Musculoskeletal ultrasound of the knee
- Mederic M Hall, MD
Mederic M Hall, MD
- Associate Professor of Orthopedics and Rehabilitation
- UI Sports Medicine, University of Iowa
- Sathish Rajasekaran, MD
Sathish Rajasekaran, MD
- Assistant Clinical Professor of Physical Medicine and Rehabilitation
- University of Alberta
- Section Editor
- Karl B Fields, MD
Karl B Fields, MD
- Editor-in-Chief — Primary Care Sports Medicine (Adolescents and Adults)
- Section Editor — Biomechanics, Rehabilitation, and Recovery; Sports-Related Injuries; Symptom Assessment and Physical Examination
- Professor of Family Medicine and Sports Medicine
- University of North Carolina at Chapel Hill
- Deputy Editor
- Jonathan Grayzel, MD, FAAEM
Jonathan Grayzel, MD, FAAEM
- Senior Deputy Editor — UpToDate
- Deputy Editor — Emergency Medicine (Adult and Pediatric)
- Deputy Editor — Primary Care Sports Medicine (Adolescents and Adults)
- Assistant Professor of Emergency Medicine
- University of Massachusetts Medical School
The extra-articular structures of the knee are readily accessible for detailed sonographic evaluation. While intraarticular evaluation is incomplete, many structures can be partially visualized, and the examination often provides useful clinical information.
This topic will describe a systematic approach to complete sonographic evaluation of each knee quadrant. Topics devoted to knee pain and specific knee conditions are found separately. (See "Approach to the adult with knee pain likely of musculoskeletal origin" and "Anterior cruciate ligament injury" and "Posterior cruciate ligament injury" and "Medial collateral ligament injury of the knee" and "Meniscal injury of the knee" and "Knee bursitis" and "Osgood-Schlatter disease (tibial tuberosity avulsion)".)
USES, ADVANTAGES, AND LIMITATIONS OF KNEE ULTRASOUND
Physical principles and technology of ultrasound are reviewed separately. (See "Basic principles and safety of diagnostic ultrasound in obstetrics and gynecology".)
Below, the advantages and limitations of the ultrasound examination of the knee are reviewed; the general advantages and limitations of musculoskeletal ultrasound are discussed separately. (See "Musculoskeletal ultrasound of the shoulder", section on 'Uses, advantages, and limitations of shoulder ultrasound' and "Musculoskeletal ultrasound of the ankle and hindfoot".)
Ultrasound evaluation of the knee offers many benefits. Its superior spatial resolution allows for detailed evaluation of tendon, ligament, and nerve disorders that may not be possible with other imaging modalities. Mechanical complaints of snapping or clicking can be assessed dynamically in real time, and the location of pain can be correlated with precise anatomic structures by palpation with the ultrasound transducer (ie, sonopalpation). Orthopedic hardware does not produce artifacts in ultrasound images, allowing for evaluation of surrounding structures for signs of impingement, irritation, or injury. However, although many knee structures are easily accessible for sonographic examination, intraarticular structures are not, and this inherent limitation of ultrasound technology means that other imaging modalities may be required to assess the knee joint thoroughly.
- American College of Radiology (ACR), Society for Pediatric Radiology (SPR), Society of Radiologists in Ultrasound (SRU). AIUM practice guideline for the performance of a musculoskeletal ultrasound examination. J Ultrasound Med 2012; 31:1473.
- Finnoff JT, Berkoff D, Brennan F, et al. American Medical Society for Sports Medicine recommended sports ultrasound curriculum for sports medicine fellowships. Br J Sports Med 2015; 49:145.
- Klauser AS, Tagliafico A, Allen GM, et al. Clinical indications for musculoskeletal ultrasound: a Delphi-based consensus paper of the European Society of Musculoskeletal Radiology. Eur Radiol 2012; 22:1140.
- www.essr.org/html/img/pool/knee.pdf (Accessed on October 08, 2015).