1. AP view = joint space narrowing or calcification of cartilage
2. Lateral view = (w/partial FLX) – patella and joint effusion
3. Sunrise or Merchant view = relationship of patella to A femur
4. Tunnel view = tibial spines an femoral epicondyle
9Plain film of knee (4)
MRI
(after you do plain film first)
Best Study of:
-Ligaments
-Cartilage
-Tendons
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1. Pittsburgh knee rule
2. Ottawa knee rule
*both for acute (not chronic) knee pain*
Two CPR’s for knee
Blunt trauma or fall as mechanism of injury + either one of the following:
1. Age <12 or >50
2. Inability to walk 4 WB’ing steps in emergency department
Pittsburgh knee rule
Order knee X-rays for acute knee injuries if ANY of the 5 items are present:
1. Age > 55
2. Isolated tenderness over patella
3. Tendernes over fibular head
4. Unable to FLX > 90
5. Unable to WB immediately, or in emergency room for 4 steps
Ottawa knee rule
look for avulsion
-able to see condyles
knee tunnel view
Yes – injuries to ligaments, menisci and tendons usually not seen on PF
***Use MRI if soft tissue issue
Can PF be normal even with pathology of the knee?
Lateral view superior to patella and anterior to femur
Joint effusion best seen on what view?
1. Pain with motion
2. Limited ROM
3. Redness/Swelling
4. Visible deformity
Sx of OA of knee
Loose body = ABNORMAL
Fabella = normal
Loose body vs. Fabella
irregular borders
Loose body
-characteristics
NORMAL!
Sesamoid bone
(usually in head of gastroc)
Fabella
In Meniscus
Chondrocalcinosis
1. Patella
2. Tibia
3. Fibula
4. Femur
Knee Fractures
(4 locations)
NORMAL
may look like a fx
Bipartate patella
AP view
(if neg and still suspect fx, use MRI)
Tibial plateau fx
-which x-ray view to see it
Cortical avulsion fx off proximal lateral tibia (distal to tibial plateau, at insertion of middle third of LCL resulting from excessive IR/VARUS)
***Significant –> associated with:
-ACL tears (75-100%)
-Meniiscal tears (66-75%)
-PLC
***Get MRI if you see this
Segond Fracture
Osteochondritis Dessicans = (lesion involving both bone AND cartilage)
***Causes 50% of loose bodies in knee
Men
Medial femoral condyle
OCD Lesion
-stands for ____
-causes what?
-most common: M/W
-most common where?
tibial tubercle apophysitis
*Mostly boys aged 11-15, coincides with growth spurts*
Osgood-Schlatter disease
-aka
-seen with who?
Analogus to Osgood-Schlatters, involving patellar tendon and lower margin of patella
(instead of upper tibia)
Sinding-Larsen-Johansson syndrome
Posterior
Which way does the knee usually dislocate?
