7. 7. Patellar Tendon - Transverse• Leg position: 30o Flexion with bolster• Tip: Find longitudinal view and turn probe 90o• MRI equivalent: Axial plane
  8. 8. Patellar Tendon – Long / Sup vs Inf• Superior: More common area of tendonopathy• Inferior: May see evidence of Osgood-Schlatter dz
  9. 9. Patellar Tendinosis
  10. 10. Partial Patellar Tendon Tear
  11. 11. Patellar Tendon Rupture
  12. 12. Patellar Tendon Repair
  13. 13. Patellar Tendon Repair
  14. 14. Trochlea• Leg position: Full Flexion• Tip: Superior to patella• MRI equivalent: Axial plane
  15. 15. Femoral Condyles - Anterior• Leg position: Full Flexion• Tip: Superior to patella• MRI equivalent: Sagittal plane
  16. 16. MFC Chondral Lesion
  17. 17. ACL• Leg position: Full Flexion• Tip: Transpatellar tendon, tilt probe in plane with ligament• MRI equivalent: Sagittal plane
  18. 18. Ultrasound Technique - Medial • Medial meniscus • MCL • MPFL • Pes anserine bursae *
  19. 19. MCL• Leg position: 30o Flexion; Hip externally rotated• Tip: Find medial epicondyle and follow to joint• MRI equivalent: Frontal plane
  20. 20. MCL Tear
  21. 21. MCL Tear
  22. 22. MCL Tear
  23. 23. Medial Meniscus• Leg position: 30o Flexion; Hip externally rotated• Tip: After finding medial meniscus, follow joint anterior / posterior• MRI equivalent: Frontal plane
  24. 24. Medial Meniscus Tear
  25. 25. Post-op Medial Menisectomy
  26. 26. MPFL• Leg position: 30o Flexion; Hip externally rotated• Tip: Mid-patella and follow medial to adductor tubercle• MRI equivalent: Axial plane
  27. 27. MPFL Strain
  28. 28. Ultrasound Technique - Lateral • IT band • LCL • Lateral meniscus • Posterolateral corner • Popliteus
  29. 29. LCL• Leg position: 30o Flexion; Hip internally rotated• Tip: Find fibular head and follow to lateral epicondyle• MRI equivalent: Frontal plane
  30. 30. LCL Sprain
  31. 31. IT Band• Leg position: Extension; Hip internally rotated• Tip: Find Gerdy’s tubercle and follow proximally• MRI equivalent: Frontal plane
  32. 32. Lateral Meniscus• Leg position: Extension; Hip internally rotated• Tip: Find lateral joint line. Stay perpendicular to joint line• MRI equivalent: Frontal plane
  33. 33. Lateral Meniscus Tear
  34. 34. Lateral Meniscus Tear
  35. 35. Popliteus• Leg position: 30o Flexion; Hip internally rotated• Tip: Angle probe, find groove in condyle laterally under LCL• MRI equivalent: Frontal plane
  36. 36. Ultrasound Technique - Posterior • Menisci • PCL • Pes anserine – Sartorius, Gracilis, Semitendinosus • Semimembranosus • Biceps femoris • Gastrocnemius • Femoral condyles • Popliteal artery & vein • Tibial & Peroneal nerves
  37. 37. Posterior Mensici• Leg position: Prone, extension• Tip: Find joint line and move over medial knee• MRI equivalent: Sagittal plane
  38. 38. Posterior Medial Meniscus Tear
  39. 39. Posterior Medial Meniscus Tear
  40. 40. Baker’s Cyst & Loose Body
  41. 41. Posterior Condyles• Leg position: Prone, extension• Tip: Find meniscus then move superior• MRI equivalent: Sagittal plane
  42. 42. PCL• Leg position: Prone, extension• Tip: Find joint line and move central. Will find medial to popliteal a.• MRI equivalent: Sagittal plane
  43. 43. NV Structures - Transverse• Leg position: Prone, extension• Tip: Center of posterior knee. Compression to identify artery/vein• Use CPD to identify artery/vein• MRI equivalent: Axial plane
  44. 44. NV Structures - Longitudinal• Leg position: Prone, extension• Tip: Find NV transverse plane then turn probe 90o• MRI equivalent: Sagittal plane

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From SonoSite MSK Ultrasound Course, Pacific Medical, Tracy CA, February 2012

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