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Diagnostic Imaging 2 > Knee > Flashcards

Knee Flashcards

1
Q

routine views

A

AP view
Lateral view
PA “Tunnel” view
tangential “Sunrise” view of the patella

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2
Q

what to notice in an AP view

A
  • patellar apex at level of joint line
  • joint space heights (should be equal)
  • tibiofemoral alignment
  • view parallel to tibial plateau
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3
Q

AP view outline

A

Femur:

  • epicondyles
  • condyles

Proximal tibia

  • condyles
  • intercondylar tubercles

Proximal fibula
-head, neck, shaft

Patella:

  • base
  • apex
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4
Q

what to notice in a lateral view

A
  • medial femoral condyle magnified (further from the plate)
  • patellar tendon length=patellar length +/- 20%
  • patellar alta (superiorly shifted)
  • patellar baja (shifted inferiorly)
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5
Q

lateral view outline

A

Femur:
-condyles

Proximal tibia

  • intercondylar eminence
  • tibial tuberosity

Proximal fibula
-head, neck, shaft

Patella

Fabella (sesamoid bone in the gastroc)

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6
Q

PA tunnel view is best for:

A
  • intracondylar notch should be U shape
  • loose bodies in the joint
  • joint space narrowing
  • tibial plateau

*pt prone with knee flexed ~45 deg

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7
Q

PA tunnel view outline

A

Femur:

  • epicondyles
  • condyles
  • intercondylar fossa

Tibia

  • condyles
  • intercondylar eminences

Fibula

  • head
  • neck
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8
Q

Tangential “sunrise” view of the patella is best for showing:

A

patellofemoral joint space (cartilage thickness)

patellar alignment

  • sulcus angle
  • congruence angle
  • patellar tilt

*pt supine w/ knee flexed 45 deg

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9
Q

sulcus angle

A

(apex at point A)

-lines between the deepest point of the groove and the highest points of each femoral condyle

Normal= 138 deg (+/- 6 deg)

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10
Q

congruence angle

A

(angle cab)

  • bisect sulcus angle (line ab)
  • line between apex of sulcus angle and most posterior point on patella (line ac)

negative= medial
normal= -6 deg
lateral sublux= +16 deg

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11
Q

patellar tilt

A

(angle T)

angle between a line connecting medial and lateral edges of the patella, and the horizontal

normal= <5 deg

patellar malalignment

  • spec=92%, sens=85%
  • accuracy=89%
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12
Q

tangential “sunrise patella view outline

A

Femur:

  • lateral condyle (lat. trochlear ridge)
  • trochlear groove
  • medial condyle (med. trochlear ridge)

Patella:

  • lateral facets
  • medial facets

Measure:

  • sulcus angle
  • congruence angle
  • patellar tilt
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13
Q

distal femur fractures

A

supracondylar

  • nondisplaced
  • impacted
  • displaced
  • comminuted

condylar

intercondylar

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14
Q

fracture of the tibial plateau

A

often hard to see actual fracture, but can see the abnormal fat and blood within the capsule (MRI is better)

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15
Q

meniscal tears

A

common sports-related injuries. isolated tears present with intermittent clicking, locking, effusion and pain.

occur during shear, rotary, and compression forces.

medial meniscus is more frequently injured bc of its greater peripheral attachment and decreased mobility, impairing its ability to withstand imposed forces.

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16
Q

kinds of meniscal tears

A 
vertical
bucket handle 
peripheral
horizontal
discoid meniscus
17
Q

normal ACL- MRI

A
  • normal lat –> med course makes visualization of entire length difficult
  • should be “ruler straight” possibly very slightly convex inferiorly
  • segond fracture??

some reference measurements:

  • Blumensaat line angle
  • anterior tibial line
18
Q

segond fracture

A

=fracture of the lateral tibial plateau

-often associated with internal derangements of the knee (mostly ACL)

19
Q

blumensaat line angle

A

The ACL Blumensaat line angle is the angle between a line drawn parallel to the posterior surface of the femur a line along the margin of the ACL

this angle has a negative value when its apex is pointed superiorly and a positive value when its apex is pointed inferiorly

normal= -13 deg

*if 0: probability or normal=91%, probability of torn=9%

20
Q

anterior tibial line

A

sagittal view half way through the lateral femoral condyle

  • vertical line from posterior margin of tibia
  • should not cut through
21
Q

acute torn ACL- MRI

A

note the hemorrhage in intracondylar notch area

-bone bruises can often be seen in T2 weighted images

22
Q

partial ACL tears

A

chronic partial ACL tears are difficult to see in absence of:

  • segond fracture
  • bone bruises
  • hemorrhage

Blumensaat line angles can be normal

adjacent images can look OK

results in false negative reports

23
Q

torn MCL

A

more commonly injured
by a valgus force

if deep and superficial layers are torn should be able to note the edema and joint effusion

24
Q

lateral collateral ligament complex

A 
LCL
arcuate ligament
fabellofibular ligament
popliteus tendon
biceps femoris tendon
25
Q

patella alta

A

patella is too high

expect to see decreased strength bc patella isn’t acting as a good spacer to increase moment arm- quad may be too short

26
Q

pittsburgh knee rules for conventional radiographs

A

History of blunt trauma/fall
AND EITHER OR BOTH OF:

  • age 50
  • inability to walk 4 WBing steps

sensitivity=99% (if you have it the test will be positive)
specificity= 60% (if you don’t have it the test will be negative)

27
Q

Ottawa knee rules for conventional radiographs

A

(not to be applied if age 50

  • tenderness at the fibular head
  • isolated tenderness of the patella
  • inability to flex knee to 90 deg
  • inability to walk 4 WBing steps immediately (from hx) AND in clinic

sensitivity=97%
specificity= 27%

Diagnostic Imaging 2 (6 decks)

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