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Updated: Jun 16 2021

Knee Imaging

Images fx_moved.jpg - Pellegrini-Stieda_moved.jpg lesion xray.jpg altal.jpg baja.jpg knee.jpg
  • High yield findings
      • High yield findings
      • Finding
      • Importance
      • Segond sign
      • Small lateral tibial avulsion fracture that indicates a ACL tear
      • Reverse Segond sign
      • Small medial tibial avulsion fracture that indicates a PCL tear
      • Arcuate sign
      • Fibular head avulsion fracture that indicates a PLC injury
      • Pellegrini Stieda sign
      • Medial femoral condyle avulsion fracture that indicates a chronic MCL injury
      • Patella alta
      • Patellofemoral pathology
      • Patella baja
      • Arthrofibrosis
      • Fairbanks changes
      • DJD - post meniscectomy (square condyle, peak eminences, ridging, narrowing)
      • Lateral MFC lesion
      • OCD
      • Crescent-shaped MFC lesion
      • Spontanous osteonecrosis of the knee (SONK)
      • Square lateral femoral condyle, cupped lateral tibial plateau
      • Discoid meniscus
      • 3 sagittal MRI images
      • Discoid meniscus
      • Bipartite patella
      • Must differentiate from fracture
  • Radiographic
    • Standard Radiographs
      • Weightbearing
        • preferred for evaluation of joint space
      • 45 degree PA flexion view (Rosenberg view)
        • best for early tibiofemoral arthritis, posterior wear
        • best for early tibiofemoral arthritis, posterior wear
      • best for early tibiofemoral arthritis, posterior wear
      • Merchant or sunrise view
        • to evaluate patellofemoral space, tilt, and alignment
    • best for early tibiofemoral arthritis, posterior wear
    • Stress Radiographs
      • Varus-valgus stress radiographs
        • two diagnostic indications
          • physeal fractures in children
          • MCL / LCL injuries
      • Posterior stress radiographs
        • isolated PCL injury (10-12 mm posterior displacement)
        • PCL and PLC injury (>12 mm posterior displacement)
  • MRI
    • Views
      • sagittal
        • evaluate menisci, cruciates, cartilage, extensor mechanism
      • coronal
        • evaluate menisci, cruciates, collaterals, cartilage
      • axial
        • evaluate patellofemoral joint, cruciates, popliteal fossa
    • Sequences
      • T1
        • water dark, fat bright
        • best for showing anatomy, but not pathology
      • T2
        • fat dark, water bright
        • well suited for imaging edema and pathology
      • STIR (Short T1 Inversion Recovery)
        • fat suppression technique
        • improved quality imaging in the presence of orthopedic prostheses
    • Excellent for
      • meniscal injury
        • medial meniscal extrusion >3mm is associated with severe meniscal degeneration, a large meniscal tear, or tear of the root
        • radial meniscal tears are more common in patients following prior meniscal surgery (32% prevalence of radial meniscal tears in post-op knees compared to 14% in patients without prior surgery)
        • 3.0 T MRI has accuracy, sensitivity, and specificity of >90% for detecting medial and lateral meniscus tears
      • ligament tear
        • increased signal intensity, thickening, and cysts within and adjacent to ACL are common findings, and clinically insignificant (no instability)
      • bone bruise
        • near sulcus terminalis
        • osteochondral injury
      • PLC corner injuries
        • can routinely visualize LCL and popliteus tendon with MRI, other structures are more rarely seen
        • edema posterior to popliteus tendon can indicate an injury to the underlying structures of the PLC
  • Ultrasound
    • Excellent for
      • fluid collections
        • useful to evaluate bursae and fluid collections about the knee
      • arthrofibrosis
        • effective in detecting arthrofibrosis of the knee following TKA
        • key findings for arthrofibrosis are synovial thickening and neovascularity
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