knee red dot
TRANSCRIPT
-
8/12/2019 Knee Red Dot
1/129
-
8/12/2019 Knee Red Dot
2/129
Anatomy
Image Evaluation
Fractures and Pathology
Pitfalls and Variants
Images
Case Study
-
8/12/2019 Knee Red Dot
3/129
-
8/12/2019 Knee Red Dot
4/129
Made up of 3 bones - femur,the tibia and the patella
2 ligaments - medial and
lateral collateral ligaments,(stabilize the knee from side-
to-side), ACL and PCL
(stabilize the knee from front-to-back)
AP Knee
-
8/12/2019 Knee Red Dot
5/129
-
8/12/2019 Knee Red Dot
6/129
Lateral Knee
-
8/12/2019 Knee Red Dot
7/129
-
8/12/2019 Knee Red Dot
8/129
Skyline View
Source: Wikiradiography
-
8/12/2019 Knee Red Dot
9/129
-
8/12/2019 Knee Red Dot
10/129
-
8/12/2019 Knee Red Dot
11/129
Ligament Origin Insertion Function
Medial CollateralLigament (MCL)
Medial Epicondyleof Femur Superior Tibia
The MCL protects the medialside from a valgus force.
Lateral CollateralLigament (LCL)
Lateral Epicondyleof Femur Head of Fibula
The LCL protects the lateralside from a varus force
Anterior CruciateLigament (ACL)
Lateral Condyle ofFemur
Tibia Plateau (anteriorintercondylar area)
The ACL prevents anteriordisplacement of the tibia
relative to the femur.
Posterior CruciateLigament (PCL)
Medial Condyle ofFemur
Tibia Plateau (posteriorintercondylar area)
The PCL prevents posteriordisplacment of the tibia
relative to the femur.
Arcuate Ligament Lateral Epicondyle &Condyle of Femur Medial Fibular headStrengthens the joint capsule
posteriorlaterally.
Oblique PoplitealLigament Medial Tibial
Condyle Lateral Femoral Condlye
A recurrent expansion of thetendon of the
semimembranosus thatreinforces the joint capsule
posteriorly.
Patellar Ligament Apex of the Patella Tibial Tuberosity
A very strong, thick fibrousband that helps maintain
alignment of the patella and
the way it articulates on thesurface of the femur.
-
8/12/2019 Knee Red Dot
12/129
-
8/12/2019 Knee Red Dot
13/129
A bursa is a fluid-filled structure that is present betweenthe skin and tendon or tendon and bone to reducefriction between adjacent moving structures.
-
8/12/2019 Knee Red Dot
14/129
Methode 1:
The lateral
condylopatellar
sulcus(arrowed) @ lateralfemoral notch,
distinguishes the lateral
femoral condyle from the
medial femoral condyle.
-
8/12/2019 Knee Red Dot
15/129
Methode 2:
The most reliable method
for identifying the medial
condyle is to locate therounded bony tubercle
(black arrow) known as
the adductor tubercle.
-
8/12/2019 Knee Red Dot
16/129
-
8/12/2019 Knee Red Dot
17/129
On AP, a
perpendicular linedrawn at the mostlateral margin offemoral condyle
should not havemore than 5 mm ofthe lateral margin oftibia condyle outside
of it
-
8/12/2019 Knee Red Dot
18/129
>5mm
Tibia plateaufracture
-
8/12/2019 Knee Red Dot
19/129
1. Lateral split.
2. Split with depression.
3. Pure lateral depression.
4. Pure medial depression.
5. Bicondylar.
6. Split extends tometadiaphyseal region
-
8/12/2019 Knee Red Dot
20/129
The patellar tilt angle is
formed by a line drawn
across the anterior limits of
the femoral condyle and aline connecting the apex of
the patellar articular surface
(lateral)+ve angle = normal
00 or ve angle = abnormal
-
8/12/2019 Knee Red Dot
21/129
-
8/12/2019 Knee Red Dot
22/129
Alta Baja
-
8/12/2019 Knee Red Dot
23/129
Alternative to Insall-Salvati ratioA horizontal line at the level of the tibial
plateau is drawn. Perpendicular to this
line vertically and a measurement ( B)
made of the distance between thehorizontal line and the inferior aspect of
the patellar articular surface. A second
measurement ( A) is made along the
patellar articular surface.B/ A is a measure of patellar height
Normal value = ratio of 0.8.
Patella alta = ratio >1.0
-
8/12/2019 Knee Red Dot
24/129
Identified by significant patella alta blurring of the posterior
margin of the patellartendon in to Hoffas fat
pad
presence of an avulsionfracture
-
8/12/2019 Knee Red Dot
25/129
This patient has had an unknown injury to the knee causing
rupture of the quadriceps femoris tendon. Note the unusual low position and forward tilting of the patella. The quadriceps tendon which is usually visualised contrasted
by the suprapatellar fat body is not demonstrated(arrow)
-
8/12/2019 Knee Red Dot
26/129
Lines drawn along the lateral patellar facet and the
anterior margins of the femoral trochlea.
The lateral patellofemoral angle should be open laterally.
-
8/12/2019 Knee Red Dot
27/129
-
8/12/2019 Knee Red Dot
28/129
Line BD should be equal or medial to the bisector line BD.
If it is lateral (as in this case), patellar subluxation can be
confirmed.
-
8/12/2019 Knee Red Dot
29/129
-
8/12/2019 Knee Red Dot
30/129
Yellow = Hoffa's fat pad
[largest]
Blue = Posterior
suprapatellar fat pad
Red = Anterior
suprapatellar fat pad
-
8/12/2019 Knee Red Dot
31/129
If suprapatellarpouch (bursa)> 5mm jointeffusion
Normal appearance
-
8/12/2019 Knee Red Dot
32/129
Appears as well-defined rounded homogeneous soft tissue density
within the suprapatella recess.
Will displace the quadraceps tendon and patella anteriorly.
Can result from inflammation, infection or trauma and may be an
exudate, transudate, blood or fat.
-
8/12/2019 Knee Red Dot
33/129
A particular type of effusion that occurs inintra-articular fracture.
A fat-fluid level is seen due to marrow fat
leaking into the joint space via the fracture.
-
8/12/2019 Knee Red Dot
34/129
-
8/12/2019 Knee Red Dot
35/129
-
8/12/2019 Knee Red Dot
36/129
(a) Transverse (usually in
central or distal third of
the patella)
(b) Vertical
(c) Marginal
(d) Comminuted
(e) Osteochondral
(f) Sleeve
-
8/12/2019 Knee Red Dot
37/129
Transverse fracture Vertical fracture
-
8/12/2019 Knee Red Dot
38/129
Marginal fracture fracture of edge of thepatella, do not extend acrosspatella
Comminuted fracture
-
8/12/2019 Knee Red Dot
39/129
Osteochondral fracture: An immediate fracture around the point of contact, separating a single
fragment that includes articular cartilage, subchondral bone, and
supporting trabecular bone.
-
8/12/2019 Knee Red Dot
40/129
Sleeve fracture Chondral or osteochondral avulsion injury at the inferior pole of the patella. Occur in the pediatric population, typically between 8 - 12 years old. Result from sudden and forceful contraction of quadriceps.
-
8/12/2019 Knee Red Dot
41/129
(A)An avulsion fracture between ligament and bone and
(B) An osteochondral fracture between the articular cartilages;
(C)Following patellar relocation, the osteochondral fragment
resulting from the fracture is located between the lateral facet of
the patella and the lateral femoral condyle.
-
8/12/2019 Knee Red Dot
42/129
-
8/12/2019 Knee Red Dot
43/129
- Fracture at the superior pole of the patella
-
8/12/2019 Knee Red Dot
44/129
May involve one or both condyles.
Usually associated with high impaction.
Usually associated soft tissue injury due to disruption
of ligamentous attachments.
Mechanism of injury: axial loading with varus/
valgus force
-
8/12/2019 Knee Red Dot
45/129
Type A: extra-articular fracture
Type B: partial articular fracture
Type C: complete articular fracture
-
8/12/2019 Knee Red Dot
46/129
-
8/12/2019 Knee Red Dot
47/129
Often associates with soft tissue injury
Caused by varus/valgus load with/without axial
load
Frequency :
lateral (60%)> bicondylar (25%)> medial(15%)
Partial or complete ligamentous ruptures occur in
about 15-45% & meniscal lesions in about 5-37% of
all tibia plateau fracture.
http://www.wheelessonline.com/ortho/tibial_plateau_fractures
http://www.wheelessonline.com/ortho/tibial_plateau_fractureshttp://www.wheelessonline.com/ortho/tibial_plateau_fractures -
8/12/2019 Knee Red Dot
48/129
-
8/12/2019 Knee Red Dot
49/129
1. Lateral split.2. Split with depression.3. Pure lateral
depression.4. Pure medialdepression.5. Bicondylar.6. Split extends tometadiaphyseal region
-
8/12/2019 Knee Red Dot
50/129
-
8/12/2019 Knee Red Dot
51/129
60% of plateau fractureinvolve lateral plateau.
This probably is result ofvalgus alignment of lowerextremity and fact thatmost injuring forces aredirected laterally tomedially.
-
8/12/2019 Knee Red Dot
52/129
-
8/12/2019 Knee Red Dot
53/129
Segond fracture
Reverse Segond fracture
Anterior cruciate ligament avulsion fracture
Posterior cruciate ligament avulsion fracture
Arcuate complex avulsion fracture
Biceps femoris avulsion fracturePellegrini Stieda disease (MCL tear)
http://radiopaedia.org/articles/avulsion-fractures-of-the-knee
http://radiopaedia.org/articles/avulsion-fractures-of-the-kneehttp://radiopaedia.org/articles/avulsion-fractures-of-the-kneehttp://radiopaedia.org/articles/avulsion-fractures-of-the-kneehttp://radiopaedia.org/articles/avulsion-fractures-of-the-kneehttp://radiopaedia.org/articles/avulsion-fractures-of-the-kneehttp://radiopaedia.org/articles/avulsion-fractures-of-the-kneehttp://radiopaedia.org/articles/avulsion-fractures-of-the-kneehttp://radiopaedia.org/articles/avulsion-fractures-of-the-kneehttp://radiopaedia.org/articles/avulsion-fractures-of-the-kneehttp://radiopaedia.org/articles/avulsion-fractures-of-the-knee -
8/12/2019 Knee Red Dot
54/129
Avulsion fracture of the
lateral tibial plateau
75% associated with
disruption of ACL
Occurs as a result of internal
rotation and varus stress
http://radiopaedia.org/articles/segond-fracture
http://radiopaedia.org/articles/segond-fracturehttp://radiopaedia.org/articles/segond-fracturehttp://radiopaedia.org/articles/segond-fracturehttp://radiopaedia.org/articles/segond-fracture -
8/12/2019 Knee Red Dot
55/129
-
8/12/2019 Knee Red Dot
56/129
Involves a fragment similar to that of the Segondfracture except that it is located on the medial
aspect of the proximal tibia.
Represents an avulsion of the deep capsular
component of the medial collateral ligament
Mechanism of injury: external rotation and a valgus
stress applied to the knee
-
8/12/2019 Knee Red Dot
57/129
-
8/12/2019 Knee Red Dot
58/129
http://radiopaedia.org/cases/diagram-classification-of-acl-avulsion-fractures-1
Type 1 - minimally/non-displaced fragment
Type 2 - anteriorelevation of the fragment
Type 3 - completeseparation of thefragment. 3b - Involvesthe majority of theeminence.
Type 4 - comminutedavulsion or a rotation ofthe fragment.
http://radiopaedia.org/cases/diagram-classification-of-acl-avulsion-fractures-1http://radiopaedia.org/cases/diagram-classification-of-acl-avulsion-fractures-1http://radiopaedia.org/cases/diagram-classification-of-acl-avulsion-fractures-1http://radiopaedia.org/cases/diagram-classification-of-acl-avulsion-fractures-1http://radiopaedia.org/cases/diagram-classification-of-acl-avulsion-fractures-1http://radiopaedia.org/cases/diagram-classification-of-acl-avulsion-fractures-1http://radiopaedia.org/cases/diagram-classification-of-acl-avulsion-fractures-1http://radiopaedia.org/cases/diagram-classification-of-acl-avulsion-fractures-1http://radiopaedia.org/cases/diagram-classification-of-acl-avulsion-fractures-1http://radiopaedia.org/cases/diagram-classification-of-acl-avulsion-fractures-1http://radiopaedia.org/cases/diagram-classification-of-acl-avulsion-fractures-1http://radiopaedia.org/cases/diagram-classification-of-acl-avulsion-fractures-1http://radiopaedia.org/cases/diagram-classification-of-acl-avulsion-fractures-1http://radiopaedia.org/cases/diagram-classification-of-acl-avulsion-fractures-1 -
8/12/2019 Knee Red Dot
59/129
Most common in children between ages of8-14 years
Usually result from avulsions of anterior
intercondylar eminence from pull of ACL
Caused by hyperflexion of the knee with
tibial internal rotation, or hyperextension ofthe knee.
-
8/12/2019 Knee Red Dot
60/129
-
8/12/2019 Knee Red Dot
61/129
White arrow - capsular
avulsion fracture,
termed a Segond #.
Segond # are highlyassociated with ACL
tears.
Black arrow - avulsion #
of the tibial spines,
indicates ACL injury.
-
8/12/2019 Knee Red Dot
62/129
Fracture of the posterior tibia
eminence
Less common
Caused by sudden
hyperextension of the knee or
a violent posterior
displacement of the tibiawhile the knee is in flexion.
-
8/12/2019 Knee Red Dot
63/129
The arcuate sign describes an avulsed bone fragment relatedto the insertion of the arcuate complex at the fibular styloidprocess.
The avulsed bone fragment appears as an elliptic piece of bonearising from the fibular styloid process with its long axis orientedhorizontally on the AP knee
-
8/12/2019 Knee Red Dot
64/129
Difficult to distinguish an avulsion fracture of the fibular head fromthat of the arcuate sign
Compare to appearance of arcuate sign, avulsion fracture ofthe biceps femoris tendon appears simply as an irregular bone
fragment arising from the fibular head
-
8/12/2019 Knee Red Dot
65/129
Uncommon
Calcification of MLC may occur after
MLC tear, known as Pellegrini Stieda
disease
-
8/12/2019 Knee Red Dot
66/129
Post traumatic ossification in or near the medial collateral ligament near
the margin of the medial femoral condyle
-
8/12/2019 Knee Red Dot
67/129
-
8/12/2019 Knee Red Dot
68/129
Chronic avulsion injury related to
repetitive microtrauma and traction on
the tibial tubercle by the patellar tendon
Always occurs in adolescent athletes
performing activities that require jumping& kicking
X-ray: reveal fragmentation anterior to
the tibial tubercle, soft-tissue swelling, and
obliteration of the inferior angle of the
infrapatellar fat pad
Mainly a clinical diagnosis rather than a
radiographic one
-
8/12/2019 Knee Red Dot
69/129
-
8/12/2019 Knee Red Dot
70/129
Osteochondrosis involving the apex of
patella
Usually seen in active adolescents between
10-14 years old
Calcification and ossification seen at inferiorpole of patella
X ray: small bony fragments adjacent to the
distal surface of patella with overlying soft
tissue swelling
Further evaluation with MRI is necessary to
distinguish this from patella sleeve fracture
http://www.pedsradiology.com/Historyanswer.aspx?qid=140&fid=1
http://www.pedsradiology.com/Historyanswer.aspx?qid=140&fid=1http://www.pedsradiology.com/Historyanswer.aspx?qid=140&fid=1 -
8/12/2019 Knee Red Dot
71/129
-
8/12/2019 Knee Red Dot
72/129
Sub-articular, post traumaticnecrosis
Result of aseptic separation of an
osteochondral fragment withgradual fragmentation of the
articular surface
Commonly caused by direct blow
85% seen at medial condyle, 15%
at lateral condyle
http://radiopaedia.org/articles/osteochondritis_dissecans
http://radiopaedia.org/articles/osteochondritis_dissecanshttp://radiopaedia.org/articles/osteochondritis_dissecans -
8/12/2019 Knee Red Dot
73/129
-
8/12/2019 Knee Red Dot
74/129
An uncommon disease in which there is metaplasia
of the synovial lining of joints, bursae or tendons
into cartilaginous nodules
The nodules may detach and become loosebodies in the joint
As the loose bodies receive their nourishment from
the synovial fluid, they may continue to grow eventhough floating in the joint
http://www.learningradiology.com/archives06/COW%20209-Synovial%20Chondromatosis/synchondromatosiscorrect.htm
http://www.learningradiology.com/archives06/COW%20209-Synovial%20Chondromatosis/synchondromatosiscorrect.htmhttp://www.learningradiology.com/archives06/COW%20209-Synovial%20Chondromatosis/synchondromatosiscorrect.htmhttp://www.learningradiology.com/archives06/COW%20209-Synovial%20Chondromatosis/synchondromatosiscorrect.htmhttp://www.learningradiology.com/archives06/COW%20209-Synovial%20Chondromatosis/synchondromatosiscorrect.htmhttp://www.learningradiology.com/archives06/COW%20209-Synovial%20Chondromatosis/synchondromatosiscorrect.htm -
8/12/2019 Knee Red Dot
75/129
-
8/12/2019 Knee Red Dot
76/129
Multiple exostoses / osteochondromas whicharise from the metaphyseal region and point
away from the joint.
Usually asymptomatic, but can become large
and may fracture.
May become malignant, particularly if located
axially rather than from a long bone.
-
8/12/2019 Knee Red Dot
77/129
-
8/12/2019 Knee Red Dot
78/129
Most common benign tumour in pediatric
A benign lytic lesion often seen at the distal femur
and proximal tibia.
Large fibrous cortical defect (>2cm) located within
the diametaphyseal region of a long bone.
Appears as metaphyseal eccentric "bubbly" lyticlesion surrounded by sclerotic rim.
http://radiopaedia.org/articles/non-ossifying_fibroma
http://radiopaedia.org/articles/non-ossifying_fibromahttp://radiopaedia.org/articles/non-ossifying_fibromahttp://radiopaedia.org/articles/non-ossifying_fibromahttp://radiopaedia.org/articles/non-ossifying_fibroma -
8/12/2019 Knee Red Dot
79/129
-
8/12/2019 Knee Red Dot
80/129
-
8/12/2019 Knee Red Dot
81/129
-
8/12/2019 Knee Red Dot
82/129
-
8/12/2019 Knee Red Dot
83/129
The fragment margins appearsmooth
The fragment will not fit back(like a broken biscuit) to makea normal smooth contouredpatella
Differential diagnosis:
Sinding-Larsen-Johanssondisease
patellar sleeve fracture
osteochondral fracture.
-
8/12/2019 Knee Red Dot
84/129
-
8/12/2019 Knee Red Dot
85/129
Bipartite patella Tripartite patella
-
8/12/2019 Knee Red Dot
86/129
-
8/12/2019 Knee Red Dot
87/129
Os Cyamella(Embedded in thepopliteus tendon)
Adjacent to Fibular Head
-
8/12/2019 Knee Red Dot
88/129
Meniscal Ossicles(occur usually in the
medial aspect)
-
8/12/2019 Knee Red Dot
89/129
-
8/12/2019 Knee Red Dot
90/129
-
8/12/2019 Knee Red Dot
91/129
An accentuated groove for thepatellar tendon
Differential diagnosis: erosion
-
8/12/2019 Knee Red Dot
92/129
The epiphyseal region of the tibial head forms a beak-shaped
process that extends downward anteriorly over the tibia at itsdistal end.
There is an isolated ossification center which forms the tuberosity. DDx: Osgood-Schlatter disease
-
8/12/2019 Knee Red Dot
93/129
May be mistaken as avulsion fracture of the tibial tuberosity
or Osgood Schlatter disease
-
8/12/2019 Knee Red Dot
94/129
An old injury (or injuries) to
the medial collateral
ligament (MCL).
A form of myosotis
ossificans soft tissue
calcification.
Located within the
superior attachment ofthe medial collateral
ligament
Mimics #
-
8/12/2019 Knee Red Dot
95/129
1. pedestrian struck by car head injury ? left humerus fracture
-
8/12/2019 Knee Red Dot
96/129
1. pedestrian struck by car head injury ? left humerus fracture
-
8/12/2019 Knee Red Dot
97/129
Mildly displaced fractures of the (L) distal femur, lateral tibial condyle of the(L) proximal tibia and (L) proximal fibula are seen. A sizeable (L) suprapatellar
effusion is noted, associated with soft tissue swelling.
-
8/12/2019 Knee Red Dot
98/129
2. No clinical diagnosis
-
8/12/2019 Knee Red Dot
99/129
Fracture, (L) patella. Bony density along the medial tibial plateau isnoted, with lucency in the medial tibial spine, suspicious for anotherfracture. A (L) suprapatellar joint effusion is noted, along with soft tissue
swelling of the (L) knee.
3.
-
8/12/2019 Knee Red Dot
100/129
-
8/12/2019 Knee Red Dot
101/129
-
8/12/2019 Knee Red Dot
102/129
There is a minimally depressed (0.2 cm) fractureof the medial tibial plateau with condensationof the trabeculae extending from the
metaphyseal region to the intercondylar region.Non-depressed fracture of the medial tibialplateau extending to its articular surface is alsopresent.ConclusionSchatzker Type V fracture
4. rt knee pain and swelling
-
8/12/2019 Knee Red Dot
103/129
4. rt knee pain and swelling
-
8/12/2019 Knee Red Dot
104/129
Prominent anterior tibial tubercle is commonly seen in patient with OsgoodSchlatter's disease.No evident cortical break or fracture line seen.There is obliteration of the suprapatellar fat space suggestive of joint space
effusion.
6. JUMPED AND LANDED IN FULL EXTENSION ON LEFT LL, NOW WITH LEFT KNEEPAIN AND SWELLING
-
8/12/2019 Knee Red Dot
105/129
6. JUMPED AND LANDED IN FULL EXTENSION ON LEFT LL, NOW WITH LEFT KNEEPAIN AND SWELLING
-
8/12/2019 Knee Red Dot
106/129
Lateral tibial plateau fracture suspected. Repeat AP view suggested.A joint effusion/ haemoarthrosis associated.
-
8/12/2019 Knee Red Dot
107/129
7. left knee pain with bruised
-
8/12/2019 Knee Red Dot
108/129
7. left knee pain with bruised
-
8/12/2019 Knee Red Dot
109/129
(L) suprapatellar effusion is noted.No fracture or dislocation is seen; the lucency across the lateral aspect of the
patella which appears well corticated is likely related to a bipartite patella.
8. left shin pain after fell into drain
-
8/12/2019 Knee Red Dot
110/129
-
8/12/2019 Knee Red Dot
111/129
-
8/12/2019 Knee Red Dot
112/129
9. Right knee pain
-
8/12/2019 Knee Red Dot
113/129
Cortical irregularity seen at the anterior aspect of the intercondylareminence suggests an avulsion fracture at the tibial insertion of the anterior
cruciate ligament. A small joint effusion is demonstrated.
-
8/12/2019 Knee Red Dot
114/129
10. slipped and fel into drain. rt knee pain, limited rom
-
8/12/2019 Knee Red Dot
115/129
There is suggestion of a fluid--fluid level seen in the supra-patellar pouch andthis may represent a lipo-haemarthrosis.
11. left knee
-
8/12/2019 Knee Red Dot
116/129
11. left knee
-
8/12/2019 Knee Red Dot
117/129
A radiolucent cortical lesion measuring 2.7 x 1.8cm in posterolateralmetaphyseal region of distal tibia, associated with narrow zone oftransition and sclerotic margin, likely to represent fibrous cortical defect(FCD).
12. laceration rt knee
-
8/12/2019 Knee Red Dot
118/129
12. laceration rt knee
-
8/12/2019 Knee Red Dot
119/129
No opaque foreign body or bony injury seen.Lucencies in the suprapatellar pouch and tibiofemoral joint are suspiciousfor intra-articular air from penetrating injury.
-
8/12/2019 Knee Red Dot
120/129
-
8/12/2019 Knee Red Dot
121/129
-
8/12/2019 Knee Red Dot
122/129
-
8/12/2019 Knee Red Dot
123/129
-
8/12/2019 Knee Red Dot
124/129
-
8/12/2019 Knee Red Dot
125/129
-1.0x 0.4cm recent subchondral # w submeniscal chondral fissure of lat tibialplateau.- Mild chondromalacia noted at posterior aspect of lateral femoral condyle &inf patellar surface.
-
8/12/2019 Knee Red Dot
126/129
-
8/12/2019 Knee Red Dot
127/129
Report: No fracture or dislocation is detected .
-
8/12/2019 Knee Red Dot
128/129
# of the medialtibial plateau
-
8/12/2019 Knee Red Dot
129/129