Radiologic evaluation of the chronically painful knee in adults
- Shahla Modarresi, MD
Shahla Modarresi, MD
- Associate Clinical Professor of Radiology
- David Geffen School of Medicine at UCLA
- Cecilia Matilda Jude, MD
Cecilia Matilda Jude, MD
- Clinical Professor of Radiology
- David Geffen School of Medicine at UCLA
The knee is one of the largest and most complex joints in the body. It is lined by synovium and consists of two hinge-type joints between the femoral condyles and the medial and lateral tibial plateaus, and a gliding-type joint between the patella and the trochlear groove of the anterior distal femur (figure 1) . The major stabilizers of the joint are the extensor tendons (quadriceps and patellar tendons), medial and lateral collateral ligament complex, and cruciate ligaments. The menisci are fibrocartilaginous structures that distribute the stress over the articular cartilage, absorb the shock in axial loading, stabilize the joint in flexion and extension, and have a role in joint lubrication .
For the purposes of this discussion, “chronic knee pain” is defined as pain of at least three months’ duration. Imaging modalities used to evaluate adults with chronic knee pain and the appropriateness of particular studies in different clinical scenarios will be reviewed here. The history and physical examination, which are necessary to develop a differential diagnosis prior to the selection of imaging tests; a general review of imaging tests that are used in the evaluation of bone and joint pain; and radiologic evaluation of adults with acute knee pain are presented separately. (See "Approach to the adult with unspecified knee pain" and "Imaging techniques for evaluation of the painful joint" and "Radiologic evaluation of the acutely painful knee in adults".)
Chronic knee pain is most commonly caused by arthritis, bursitis and cystic lesions around the joint, tendon pathology, cartilage pathology, chronic infection, osteonecrosis (avascular necrosis), stress fractures, and avulsion injuries.
Referred pain is an important clinical consideration in the patient with chronic knee pain; however, knee pain that is referred from other anatomic sites is beyond the scope of our discussion and is discussed elsewhere.
The use of imaging in the assessment of children and adolescents with knee pain is also presented elsewhere. (See "Approach to acute knee pain and injury in children and skeletally immature adolescents", section on 'Imaging' and "Approach to chronic knee pain or injury in children or skeletally immature adolescents", section on 'Imaging'.)
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- Calcium pyrophosphate deposition disease
- Rheumatoid arthritis
- Psoriatic arthritis and reactive arthritis
- Ankylosing spondylitis
- Neuropathic arthropathy
- Gouty arthritis
- Hemophilic arthropathy
- BURSITIS AND CYSTS
- - Popliteal bursitis
- - Prepatellar bursitis
- - Pes anserinus bursitis
- - Ganglion cyst
- - Meniscal cyst
- TENDON PATHOLOGY
- ARTICULAR CARTILAGE PATHOLOGY
- MENISCAL CARTILAGE PATHOLOGY
- CHRONIC INFECTION
- Chronic infectious arthritis
- Chronic osteomyelitis
- OSTEONECROSIS (AVASCULAR NECROSIS OF BONE)
- Osteochondritis dissecans
- STRESS AND INSUFFICIENCY FRACTURES
- KNEE TUMORS
- PLICA SYNDROME
- CHONDROMALACIA PATELLAE
- DISCOID MENISCUS