knee radiograph
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Radiography of the knee
Veronica Lagos-Jaramillo, MS4September 2012
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Knee Anatomy The knee is the largest joint in the body. The knee is stabilized by the collateral
ligaments. The lateral and medial menisci function as
shock absorbers. The bursae decrease friction of tendons
and muscles as they move over bones.
CURRENT Medical Diagnosis & Treatment 2012. www.accessmedicine.com
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Knee Anatomy
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Knee Joint Anatomy
Am Fam Physician. 1999;60(9):2599-2608.
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Imaging the kneePlain radiograph for:
Fractures Degenerative changes Osteochondral defects Effusions
CT for: Fractures in patients with knee trauma
MRI for: Damage to cartilage, menisci or ligaments
Cleveland Clinic Journal of Medicine 2008;75:377-384
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AP view of the knee
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Lateral view of the knee
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Sunrise view of the kneeTo assess the patellofemoral articulationFemur and tibia are superimposed Medial condyle is more rounded and prominent
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Identify the following . . .
femur
tibia
fibula
patella
lateral condyle
medial condyle
lateral epicondyle
medial epicondyle
intercondylar notch
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Identify the following . . .
medial femoral condyle
lateral femoral condyle
Inferior patellar tendon
Quadriceps femoris tendon
Tibial tuberosity
femur
tibia fibula
patella
intercondylar notch
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Knee injuries
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Patellar fracturesThe patella can be fractured
through one of its poles or through its central body.
Patellar fractures can be simple or comminuted.
Transverse fractures are most common and are most likely to
be displaced.
Am Fam Physician. 1999;60(9):2599-2608.
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Patellar fracturesDisplaced fracture of the lower pole of the
patella
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Patellar fracturesWhere is the fracture?
The Color Atlas of Family Medicine: http:accessmedicine.com
What type of fracture is this? Non-displaced patellar fracture
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FracturesFemoral condyle fractures account for 4% of
femur fractures. Potential complications include: DVT, fat embolus syndrome, delayed union ort malunion, and osteoarthritis.
Tibial spine and tuberosity fractures usually result in cruciate ligament insufficiency.
Fractures of the tibial plateau are seen more commonly in the elderly. Lateral plateau is more often fractured. Potential complications include: popliteal artery injury, DVT and osteoarthritis.
Tintinalli's Emergency Medicine: A Comprehensive Study Guide, 7e. www.accessmedicine.com
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Lateral condylar split fracture
Usually the result of low impact trauma
Common in kids
The Color Atlas of Family Medicine : http:accessmedicine.com
Where is the fracture?
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Tibial intercondylar emminence fracture
The lipohemarthrosis (composed of blood and fat from the marrow) seen above is a specific sign of an intra-articular fracture although a fracture is not visualized.
Identify the lipohemarthrosis on the radiograph
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Comminuted left tibial metaphysis and lateral plateau fracture
left tibial metaphysis fracture
Lateral plateau fracture
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Fracture of the tibial eminence
Koplas M et al. Cleveland Clinic Journal of Medicine 2008;75:377-384
joint effusion
lateral tibial bone depressed posteriorly
fracture
An additional sign of a fracture includes a joint effusion
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Epiphyseal platesEpiphyseal plates in children can be mistaken for
fractures
http://www.dartmouth.edu/~anatomy/Lowerextremity/leg-knee/radiology/APknee-child.htm
Child Adult
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Knee dislocation Often associated with a fracture of the tibial plateau
Usually the result of motor vehicle crashes, falls, sports, and industrial injuries
Knee dislocations are associated with popliteal artery and common peroneal and tibial nerve injuries
The Atlas of Emergency Medicine: http:accessmedicine.com
Posterior displacement of the tibia
Anterior knee displacement
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Patellar tendon rupture
The Atlas of Emergency Medicine: http:accessmedicine.com
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Arthritis
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Flow chart shows approach to radiographic evaluation of arthritis.
Jacobson J A et al. Radiology 2008;248:737-747©2008 by Radiological Society of North America
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Osteoarthritis of the knee
Felson DT. N Engl J Med 2006; 354:841-848
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Radiographic findingsOsteoarthritis: initially involves medial
sidejoint space narrowing subchondral cystsosteophytessclerosis
Basic Radiology, 2nd edition: http:accessmedicine.com
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Osteoarthritis
Bone on bone contact
Patellar osteophyte
subchondral osteophyte
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Radiographic findingsRheumatoid arthritis:OsteopeniaLoss of joint spaceLigamentous laxity Joint effusionBone erosion
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Rheumatoid arthritis
Tibial erosion
Jointeffusion
Diffuse osteopenia
Symmetric joint space narrowing Bone
erosion
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Identify the type of arthritis
What radiographic features do you see?
joint space narrowing medial or lateral side? medial
osteophyte
subchondral cyst
Osteoarthritis
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ReferencesFelson DT. N Engl J Med 2006; 354:841-848.
Geisel School of Medicine at Dartmouth, Department of Anatomy. Introduction to Radiology. Retreived September 6, 2012 from http://www.dartmouth.edu/~anatomy/Intro-to-radiology/index.htm.
Glaspy J.N., Steele M.T. (2011). Chapter 271. Knee Injuries. In Tintinalli's Emergency Medicine: A Comprehensive Study Guide, 7e. Retrieved September 6, 2012 from http://www.accessmedicine.com.
Gonzales R., Nadler P.L. (2013). Chapter 2. Common Symptoms. In M.A. Papadakis, S.J. McPhee, M.W. Rabow (Eds), CURRENT Medical Diagnosis & Treatment 2013. Retrieved September 6, 2012 from http://www.accessmedicine.com.
Jacobson J, Girish G, Jiang Y, et al. Radiographic evaluation of arthritis: degenerative joint disease and variations. Radiology. 2008; 248: 737-747.
Koplas M, Schils J and Sundaram M. The painful knee: choosing the right imaging test. Cleveland Clinic Journal of Medicine 2008;75:377-384.
Raukar N.P., Raukar G.J., Savitt D.L. (2010). Chapter 11. Extremity Trauma. In K.J. Knoop et al. (Eds), The Atlas of Emergency Medicine, 3e. Retrieved September 7, 2012 from http://www.accessmedicine.com.
Tandeter HB and P Shvartzman. Acute knee injuries: use of decision rules for selective radiograph ordering. Am Fam Physician. 1999 Dec 1;60(9):2599-2608.
Wasserman P.L., Pope T.L. (2011). Chapter 7. Imaging of Joints. In M.Y. Chen, T.L. Pope, D.J. Ott (Eds), Basic Radiology, 2e. Retrieved September 7, 2012 from http://www.accessmedicine.com.