Knee Checklist
HIDEInteractive Transcript
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This concludes our section on the knee.
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What I have on the slide here is a recap
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of the knee checklist.
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So again, the the knee would typically do frontal
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and lateral projections
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and maybe augmented by additional projections.
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We wanna look for the bone integrity, identify
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that the cortex is contiguous
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and smooth along our femur,
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that our femoral condyles maintain the hemispheric
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that the tibial plateaus are maintained.
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And then for particular things
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that we would think about in the knee is we're always
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looking for a joint effusion in the super patella recess
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and potentially characterizing it as a lipo arthrosis,
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meaning that in addition to fluid, if you see fat, you have
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to have a high index of suspicion
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that there's been an intraarticular injury
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that includes a fracture,
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and that may warrant further investigation
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to identify the source of that lipo arthrosis.
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And so that speaks toward having occult
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intraarticular fracture.
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Supracondylar and condylar fractures are typically something
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that's seen more in the osteoporotic patients.
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Tibial plateau fractures occur related to trauma,
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and there is a classification scheme that's utilized
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by orthopedic surgeons
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and that radiologists should be familiar with.
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So in the knee there is the extensor mechanism
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and you can have unique injuries related to disruption
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of the extensor mechanism.
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Think about the patella bone as a
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sesamoid within the extensor mechanism,
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meaning you have the quadriceps tendon, patella sleeve,
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and then the patella tendon.
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When you have patella fractures, they may be non-displaced.
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Or if the fracture line goes all the way through
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and disrupts the soft tissue envelope,
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you may have displacement of it.
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More common than patella fractures is probably patella
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femoral dislocations.
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Again, the nature of that patella femoral joint is
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that there is a spectrum of patella femoral dysplasia,
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and in certain individuals they can get a dislocation
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and often not realize it
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because it tends to spontaneously reduce
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and then present with a lot of knee swelling.
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But they can also get osteochondral fragments
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and fractures off of the medial aspect of the patella.
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The quadriceps and patella tendons can rupture themselves.
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So quadriceps rupture may result in patella baja,
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or malpositioning
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of patella lower than the typical position patella tendon.
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Complete rupture can result in patella alta,
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meaning the patella bone is malpositioned more
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superior than typically.
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Remember that the sagun fracture has a high association
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with anterior cruciate ligament tears,
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and that in complete knee dislocations you may see
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disruption of some of the neurovascular structures.
John A Carrino, MD, MPH
Vice-Chairman, Radiology and Imaging
Hospital for Special Surgery
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