Evaluation of the knee joint with ultrasound and magnetic resonance imaging

Pandya, Siddharth; Melville, David M.

doi:10.15557/jou.2023.0032

Abstract

The knee joint relies on a combination of deep and superficial structures for stability and function. Both ultrasound and high-resolution magnetic resonance imaging are extremely useful in evaluating these structures and associated pathology. This article reviews a combination of critical anatomic structures, joint abnormalities, and pathologic conditions at the knee joint, while highlighting the merits, limitations, and pitfalls of the two imaging modalities. A clear appreciation of each method paired with its relative strengths will aid in expediting diagnosis and appropriate treatment for a wide range of knee joint conditions.

References

Nacey NC, Geeslin MG, Miller GW, Pierce JL: Magnetic resonance imaging of the knee: An overview and update of conventional and state of the art imaging. J Magn Reson Imaging 2017; 45: 1257–1275. doi: 10.1002/jmri.25620.
Open DOI Search in Google Scholar Back to article
Alves TI, Girish G, Kalume Brigido M, Jacobson JA: US of the knee: scanning techniques, pitfalls, and pathologic conditions. Radiographics 2016; 36: 1759–1775. doi: 10.1148/rg.2016160019.
Open DOI Search in Google Scholar Back to article
Khoury V, Cardinal E, Bureau NJ: Musculoskeletal sonography: a dynamic tool for usual and unusual disorders. Am J Roentgenol 2007; 188: W63–73. doi: 10.2214/AJR.06.0579.
Open DOI Search in Google Scholar Back to article
Bruce W, Lee TS, Sundarajan V, Walker P, Magnussen J, Van der Wall H: Performance characteristics of ultrasound of the knee in a general radiological setting. Knee 2004; 11: 303–306. doi: 10.1016/j.knee.2003.07.006.
Open DOI Search in Google Scholar Back to article
Basha MAA, Eldib DB, Aly SA, Azmy TM, Mahmoud NEM, Ghandour TM et al.: Diagnostic accuracy of ultrasonography in the assessment of anterior knee pain. Insights Imaging 2020; 11: 107. doi: 10.1186/s13244-020-00914-2.
Open DOI Search in Google Scholar Back to article
Flemming DJ, Hash TW 2nd, Bernard SA, Brian PS: MR imaging assessment of arthritis of the knee. Magn Reson Imaging Clin N Am 2014; 22: 703–724. doi: 10.1016/j.mric.2014.07.012.
Open DOI Search in Google Scholar Back to article
Jacobson JA, Ruangchaijatuporn T, Khoury V, Magerkurth O: Ultrasound of the knee: common pathology excluding extensor mechanism. Semin Musculoskelet Radiol 2017; 21: 102–112. doi: 10.1055/s-0037-1599204.
Open DOI Search in Google Scholar Back to article
Fenn S, Datir A, Saifuddin A: Synovial recesses of the knee: MR imaging review of anatomical and pathological features. Skeletal Radiol 2009; 38: 317–328. doi: 10.1007/s00256-008-0570-0.
Open DOI Search in Google Scholar Back to article
Mandl P, Brossard M, Aegerter P, Backhaus M, Bruyn GA, Chary-Valckenaere I et al.: Ultrasound evaluation of fluid in knee recesses at varying degrees of flexion. Arthritis Care Res (Hoboken) 2012; 64: 773–779. doi: 10.1002/acr.21598.
Open DOI Search in Google Scholar Back to article
Bonnefoy O, Diris B, Moinard M, Aunoble S, Diard F, Hauger O: Acute knee trauma: role of ultrasound. Eur Radiol 2006; 16: 2542–2548. doi: 10.1007/s00330-006-0319-x.
Open DOI Search in Google Scholar Back to article
Schick C, Mack MG, Marzi I, Vogl TG: Lipohemarthrosis of the knee: MRI as an alternative to the puncture of the knee joint. Eur Radiol 2003; 13: 1185–1187. doi: 10.1007/s00330-002-1375-5.
Open DOI Search in Google Scholar Back to article
Thoenen J, Stevens KJ, Turmezei TD, Chaudhari A, Watkins LE, McWalter EJ et al.: Non-contrast MRI of synovitis in the knee using quantitative DESS. Eur Radiol 2021; 31: 9369–9379. doi: 10.1007/s00330-021-08025-2.
Open DOI Search in Google Scholar Back to article
Son YN, Jin W, Jahng GH, Cha JG, Park YS, Yun SJ et al.: Efficacy of double inversion recovery magnetic resonance imaging for the evaluation of the synovium in the femoro-patellar joint without contrast enhancement. Eur Radiol 2018; 28: 459–467. doi: 10.1007/s00330-017-5017-3.
Open DOI Search in Google Scholar Back to article
Song IH, Althoff CE, Hermann KG, Scheel AK, Knetsch T, Schoenharting M et al.: Knee osteoarthritis. Efficacy of a new method of contrast-enhanced musculoskeletal ultrasonography in detection of synovitis in patients with knee osteoarthritis in comparison with magnetic resonance imaging. Ann Rheum Dis 2008; 67: 19–25. doi: 10.1136/ard.2006.067462.
Open DOI Search in Google Scholar Back to article
Sibbitt WL Jr., Kettwich LG, Band PA, Chavez-Chiang NR, DeLea SL, Haseler LJ et al.: Does ultrasound guidance improve the outcomes of arthrocentesis and corticosteroid injection of the knee? Scand J Rheumatol 2012; 41: 66–72. doi: 10.3109/03009742.2011.599071.
Open DOI Search in Google Scholar Back to article
Gaigneux E, Cormier G, Varin S, Mérot O, Maugars Y, Le Goff B: Ultrasound abnormalities in septic arthritis are associated with functional outcomes. Joint Bone Spine 2017; 84: 599–604. doi: 10.1016/j.jbspin.2017.02.002.
Open DOI Search in Google Scholar Back to article
Bradley AT, King CA, Cohen-Rosenblum A, Sculco PK, Landy DC: Gout in primary total knee arthroplasty: Prevalent but not independently associated with complications. Knee 2021; 28: 45–50. doi: 10.1016/j.knee.2020.11.007.
Open DOI Search in Google Scholar Back to article
Upadhyay N, Saifuddin A: The radiographic and MRI features of gout referred as suspected soft tissue sarcoma: a review of the literature and findings from 27 cases. Skeletal Radiol 2015; 44: 467–476. doi: 10.1007/s00256-014-2005-4.
Open DOI Search in Google Scholar Back to article
Thiele RG: Role of ultrasound and other advanced imaging in the diagnosis and management of gout. Curr Rheumatol Rep 2011; 13: 146–153. doi: 10.1007/s11926-010-0156-4.
Open DOI Search in Google Scholar Back to article
Girish G, Glazebrook KN, Jacobson JA: Advanced imaging in gout. AJR Am J Roentgenol 2013; 201: 515–525. doi: 10.2214/AJR.13.10776.
Open DOI Search in Google Scholar Back to article
Filippucci E, Scire CA, Delle Sedie A, Iagnocco A, Riente L, Meenagh G et al.: Ultrasound imaging for the rheumatologist. XXV. Sonographic assessment of the knee in patients with gout and calcium pyrophosphate deposition disease. Clin Exp Rheumatol 2010; 28: 2–5.
Search in Google Scholar Back to article
Yu JS, Chung C, Recht M, Dailiana T, Jurdi R: MR imaging of tophaceous gout. AJR Am J Roentgenol 1997; 168: 523–527. doi: 10.2214/ajr.168.2.9016240.
Open DOI Search in Google Scholar Back to article
Skovgaard Larsen LP, Rasmussen OS: Diagnosis of acute rupture of the anterior cruciate ligament of the knee by sonography. Eur J Ultrasound 2000; 12: 163–167. doi: 10.1016/s0929-8266(00)00109-9.
Open DOI Search in Google Scholar Back to article
Kumar S, Kumar A, Kumar S, Kumar P: Functional ultrasonography in diagnosing anterior cruciate ligament injury as compared to magnetic resonance imaging. Indian J Orthop 2018; 52: 638–644. doi: 10.4103/ortho.IJOrtho_28_17.
Open DOI Search in Google Scholar Back to article
Wu WT, Lee TM, Mezian K, Naňka O, Chang KV, Özçakar L: Ultrasound imaging of the anterior cruciate ligament: a pictorial essay and narrative review. Ultrasound Med Biol 2022; 48: 377–396. doi: 10.1016/j.ultrasmedbio.2021.11.004.
Open DOI Search in Google Scholar Back to article
Breukers M, Haase D, Konijnenberg S, Klos TVS, Dinant GJ, Ottenheijm RPG: Diagnostic accuracy of dynamic ultrasound imaging in partial and complete anterior cruciate ligament tears: a retrospective study in 247 patients. BMJ Open Sport Exerc Med 2019; 5: e000605. doi: 10.1136/bmjsem-2019-000605.
Open DOI Search in Google Scholar Back to article
Cho KH, Lee DC, Chhem RK, Kim SD, Bouffard JA, Cardinal E et al.: Normal and acutely torn posterior cruciate ligament of the knee at US evaluation: preliminary experience. Radiology 2001; 219: 375–380. doi: 10.1148/radiology.219.2.r01ma22375.
Open DOI Search in Google Scholar Back to article
Andrews K, Lu A, McKean L, Ebraheim N: Review: Medial collateral ligament injuries. J Orthop 2017; 14: 550–554. doi: 10.1016/j.jor.2017.07.017.
Open DOI Search in Google Scholar Back to article
De Maeseneer M, Van Roy F, Lenchik L, Barbaix E, De Ridder F, Osteaux M: Three layers of the medial capsular and supporting structures of the knee: MR imaging-anatomic correlation. Radiographics 2000; 20 Spec No: S83–89. doi: 10.1148/radiographics.20.suppl_1.g00oc05s83.
Open DOI Search in Google Scholar Back to article
Recondo JA, Salvador E, Villanúa JA, Barrera MC, Gervás C, Alústiza JM: Lateral stabilizing structures of the knee: functional anatomy and injuries assessed with MR imaging. Radiographics 2000; 20: S91–S102. doi: 10.1148/radiographics.20. suppl_1.g00oc02s91.
Open DOI Search in Google Scholar Back to article
Carneiro BC, Araújo FF, Guimarães JB, Chemin RN, Jorge RB, Filho AGO et al.: Stener-like lesions in the hand, knee and foot: a review of anatomy, mechanism of injury and imaging evaluation. Clin Imaging 2021; 76: 235–246. doi: 10.1016/j.clinimag.2021.05.001.
Open DOI Search in Google Scholar Back to article
Gupta N, Taylor RE, Lambert B, Dong D, Phillips P, Jack RA 2nd et al.: Shear wave elastography of the ulnar collateral ligament in division IA pitchers across a competitive collegiate season. JSES Int 2023: 7: 703–708. doi: 10.1016/j.jseint.2023.03.014.
Open DOI Search in Google Scholar Back to article
Taljanovic MS, Gimber LH, Becker GW, Latt LD, Klauser AS, Melville DM et al.: Shear-wave elastography: basic physics and musculoskeletal applications. Radiographics 2017; 37: 855–870. doi: 10.1148/rg.2017160116.
Open DOI Search in Google Scholar Back to article
Wadugodapitiya S, Sakamoto M, Tanaka M, Sakagami Y, Morise Y, Kobayashi K. Assessment of knee collateral ligament stiffness by strain ultrasound elastography. Biomed Mater Eng 2022; 33: 337–349. doi: 10.3233/BME-211282.
Open DOI Search in Google Scholar Back to article
Meyer P, Reiter A, Akoto R, Steadman J, Pagenstert G, Frosch KH et al.: Imaging of the medial collateral ligament of the knee: a systematic review. Arch Orthop Trauma Surg 2022; 142: 3721–3736. doi: 10.1007/s00402-021-04200-8.
Open DOI Search in Google Scholar Back to article
Watura C, Morgan C, Flaherty D, Gibbons C, Sookur P: Medial collateral ligament injury of the knee: correlations between MRI features and clinical gradings. Skeletal Radiol 2022; 51: 1225–1233. doi: 10.1007/s00256-021-03949-8.
Open DOI Search in Google Scholar Back to article
Brimmo OA, Senne JA, Crim J: MRI findings of Stener-like lesion of the knee: A case series with surgical correlation. Eur J Radiol 2019; 121: 108709. doi: 10.1016/j.ejrad.2019.108709.
Open DOI Search in Google Scholar Back to article
Lee JI, Song IS, Jung YB, Kim YG, Wang CH, Yu H et al.: Medial collateral ligament injuries of the knee: ultrasonographic findings. J Ultrasound Med 1996; 15: 621–625. doi: 10.7863/jum.1996.15.9.621.
Open DOI Search in Google Scholar Back to article
Slane LC, Slane JA, Scheys L: The measurement of medial knee gap width using ultrasound. Arch Orthop Trauma Surg 2017; 137: 1121–1128. doi: 10.1007/s00402-017-2740-9.
Open DOI Search in Google Scholar Back to article
Sekiya JK, Jacobson JA, Wojtys EM: Sonographic imaging of the posterolateral structures of the knee: findings in human cadavers. Arthroscopy 2002; 18: 872–881. doi: 10.1053/jars.2002.32845.
Open DOI Search in Google Scholar Back to article
Oei EH, Nikken JJ, Verstijnen AC, Ginai AZ, Myriam Hunink MG: MR imaging of the menisci and cruciate ligaments: a systematic review. Radiology 2003; 226: 837–848. doi: 10.1148/radiol.2263011892.
Open DOI Search in Google Scholar Back to article
Stensby JD, Pringle LC, Crim J: MRI of the meniscus. Clin Sports Med 2021; 40: 641–655. doi: 10.1016/j.csm.2021.05.004.
Open DOI Search in Google Scholar Back to article
Azzoni R, Cabitza P: Is there a role for sonography in the diagnosis of tears of the knee menisci? J Clin Ultrasound 2002; 30: 472–476. doi: 10.1002/jcu.10106.
Open DOI Search in Google Scholar Back to article
Guillin R, Marchand AJ, Roux A, Niederberger E, Duvauferrier R: Imaging of snapping phenomena. Br J Radiol 2012; 85: 1343–1353. doi: 10.1259/bjr/52009417.
Open DOI Search in Google Scholar Back to article
Marchand AJ, Proisy M, Ropars M, Cohen M, Duvauferrier R, Guillin R: Snapping knee: imaging findings with an emphasis on dynamic sonography. AJR Am J Roentgenol 2012; 199: 142–150. doi: 10.2214/AJR.11.7817.
Open DOI Search in Google Scholar Back to article
Guillin R, Mendoza-Ruiz JJ, Moser T, Ropars M, Duvauferrier R, Cardinal E: Snapping biceps femoris tendon: a dynamic real-time sonographic evaluation. J Clin Ultrasound 2010; 38: 435–437. doi: 10.1002/jcu.20728.
Open DOI Search in Google Scholar Back to article
Kennedy MI, DePhillipo NN, Chahla J, Armstrong C, Ziegler CG, Buckley PS et al.: Surgical repair of dynamic snapping biceps femoris tendon. Arthrosc Tech 2018; 7: e1129–e1133. doi: 10.1016/j.eats.2018.07.010.
Open DOI Search in Google Scholar Back to article
Koh YG, Kim SJ, Chun YM, Kim YC, Park YS: Arthroscopic treatment of patellofemoral soft tissue impingement after posterior stabilized total knee arthroplasty. Knee 2008; 15: 36–39. doi: 10.1016/j.knee.2007.08.009.
Open DOI Search in Google Scholar Back to article
Okamoto T, Futani H, Atsui K, Fukunishi S, Koezuka A, Maruo S: Sonographic appearance of fibrous nodules in patellar clunk syndrome: a case report. J Orthop Sci 2002; 7: 590–593. doi: 10.1007/s007760200106.
Open DOI Search in Google Scholar Back to article
Geannette C, Miller T, Saboeiro G, Parks M: Sonographic evaluation of patellar clunk syndrome following total knee arthroplasty. J Clin Ultrasound 2017; 45: 105–107. doi: 10.1002/jcu.22389.
Open DOI Search in Google Scholar Back to article
Falkowski AL, Jacobson JA, Hirschmann MT, Kalia V: MR imaging of the quadriceps femoris tendon: distal tear characterization and clinical significance of rupture types. Eur Radiol 2021; 31: 7674–7683. doi: 10.1007/s00330-021-07912-y.
Open DOI Search in Google Scholar Back to article
Warden SJ, Kiss ZS, Malara FA, Ooi AB, Cook JL, Crossley KM: Comparative accuracy of magnetic resonance imaging and ultrasonography in confirming clinically diagnosed patellar tendinopathy. Am J Sports Med 2007; 35: 427–436. doi: 10.1177/0363546506294858.
Open DOI Search in Google Scholar Back to article
Breda SJ, van der Vlist A, de Vos RJ, Krestin GP, Oei EHG: The association between patellar tendon stiffness measured with shear-wave elastography and patellar tendinopathy – a case-control study. Eur Radiol 2020; 30: 5942–5951. doi: 10.1007/s00330-020-06952-0.
Open DOI Search in Google Scholar Back to article
Gulledge CM, Baumer TG, Juliano L, Sweeney M, McGinnis M, Sherwood A et al.: Shear wave elastography of the healing human patellar tendon following ACL reconstruction. Knee 2019; 26: 347–354. doi: 10.1016/j.knee.2018.12.006.
Open DOI Search in Google Scholar Back to article
Akkaya S, Akkaya N, Agladioglu K, Gungor HR, Ok N, Ozcakar L: Real-time elas-tography of patellar tendon in patients with auto-graft bone-tendon-bone anterior cruciate ligament reconstruction. Arch Orthop Trauma Surg 2016; 136: 837–842. doi: 10.1007/s00402-016-2459-z.
Open DOI Search in Google Scholar Back to article
Ito N, Sigurðsson HB, Pohlig RT, Cortes DH, Gravare Silbernagel K, Sprague AL: Reliability of continuous shear wave elastography in the pathological patellar tendon. J Ultrasound Med 2023; 42: 1047–1055. doi: 10.1002/jum.16115.
Open DOI Search in Google Scholar Back to article
Telischak NA, Wu JS, Eisenberg RL: Cysts and cystic-appearing lesions of the knee: A pictorial essay. Indian J Radiol Imaging 2014; 24: 182–191. doi: 10.4103/09713026.134413.
Open DOI Search in Google Scholar Back to article

Evaluation of the knee joint with ultrasound and magnetic resonance imaging

Abstract

Paradigm

My account