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Semin Musculoskelet Radiol 2007; 11(2): 137-148
DOI: 10.1055/s-2007-1001879
© Thieme Medical Publishers

Ultrasound of the Knee

Marc J. Lee1 , Kira Chow2
  • 1Department of Radiology, Saint Joseph Medical Center, Burbank, California
  • 2Department of Radiology, Santa Monica-UCLA Medical Center and Orthopedic Hospital, Santa Monica, California
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Publication History

Publication Date:
20 December 2007 (online)

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ABSTRACT

Ultrasound of the knee is best suited for the evaluation of tendons, fluid collections and effusion, synovitis, periarticular soft tissue masses, muscles, and the collateral ligaments. Advantages of sonographic evaluation include the lack of ionizing radiation, the noninvasive nature of the examination, focused evaluation correlated with the specific site of pain, multiplanar capability, and utility in patients for whom magnetic resonance imaging (MRI) is contraindicated. The ability to visualize the microanatomy of tendons, ligaments, nerves, and muscles is also an advantage over MRI. Moreover, ultrasound is generally readily accessible and of lower cost than MRI. Ultrasound is less suited for the evaluation of internal derangement. Certain structures that are exquisitely evaluated by MRI, including the menisci, cruciate ligaments, bone marrow, and articular cartilage, are suboptimally evaluated by sonography. This article reviews the structures and pathological processes for which ultrasound has been shown useful, emphasizing appropriate technique and normal anatomy, appearance of pathological processes, and advantages and limitations of sonographic evaluation.

KEYWORDS

Ultrasound - sonography - knee

REFERENCES

  • 1 Friedman L, Finlay K, Jurriaans E. Ultrasound of the knee.  Skeletal Radiol. 2001;  30(7) 361-377
    CrossrefPubMedGoogle Scholar
  • 2 Bianchi S, Zwass A, Abdelwahab I F, Banderali A. Diagnosis of tears of the quadriceps tendon of the knee: value of sonography.  AJR Am J Roentgenol. 1994;  162(5) 1137-1140
    CrossrefPubMedGoogle Scholar
  • 3 Carr J C, Hanly S, Griffin J, Gibney R. Sonography of the patellar tendon and adjacent structures in pediatric and adult patients.  AJR Am J Roentgenol. 2001;  176(6) 1535-1539
    PubMedGoogle Scholar
  • 4 Khan K M, Bonar F, Desmond P M et al.. Patellar tendinosis (jumper's knee): findings at histopathologic examination, US, and MR imaging. Victorian Institute of Sport Tendon Study Group.  Radiology. 1996;  200(3) 821-827
    CrossrefPubMedGoogle Scholar
  • 5 De Flaviis L, Scaglione P, Nessi R, Albisetti W. Ultrasound in degenerative cystic meniscal disease of the knee.  Skeletal Radiol. 1990;  19(6) 441-445
    PubMedGoogle Scholar
  • 6 Fessell D P, Jacobson J A, Craig J et al.. Using sonography to reveal and aspirate joint effusions.  AJR Am J Roentgenol. 2000;  174(5) 1353-1362
    CrossrefPubMedGoogle Scholar
  • 7 Delaunoy I, Feipel V, Appelboom T, Hauzeur J P. Sonography detection threshold for knee effusion.  Clin Rheumatol. 2003;  22(6) 391-392
    CrossrefPubMedGoogle Scholar
  • 8 Bonnefoy O, Diris B, Moinard M, Aunoble S, Diard F, Hauger O. Acute knee trauma: role of ultrasound.  Eur Radiol. 2006;  16(11) 2542-2548
    CrossrefPubMedGoogle Scholar
  • 9 Costa D N, Cavalcanti C F, Sernik R A. Sonographic and CT findings in lipohemarthrosis.  AJR Am J Roentgenol. 2007;  188(4) W389
    CrossrefPubMedGoogle Scholar
  • 10 Ward E E, Jacobson J A, Fessell D P, Hayes C W, van Holsbeeck M. Sonographic detection of Baker's cysts: comparison with MR imaging.  AJR Am J Roentgenol. 2001;  176(2) 373-380
    CrossrefPubMedGoogle Scholar
  • 11 Casser H R, Sohn C, Kiekenbeck A. Current evaluation of sonography of the meniscus. Results of a comparative study of sonographic and arthroscopic findings.  Arch Orthop Trauma Surg. 1990;  109(3) 150-154
    CrossrefPubMedGoogle Scholar
  • 12 Friedl W, Glaser F. Dynamic sonography in the diagnosis of ligament and meniscal injuries of the knee.  Arch Orthop Trauma Surg. 1991;  110(3) 132-138
    CrossrefPubMedGoogle Scholar
  • 13 Gerngross H, Sohn C. Ultrasound scanning for the diagnosis of meniscal lesions of the knee joint.  Arthroscopy. 1992;  8(1) 105-110
    PubMedGoogle Scholar
  • 14 Azzoni R, Cabitza P. Is there a role for sonography in the diagnosis of tears of the knee menisci?.  J Clin Ultrasound. 2002;  30(8) 472-476
    CrossrefPubMedGoogle Scholar
  • 15 Selby B, Richardson M L, Montana M A, Teitz C C, Larson R V, Mack L A. High resolution sonography of the menisci of the knee.  Invest Radiol. 1986;  21(4) 332-335
    CrossrefPubMedGoogle Scholar
  • 16 Selby B, Richardson M L, Nelson B D, Graney D O, Mack L A. Sonography in the detection of meniscal injuries of the knee: evaluation in cadavers.  AJR Am J Roentgenol. 1987;  149(3) 549-553
    PubMedGoogle Scholar
  • 17 van Holsbeeck M IJ, Introcaso J H. Musculoskeletal Ultrasound. St. Louis; Mosby-Year Book 2001
    Google Scholar
  • 18 Rutten M J, Collins J M, van Kampen A, Jager G J. Meniscal cysts: detection with high-resolution sonography.  AJR Am J Roentgenol. 1998;  171(2) 491-496
    CrossrefPubMedGoogle Scholar
  • 19 De Maeseneer M, Lenchik L, Starok M, Pedowitz R, Trudell D, Resnick D. Normal and abnormal medial meniscocapsular structures: MR imaging and sonography in cadavers.  AJR Am J Roentgenol. 1998;  171(4) 969-976
    CrossrefPubMedGoogle Scholar
  • 20 Court-Payen M. Sonography of the knee: intra-articular pathology.  J Clin Ultrasound. 2004;  32(9) 481-490
    CrossrefPubMedGoogle Scholar
  • 21 Seymour R, Lloyd D C. Sonographic appearances of meniscal cysts.  J Clin Ultrasound. 1998;  26(1) 15-20
    CrossrefPubMedGoogle Scholar
  • 22 Ptasznik R, Feller J, Bartlett J, Fitt G, Mitchell A, Hennessy O. The value of sonography in the diagnosis of traumatic rupture of the anterior cruciate ligament of the knee.  AJR Am J Roentgenol. 1995;  164(6) 1461-1463
    CrossrefPubMedGoogle Scholar
  • 23 Skovgaard Larsen L P, Rasmussen O S. Diagnosis of acute rupture of the anterior cruciate ligament of the knee by sonography.  Eur J Ultrasound. 2000;  12(2) 163-167
    CrossrefPubMedGoogle Scholar
  • 24 Suzuki S, Kasahara K, Futami T, Iwasaki R, Ueo T, Yamamuro T. Ultrasound diagnosis of pathology of the anterior and posterior cruciate ligaments of the knee joint.  Arch Orthop Trauma Surg. 1991;  110(4) 200-203
    PubMedGoogle Scholar
  • 25 Cho K H, Lee D C, Chhem R K et al.. Normal and acutely torn posterior cruciate ligament of the knee at US evaluation: preliminary experience.  Radiology. 2001;  219(2) 375-380
    CrossrefPubMedGoogle Scholar
  • 26 Miller T T. Sonography of injury of the posterior cruciate ligament of the knee.  Skeletal Radiol. 2002;  31(3) 149-154
    CrossrefPubMedGoogle Scholar
  • 27 Bonaldi V M, Chhem R K, Drolet R, Garcia P, Gallix B, Sarazin L. Iliotibial band friction syndrome: sonographic findings.  J Ultrasound Med. 1998;  17(4) 257-260
    PubMedGoogle Scholar
  • 28 Goh L A, Chhem R K, Wang S C, Chee T. Iliotibial band thickness: sonographic measurements in asymptomatic volunteers.  J Clin Ultrasound. 2003;  31(5) 239-244
    CrossrefPubMedGoogle Scholar
  • 29 Phornphutkul C, Sekiya J K, Wojtys E M, Jacobson J A. Sonographic imaging of the patellofemoral medial joint stabilizing structures: findings in human cadavers.  Orthopedics. 2007;  30(6) 472-478
    PubMedGoogle Scholar
  • 30 Starok M, Lenchik L, Trudell D, Resnick D. Normal patellar retinaculum: MR and sonographic imaging with cadaveric correlation.  AJR Am J Roentgenol. 1997;  168(6) 1493-1499
    PubMedGoogle Scholar
  • 31 O'Reilly M A, O'Reilly P M, Bell J. Sonographic appearances of medial retinacular complex injury in transient patellar dislocation.  Clin Radiol. 2003;  58(8) 636-641
    CrossrefPubMedGoogle Scholar
  • 32 Trikha S P, Acton D, O'Reilly M, Curtis M J, Bell J. Acute lateral dislocation of the patella: correlation of ultrasound scanning with operative findings.  Injury. 2003;  34(8) 568-571
    CrossrefPubMedGoogle Scholar
  • 33 Kwak H S, Han Y M, Lee S Y, Kim K N, Chung G H. Diagnosis and follow-up US evaluation of ruptures of the medial head of the gastrocnemius (“tennis leg”).  Korean J Radiol. 2006;  7(3) 193-198
    CrossrefPubMedGoogle Scholar
  • 34 Naredo E, Moller I, Moragues C et al.. Interobserver reliability in musculoskeletal ultrasonography: results from a “Teach the Teachers” rheumatologist course.  Ann Rheum Dis. 2006;  65(1) 14-19
    CrossrefPubMedGoogle Scholar
  • 35 Carotti M, Salaffi F, Manganelli P, Salera D, Simonetti B, Grassi W. Power Doppler sonography in the assessment of synovial tissue of the knee joint in rheumatoid arthritis: a preliminary experience.  Ann Rheum Dis. 2002;  61(10) 877-882
    CrossrefPubMedGoogle Scholar
  • 36 Kasukawa R, Yamadera Y, Takahashi A, Takeda I, Kanno T. Power Doppler sonography for detection of intraarticular vascularization in knee joints of patients with rheumatoid arthritis.  Mod Rheumatol. 2004;  14(2) 149-153
    PubMedGoogle Scholar
  • 37 Qvistgaard E, Kristoffersen H, Terslev L, Danneskiold-Samsoe B, Torp-Pedersen S, Bliddal H. Guidance by ultrasound of intra-articular injections in the knee and hip joints.  Osteoarthritis Cartilage. 2001;  9(6) 512-517
    CrossrefPubMedGoogle Scholar
  • 38 Walther M, Harms H, Krenn V, Radke S, Faehndrich T P, Gohlke F. Correlation of power Doppler sonography with vascularity of the synovial tissue of the knee joint in patients with osteoarthritis and rheumatoid arthritis.  Arthritis Rheum. 2001;  44(2) 331-338
    CrossrefPubMedGoogle Scholar
  • 39 Newman J S, Laing T J, McCarthy C J, Adler R S. Power Doppler sonography of synovitis: assessment of therapeutic response-preliminary observations.  Radiology. 1996;  198(2) 582-584
    CrossrefPubMedGoogle Scholar
  • 40 Fiocco U, Cozzi L, Rubaltelli L et al.. Long-term sonographic follow-up of rheumatoid and psoriatic proliferative knee joint synovitis.  Br J Rheumatol. 1996;  35(2) 155-163
    CrossrefPubMedGoogle Scholar
  • 41 Cellerini M, Salti S, Trapani S, D'Elia G, Falcini F, Villari N. Correlation between clinical and ultrasound assessment of the knee in children with mono-articular or pauci-articular juvenile rheumatoid arthritis.  Pediatr Radiol. 1999;  29(2) 117-123
    CrossrefPubMedGoogle Scholar
  • 42 Sureda D, Quiroga S, Arnal C, Boronat M, Andreu J, Casas L. Juvenile rheumatoid arthritis of the knee: evaluation with US.  Radiology. 1994;  190(2) 403-406
    PubMedGoogle Scholar
  • 43 de Miguel Mendieta E, Cobo Ibanez T, Uson Jaeger J, Bonilla Hernán G, Martin Mola E. Clinical and ultrasonographic findings related to knee pain in osteoarthritis.  Osteoarthritis Cartilage. 2006;  14(6) 540-544
    CrossrefPubMedGoogle Scholar
  • 44 Coari G, Iagnocco A, Zoppini A. Chondrocalcinosis: sonographic study of the knee.  Clin Rheumatol. 1995;  14(5) 511-514
    CrossrefPubMedGoogle Scholar
  • 45 Sofka C M, Adler R S, Cordasco F A. Ultrasound diagnosis of chondrocalcinosis in the knee.  Skeletal Radiol. 2002;  31(1) 43-45
    CrossrefPubMedGoogle Scholar
  • 46 Wakefield R J, Brown A, O'Connor P et al.. Rheumatological ultrasound.  Rheumatology (Oxford). 2003;  42(8) 1001
    CrossrefPubMedGoogle Scholar
  • 47 Miller T T. Sonography of joint replacements.  Semin Musculoskelet Radiol. 2006;  10(1) 79-85
    Article in Thieme ConnectPubMedGoogle Scholar
  • 48 Okamoto T, Futani H, Atsui K, Fukunishi S, Koezuka A, Maruo S. Sonographic appearance of fibrous nodules in patellar clunk syndrome: a case report.  J Orthop Sci. 2002;  7(5) 590-593
    CrossrefPubMedGoogle Scholar
  • 49 Boldt J G, Munzinger U K, Zanetti M, Hodler J. Arthrofibrosis associated with total knee arthroplasty: gray-scale and power Doppler sonographic findings.  AJR Am J Roentgenol. 2004;  182(2) 337-340
    PubMedGoogle Scholar
  • 50 Sofka C M, Adler R S, Laskin R. Sonography of polyethylene liners used in total knee arthroplasty.  AJR Am J Roentgenol. 2003;  180(5) 1437-1441
    PubMedGoogle Scholar

Kira ChowM.D. 

Department of Radiology, Santa Monica-UCLA Medical Center and Orthopedic Hospital

1250 16th St., Ste. 275, 2nd Fl., Tower, Santa Monica, CA 90404

Email: kchow@mednet.ucla.edu

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