Osteopathic Medicine. MSK Ultrasound Knee May 1,2015 POMA. Musculoskeletal Ultrasound of the Knee Patrick F. Leary, D.O.
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1 MSK Ultrasound Knee May,05 POMA Patrick F. Leary DO FAOASM FACSM FACOFP Director LECOM Sports Medicine Osteopathic Medicine. The body is a unit.. The body possesses self regulatory mechanisms.. Structure and function are reciprocally interrelated.. Rational therapy is based upon an understanding of body unity, self regulatory mechanisms, and the inter-relationship of structure and function. April 9 May, 05
2 Objectives Illustrate the anatomy of the knee in four quadrants Identify the major tendons and ligaments of the knee Demonstrate the pertinent structures via MSK ultrasound using AIUM Technical Guidelines Feature and delineate common pathologic findings Demonstrate Intra-articular Injection technique and potential extra-articular injections Anechoic Hyperechoic Hypoechoic Cortical Irregularities Fibrillar Pattern Enthesis Linear slide Long axis/longitudinal Short axis/transverse Nomenclature 50mm linear probe/curvilinear probe/hockey stick Depth Anisotropy Shadowing Artifact Hyaline cartilage stripe Fin/Directional indicator Organizations AIUM American Institute of Ultrasound Medicine AOASM Fellowship Curriculum ESSR European Society of Muskuloskeletal Radiology Certification Requirements Proficiency Exam Reimbursements by Third Party April 9 May, 05
3 MSK Ultrasound Four Quadrants Anatomy April 9 May, 05
4 Knee Joint Anatomy: Quadriceps Tendon Complex Quadriceps Tendon Complex:. Vastus Intermedius. Vastus Lateralus/Medialis. Rectus Femoris. Trochlear Hyaline Cartilage 5. Distal Femur 6. Proximal Patella degree flexion flexion Anatomy Anterior Long Axis April 9 May, 05
5 Anterior Short Axis Suprapatellar Effusion April 9 May, 05 5
6 Suprapatellar Recess/Bursa:. Quadriceps Fad Pad. Prefemoral Fat Pad. Simple Synovial Fluid. Trochlear Hyaline Cartilage 5. Distal Femur 6. Proximal Patella Anatomy degree flexion Suprapatellar Recess/Bursa Transverse Axis Complex Effusion Simple Effusion April 9 May, 05 6
7 Knee Joint Anatomy: Anterior Trochlear Cartilage 5 degree flexion, Imaged axial to the Quadriceps Tendon view Anterior Trochlea: Osteochondral Cortical Defect April 9 May, 05 7
8 Knee Joint Anatomy: Infrapatellar Tendon Infrapatellar Tendon:. Distal Patella. Tibial Tuberosity. Infrapatellar Tendon. Hoffa s Fat Pad Knee Joint Anatomy: Infrapatellar Pathology April 9 May, 05 8
9 Patellar Tendon Short Patellar Tendon Long Axis Medial Right Knee April 9 May, 05 9
10 Medial Knee Joint Anatomy: Medial Collateral Ligament Medial Collateral Ligament:. Medial Epicondyle (MCL Origin). Medial Meniscus. Medial Tibial Plateau. Flair of medial tibia 5. MCL Insertion 5 Knee Joint Anatomy: Medial Collateral Ligament Medial Collateral Ligament:. Medial Epicondyle (MCL Origin). Medial Meniscus. Medial Tibial Plateau. Flair of medial tibia 5. MCL Insertion 5 April 9 May, 05 0
11 Medial Knee Joint Anatomy: Pes Anserinus Complex Pes Anserinus Complex:. MCL over Tibial Flair. Shadow of oblique Pes Anserinus. Sartorius. Gracilis 5. Semitendinosus 5 Transverse Pes Anserinus Long Axis Pes Anserinus April 9 May, 05
12 Pes Anserine Knee Joint Anatomy: Meniscus Visualization Not the primary, definitive examination of choice Negative examination does not exclude tear Positive result should be confirmed Medial and lateral menisci partially seen Normal Complex Meniscal Cyst Knee Joint Anatomy: Meniscus Visualization April 9 May, 05
13 Lateral Right Knee Lateral Left Knee Lateral April 9 May, 05
14 Knee Joint Anatomy: Iliotibial Band/Tract Iliotibial Band/Tract:. Gerdy s Tubercle. Lateral Femur. Lateral Joint Recess. Iliotibial Bursa 5. Lateral Meniscus 6. Iliotibial Band/Tract 6 5 Lateral Knee Joint Anatomy: Lateral Colateral Ligament Lateral Colateral Ligament:. Fibular Head. Lateral Tibia. Lateral Femoral Epicondyle. Lateral Meniscus 5. Lateral Collateral Ligament 6. Bicep Femoris Shadow 7. Popliteus Tendon Groove April 9 May, 05
15 Knee Joint Anatomy: Lateral Colateral Ligament Lateral Colateral Ligament:. Fibular Head. Lateral Tibia. Lateral Femoral Epicondyle. Lateral Meniscus 5. Lateral Colateral Ligament 6. Bicep Femoris Shadow 5 6 Posterior Right Knee Areas of Interest Criss Cross Sign Semimembranosis and Medial Head Gastroc Bakers Cyst Posterior Femoral Condyle Posterior Horn Medial Meniscus Vessels PCL Medial/Lateral Gastroc Soleus April 9 May, 05 5
16 Posterior Lateral Knee Joint Anatomy: Posterior Medial Exam Semimembranosus Gastrocnemius Bursa Baker s Cyst Posterior Lateral Ganglion Cyst Not a Bakers Cyst Post Horn April 9 May, 05 6
17 Knee Joint Anatomy: Posterior Medial Exam Semimembranosus Gastrocnemius Bursa Baker s Cyst. Medial Femoral Condyle. Articular Cartilage. Semimembranosus. Medial Head of the Gastrocnemius Popliteal Fossa/Tibial Nn Peroneal Nerve/fibular head short axis April 9 May, 05 7
18 Posterior Lateral Corner Long Axis Knee Joint Anatomy: Posterior Neurovascular Structures Posterior Midline Knee:. Tibial Nerve. Popliteal Vein and Artery. Medial Femoral Condyle. Medial and Lateral Gastrocnemius Transverse Axis Long Axis Knee Joint Anatomy: Posterior Medial Exam Semimembranosus Gastrocnemius Bursa Baker s Cyst April 9 May, 05 8
19 Medial Gastroc Tear Knee Joint Anatomy: Posterior Medial Exam Semimembranosus Gastrocnemius Bursa Baker s Cyst April 9 May, 05 9
20 April 9 May, 05 0
21 Anatomy Anatomy 5 6. Subcutaneous Fat. Fascia Layer surround Distal Musculature. Quadriceps Tendon in Transverse (Axial) View. Synovial Capsule and fluid (Compressible) 5. Pre-Femoral Fat Pad April 9 May, 05
22 Other Procedures: Platelet Rich Plasma Infrapatellar Tendon April 9 May, 05
23 References Bouffard JA Ultrasonography of the knee Semin Musculoskeletal Radiology 998 :5-70 Jacobson JA Fundamentals of Musculoskeletal Ultrasound Moore RE Sonography of the Extremities 007 AIUM Practical Guidelines MSK Ultrasound ESSR Technical Guidelines for the Knee April 9 May, 05
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