Ultrasound of the knee joint [Indications and interpretation of results]

Also, a diagnostic procedure can be carried out to monitor the effectiveness of therapy. This technique allows you to monitor changes after the operation.

As you know, this examination is completely harmless, which means that not only adults, but also children can be referred for ultrasound.

This type of diagnosis is prescribed for children in the following cases:

Change in skin color;
The occurrence of swelling in the knee joint;
Presence of osteochondropathy;
Suspicion of deformation of joint tissues;
And, of course, pain.

Structure of the knee joint

The knee joint is a complex musculoskeletal structure that includes the patella and the bony anatomical structures of the femur. The joint complex, due to its natural large size, is often subject to injury, inflammation and destructive pathological processes.

The following ligaments are responsible for the integrity of the articular structure and its constancy: cruciate in front and behind, medial and lateral, paired ligaments above the knee and transverse. Soft tissue cavity structures do not allow the limb to perform excessive displacement in the anteroposterior direction. The patella (kneecap) is woven into the muscle structures of the thigh by tendons.

The superficial articulations in the joint are covered with hyaline cartilage, which also makes up the menisci - curved cartilaginous formations located between the bones of the thigh. The knee in its articular apparatus includes several bursae (bags) filled with articular fluid.

Indications for the procedure

The knee joint is one of the largest and most complex in the human body. It is responsible for the movement of the limb, connecting the patella, femur and tibia. Against the background of increased stress and degenerative processes, various pathologies can develop. Ultrasound helps to detect the slightest disturbances in the structure and functionality of cartilage, joints, and the functioning of blood vessels. Most often, specialists have to deal with meniscus tears or cruciate ligament injuries.

Main indications:

knee pain;
limited mobility;
bone deformities;
the appearance of local swelling, redness of the skin;
the presence of a palpable formation;
decreased muscle strength.

Why is ultrasound primary for examining the knee joint?

Various techniques are used to diagnose articular surfaces and ligamentous apparatus, but the primary purpose, in this case, is ultrasound of the knee joint. Why are magnetic resonance and computed tomograms or RG images not so important at the first stage? Because the entire range of ultrasound capabilities meets most of the requirements for performing diagnostic manipulations of various pathological processes that form in the soft tissues of the knee joint. This technique has no contraindications - safety and painlessness of diagnostic procedures, minimal time costs for carrying out the procedure and issuing results, reasonable cost and the absence of preliminary preparatory measures.

The absence of strict restrictions on this procedure makes it possible to perform it on pregnant women and children. None of the other diagnostic methods, except ultrasound of the knee joint, helps - it is better to visualize the cartilage tissue, to give a full opportunity to evaluate its hard and soft tissue structures and their thickness. All this data will allow us to determine the presence of pathological processes at the earliest stages of development. The technique is used during surgical interventions, punctures and arthroscopy.

Ultrasound of the knee joint is a safe procedure performed using new high-precision equipment at a price of 1,200 rubles. in ours in Moscow. The research is carried out by highly qualified specialists with over 15 years of experience in a comfortable European atmosphere.

Soft tissue neoplasms on ultrasound

Task. Vascular malformation of the knee

Task. 6 months of anterior knee pain with background history of ACL reconstruction. pain in the tibia area. They did recall an occasional smaller area of swelling appearing on the front of the lower leg in recent months. There was full range of motion of the knee. There was some localized tenderness medial to the tibial tuberosity, directly where the ACL scar was. the patellar tendon and tibial tuberosity insert were intact. There was no evidence of deep infrapatellar bursitis. There was an anechoic, noncompressible lesion medial to the tibial tuberosity that appeared to communicate with the calf cortex in the area of the ACL scar. No vascularity was visible. It was not compressible and there seemed to be a clear relationship between cortical irregularities. The lesion was painful under pressure from the probe, reproducing the patient's symptoms. When viewing the images, a collection of fluid was visible on the front tibia. opinion about the pretibial ganglion. Conclusion: Pretibial hygroma.

Tags: lectures joints ultrasound

When is an ultrasound of the knee joint prescribed?

An ultrasound scan of the knee is prescribed by a specialist if there are the following indications:

damage to the soft tissue structure of the tendons, inflammatory processes in them;
rupture of knee ligaments, menisci, nerves;
trauma to the muscular system surrounding the knee;
the inflammatory process in the periarticular bursae (bursitis) of the knee joint will be very clearly displayed on ultrasound;
Baker's cyst - a neoplasm with fluid inside, detected on an ultrasound of the knee joint on its posterior surface;
rheumatoid arthritis is an autoimmune pathology that leads to inflammation of small joints;
arthrosis – chronicization of the process of destruction of joint cartilage and the formation of defects in bone structures;
the presence of free fragments in the articular cavity of the knee after injury;
benign or malignant neoplasms in the joint;
vascular diseases;
inflammation of the fluid (synovitis) in the cavity of the knee joint can be accurately determined by ultrasound.

An ultrasound of the knee is also performed to monitor the puncture of the joint cavity. This method produces intra-articular (synovial) fluid for analysis or administration of medications. Ultrasonography is a completely safe diagnostic technique without harm to the patient. The only possible limitation to implementation may be the presence of a wound surface or skin diseases in the knee area.

At the Health Plus clinic, ultrasound of the knee joint is performed at a reasonable price, allowing you to perform an inexpensive procedure while maintaining anonymity, and our 3 centers are located in Moscow, 5 minutes away. from metro stations.

Make an appointment Online booking

Clinic on Krasnopresnenskaya +7 (499) 252-41-35 Volkov lane, 21
Clinic on Varshavskaya +7 (499) 610-02-09 Varshavskoe highway, 75, building 1
Clinic in Annino +7 (495) 388-08-08 Varshavskoe highway, 154, building 1

Anterior approach

The patient is in the supine position, the knee is bent 30-45°. The anterior approach evaluates the quadriceps tendon, suprapatellar bursa and bursa, contour and cartilage of the femoral condyles, patella and subcutaneous bursa, patellar ligament proper, superficial and deep infrapatellar bursa, and fatty body of the knee joint.

Quadriceps tendon on ultrasound

The sensor is placed above the patella in the projection of the quadriceps tendon. The tendon consists of four bundles that connect distally to the rectus, intermediate, lateral and medial heads of the muscle. It is important to examine the entire length of the tendon from its insertion at the superior edge of the patella to its transition to the muscle.

Task. Ultrasound shows a longitudinal section through the quadriceps tendon: a fibrous structure of increased echogenicity shadows from the upper edge of the patella (PA) (between the arrows); the edge of the tendon is hyperechoic, as there is no synovial membrane; a thin hyperechoic separation layer can be seen between the fascicles for the rectus, intermediate, lateral and medial heads of the muscle.

Task. Ultrasound shows a transverse section through the quadriceps tendon: the hyaline cartilage of the femoral condyles is hypoechoic, homogeneous echostructure, uniform thickness; the structure of the four quadriceps muscle bundles is studied proximally.

Task. Ultrasound shows a hypoechoic zone at the site of attachment of the quadriceps femoris tendon to the patella, a small tear in the posterior sections (arrow), a hyperechoic inclusion, and increased vascularization. Conclusion: Tendinosis of the distal quadriceps tendon.

Task. After falling on my knee, acute pain appeared; the patient cannot straighten his leg. On ultrasound, at the site of the quadriceps tendon, there is a heterogeneous hypoechoic zone with an uneven contour; tendon fibers are not identified. Conclusion: Rupture of the quadriceps tendon. Hematoma.

Task. Ultrasound shows avulsion of the tendon of one of the heads of the quadriceps femoris muscle: complete avulsion of the tendon and retraction of the rectus muscle; behind the rectus muscle, the intermediate muscle is of normal echogenicity and echostructure, the tendon is not broken.

Suprapatellar bursa on ultrasound

Under the quadriceps tendon, the suprapatellar bursa is located on a pad of fat; normally, a small amount of fluid can be seen in it.

Until the end of the 4th month of intrauterine development of the fetus, the cavity of the knee joint is separated from the suprapatellar bursa by the suprapatellar fold; by the end of the 5th month it is partially or completely reduced.

Degree of reduction of the suprapatellar fold: closed suprapatellar bursa; the suprapatellar fold has one or more openings; a residual connective tissue cord is visible, often on the inside; complete involution of the suprapatellar fold.

Task. Ultrasound shows a heterogeneous effusion in the suprapatellar bursa with a level of fine suspension; The bursa is separated from the joint cavity by a connective tissue linear structure (arrow)—the suprapatellar fold. Hemorrhagic fluid without signs of inflammation was aspirated from the suprapatellar bursa.

Task. Ultrasound shows longitudinal (1) and transverse (2) sections of the suprapatellar bursa: effusion is detected, the synovial membrane is thickened, vascularization is enhanced, the central septum is visible. Conclusion: Suprapatellar fold syndrome, local synovitis.

In 85% of cases, the suprapatellar bursa communicates with the anterior patellar inversion of the joint. Then the fluid in the suprapatellar bursa indicates effusion in the joint cavity - exudative synovitis, proliferation of the synovial membrane - exudative-proliferative synovitis.

If there is effusion in the suprapatellar inversion and bursa, it is important to examine the medial and lateral inversions of the joint; the sensor is placed transversely inward and outward from the patella.

Task. On ultrasound, effusion in the suprapatellar bursa: with normal sensor pressure, an echo picture of simple exudative synovitis; when the sensor pressure is excessive, the bag narrows and the illusion of an unevenly thickened synovial membrane appears - an echo picture of exudative-proliferative synovitis.

Task. Girl aged 10 months. On ultrasound, the patella and condyles are cartilaginously dense, growth zones are visible; in the suprapatellar volvulus there is effusion, the synovium is thickened, and vascularization is noticeably increased (2, 3, 4). Conclusion: Synovitis is exudative-proliferative.

Lipohemarthrosis occurs as a result of the extrusion of fat and blood from the bone marrow into the joint space after an intra-articular fracture. 97% of patients with intra-articular knee fracture have lipohemarthrosis.

Task. After falling from a wall, swelling, pain, and limited movement occurred in the knee joint. Ultrasound two days later showed no damage to the quadriceps tendon; in the suprapatellar volvulus and bursa there is a significant effusion from the alternation of hyper- and anechoic layers. Conclusion: Lipohemarthrosis of the knee joint, intra-articular fracture is likely. CT shows lipohemarthrosis; the patella is displaced laterally, there is a large defect in the medial edge; defect of the lateral edge of the distal femoral condyle; bone fragments in the surrounding tissues.

Task. Pigmented villonodular synovitis is a slow proliferation of the synovial membrane of large joints; nodular and villous outgrowths are formed, which can separate and form “articular mice”; accompanied by accumulation of hemorrhagic effusion, deposition of hemosiderin and the development of reactive synovitis; prolonged course leads to the appearance of degenerative changes in articular cartilage.

Hyaline cartilage of the femur on ultrasound

Task. To examine hyaline cartilage on the femoral condyles, the knee is flexed to 90° with the probe in the transverse plane above the patella. On ultrasound, the thickness of the cartilage on the femoral condyles is assessed on a transverse section: an avascular, homogeneous hypoechoic structure over the femoral condyles; The thickness of the cartilage decreases slightly from the center to the periphery.

Degenerative-dystrophic changes in cartilage on ultrasound

0-1 degree 2 degree 3 degree 4 degree

Osteophytes in the area of the medial condyles on ultrasound

with deforming osteoarthritis: moderate or absent swelling; hyaline cartilage unevenly thins, hyperechoic inclusions appear; the synovial membrane is focally thickened to 1-3 mm; moderate amount of effusion with homogeneous echostructure; the articular surfaces are grossly deformed by osteophytes.

for rheumatoid arthritis: severe swelling; hyaline cartilage in the initial stages may remain normal and even thickened due to swelling, then it becomes evenly thinner, cysts, erosions and ulcers appear; the synovial membrane is locally or diffusely thickened to 5-8 mm, fringed growths; there is a lot of effusion - fine and medium-dispersed suspension; the articular surfaces are flattened and significantly deformed.

Patella on ultrasound

Problem Double patella

Prepatellar bursitis - this type of bursitis is located directly under the skin on the patella and does not communicate with the cavity of the knee joint. If there are abrasions or wounds on the skin of the patella, then this type of bursitis becomes easily infected. Task. Prepatellar bursitis.

Task. Prepatellar bursitis

Task. Prepat hemorrhagic bursitis

Proprietary patellar ligament on ultrasound

The sensor is placed below the patella in the projection of the patellar ligament. The entire length of the ligament is examined from the place of attachment at the lower edge of the patella to the tibial tuberosity, while the condition of the fat body of the knee and subpatellar joint capsules is assessed.

Task. Ultrasound shows longitudinal and transverse sections of the patellar ligament (between the arrows): a fibrous structure of increased echogenicity stretches from the lower edge of the patella to the tibial tuberosity; above the patella, fibers from the quadriceps tendon to the patellar tendon (patella - sesamoid bone); behind the ligament is the fatty body of the knee joint and the deep infrapatellar bursa.

Task. Tendinosis of the proximal patellar ligament tendon with a thickened hypoechoic lesion with neovascularity.

Task. The jumper's knee is a patella with an uneven contour. On examination, there was no visible knee effusion and he had full range of motion; There is slight pain on palpation of the proximal insertion of the patellar tendon. On ultrasound, in the patellar ligament proper, at the site of attachment to the lower pole of the patella, there is a hypoechoic zone with hyperechoic inclusions, noticeable vascularization; The cortical layer of the patella is uneven. Conclusion: Patellar tendinopathy.

Task. Hoffa body injury

Task. Distal part of the patellar ligament.

Schlatter's disease on ultrasound

Infrapatellar bursitis – This bursitis is located under the patella, just behind the ligament. The bursa is protected by a ligament, so damage to the ligament leads to inflammation of the bursa.

Task. Schlatter - tuberosity with an uneven contour, tendinosis, bursitis.

Task. Schlatter

Task. A patient diagnosed with Osgut-Schlater disease complains of pain in the tibia. History of knee injury 10 years ago. On ultrasound, in the distal part of the patellar ligament there is a small hyperechoic structure with a posterior acoustic shadow, size 0.5x0.7 cm; echo signs of tendon tear and infrapatellar bursitis are not detected, the vascularization of the ligament and surrounding tissues is not changed. Conclusion: Bone fragment in the distal patellar ligament. X-ray data reveals a bone fragment, which can be interpreted as a consequence of an avulsion fracture, taking into account the history of the injury.

Interpretation of knee ultrasound results

When performing an ultrasound, the healthy condition of the knee joint will be reflected in the defined muscles, ligaments and cartilage, which will show clear boundaries of all structures in an adult patient. There will be no swelling and osteophytes, as well as other disorders. Hyaline cartilage has a natural width of 3 mm and a hypoechoic structure. The volume of joint fluid will be stable. The membranes of the joint are identified by folded inversions.

When deciphering the results of ultrasound diagnostics of a pathological process, certain data is displayed. Quite often, arthrosis is detected - destructive damage to cartilaginous structures, as shown by ultrasound of the knee joints:

uneven boundaries of the bone structures of the joint;
decreased cartilage thickness;
with advanced pathology - the formation of a growth;
unclear structure of the menisci;
areas with increased density for ultrasonic waves.

Not less often, an inflammatory process in the joint is determined - arthritis. The causes of the inflammatory process can be:

infection;
irritation of the epidermis;
autoimmune diseases;
metabolic disease.

In addition to a visual examination, identifying redness or swelling, the diagnosis can be confirmed by instruments. An increase in the anatomical components of the joint and its membrane is revealed. With bursitis, a decrease in the susceptibility of tissue to ultrasound waves, effusion and adhesions are detected. Inflammation of the tendon system (tendonitis) causes the knee ligaments to become thicker and calcified.

Meniscal injuries on ultrasound

Med meniscus

Task. Meniscus cyst. Lateral knee pain. There were no previous injuries, but discomfort persisted, especially when extending the knee. On examination, there was no effusion, a cystic, noncompressible, nonvascular, anechoic lesion on the lateral joint line that appeared to be associated with the lateral meniscus and joint line. The patient may have local swelling and discomfort in the joint area, and may have reduced range of motion. A meniscal cyst is a well-defined cystic lesion located along the peripheral edge of the meniscus and is often associated with horizontal meniscal tears. Meniscal cysts can be managed using guided aspiration, but are likely to be associated with meniscal pathology, which should be considered. On MRI, there is high signal in the anterior horn, and the body of the lateral meniscus extends into the lobular region of the fluid signal anteriorly and laterally, consistent with a meniscal tear and cyst. Several partitions are visible in this one.

Drawing.

Stages of ultrasound examination of the knee joint

To perform an ultrasound examination, the patient must bring a referral with the specified diagnosis issued by the attending physician, and, if available, the results of past diagnostics. By comparing them with new results, it will be easier for the doctor to assess the course of the disease. The manipulations do not require preparation, therefore, they can be carried out at any convenient time.

The patient sits on the couch, and the specialist runs a sensor over the surface of the knee and prompts the need to bend or straighten the leg. The sensor emits ultrasonic waves with an amplitude of 5–7.5 MHz. To avoid pain and discomfort, a specialized conductive gel is applied to the patient when the skin comes into contact with the sensor. It is colorless and odorless, and does not damage the skin.

The knee joint is a complex structure, so the study is performed from several positions to study it in detail. To get a clear picture, 4 approaches are used during diagnosis: anterior, posterior, medial and lateral. Thus, each access allows you to fully examine and study a specific area of the joint being examined.

Where to get an ultrasound of the knee joint in Moscow? This diagnostic test can be performed in our medical center. , to register, you can contact our website or call our administrators.

Features of diagnostics

The study is carried out without preliminary preparation. The method can be used both in the presence of complaints of pain, limited mobility and discomfort, and without clinical manifestations (for preventive purposes). When examining the lateral and anterior parts of the knee joints, the patient is lying on his back with his legs straightened. To examine the menisci, you need to flex your limbs. Inspection of the posterior sections is carried out in the prone position.

During the examination, the diagnostician examines both joints at once, even if only one hurts. It uses several accesses:

front;
medial;
lateral;
rear.

The anterior approach allows you to display the condition of the patellar ligaments, patellar bursa, fatty tissue, and subpatellar bursa.

Using the medial approach, the specialist examines the inside of the capsule and the meniscus and lateral ligaments. In this case, the patient is in a supine position with his legs extended. This access allows you to assess not only the condition of soft tissue formations, but also large bones, hyaline cartilage, determine the volume of effusion and the amount of natural lubrication.

Inspection from behind helps to assess the condition of the neurovascular formations, the posterior parts of the menisci, the head of the gastrocnemius muscle, the cruciate ligament, and tendon tissue.

Antero-longitudinal projection

In the anterior longitudinal projection, the sensor is placed above the patella. The specialist evaluates the shape and structure of the suprapatellar bursa, which looks like a triangle, determines the presence of pathological fluid, and examines the contours of the tibia and patellar ligaments.

Anterotransverse projection

Using the anterior transverse projection, the doctor evaluates the contours of the femur and suprapatellar bursa. The sensor is located above the patella. The synovial membrane is not visible. By lowering the transducer downwards, the anterior condyles of the tibia can be examined.

Lateral medial and posterior projections

During an ultrasound of the lateral medial projection of the knee, you can examine the joint spaces, medial meniscus, tibial and femoral condyles, and ligaments. When examining in posterior projections, the doctor has the opportunity to examine the bottom of the popliteal fossa, the lateral meniscus, hyaline cartilage, tendons, and the condyles of the tibia and femur. There is high-quality visualization of the neurovascular bundle located in the popliteal fossa.

Cost of ultrasound of the knee joint

Service	price, rub.
Ultrasound of the knee joint	1 200

Knee ultrasound in Moscow ranges in price from 1000 to 2500 rubles, in other cities of the Russian Federation the cost of the service is 1.5 times lower.

The cost of ultrasound is determined depending on the qualifications of the diagnostician. Carrying out an examination by a specialist without an academic degree will cost up to 1.2 thousand rubles. The price for ultrasound diagnostics for a candidate of medical sciences will reach 2 thousand rubles, doctor of medical sciences. – up to 2.5 thousand rubles. The higher the experience and knowledge of the specialist, the more expensive the cost of the service will be.

The price of an ultrasound will also depend on the quality of the equipment used.

Which joints are examined?

During the procedure, the following joints are most often examined:

shoulder;
elbows;
hip;
knee;
ankle

Shoulder and elbow

Ultrasound of the shoulder and elbow joints is performed in the following cases:

injuries, rupture of ligaments and tendons;
suspected fluid accumulation;
dysplasia;
crunching while moving;
pain;
tendon inflammation;
the appearance of edema;
suspicion of arthritis, arthrosis.

Examination of these joints is carried out in a sitting position. Periodically, the doctor asks you to change the position of your arm: bend it at the elbow, put it on your knees, move it to the side with your palm up, etc.

Hip joints

Most often, ultrasound examination of the hip joints is performed in newborns and up to a year when dysplasia is suspected.

Ultrasound of the hip joints

It is rarely performed in adults. Due to the structural features, as well as the presence of fatty deposits in these places, an MRI procedure will be more effective. However, in case of pain, swelling, deformation, or suspected pathology, the doctor may also prescribe an ultrasound examination.

Knees and ankles

Ultrasound of the knees and ankle is prescribed to identify the consequences of injuries, as well as to study pathological processes in connective tissues if they are detected. Indications also include suspicion of the appearance of neoplasms, inflammatory or degenerative processes.

It is first performed from a lying position with your back on the couch, after a while the doctor will ask you to turn onto your stomach. To clarify the picture, the joints are studied from four to five sides.

For a disease such as arthrosis, an ultrasound scan of paired joints

, even if the second joint does not cause concern. This makes it possible to diagnose joint damage before obvious signs of the disease appear.

Features of treatment of the disease in children

Baker's cyst is most often found in children under 7 years of age. As a rule, pathology does not appear on its own, but against the background of inflammatory diseases of the joints or after injuries. The symptoms of the disease are practically no different from the clinical picture that develops in adults.

If the Baker's cyst does not cause discomfort in the child and does not grow rapidly, it is monitored for some time. Surgical treatment is prescribed only for severe impairment of the motor function of the knee joint. In children, good therapeutic results can be achieved through systematic physiotherapeutic procedures and exercise therapy.

Treatment of Baker's Cyst in Naberezhnye Chelny

Only an experienced doctor can make the correct diagnosis, identify the root cause of the pathological process and prescribe adequate treatment for Baker’s cyst. At the Center for Restorative Medicine in Naberezhnye Chelny, a specialist in the field of orthopedics and traumatology can easily diagnose and treat any joint pathologies.

The cost of the clinic's services can be found by following the link. If you have any questions regarding the treatment of Baker’s cyst and other pathologies of the musculoskeletal system, you can make an appointment with a doctor by calling +7 (8552) 78-09-35, +7 (953) 482-66-62. It is important to remember that timely contact with a specialist speeds up the healing process, so don’t wait, call right now!

Physiotherapy

Physiotherapeutic procedures are prescribed after relief of an acute inflammatory process or during the rehabilitation period after surgery. A pronounced effect is obtained during a series of sessions:

mechanical traction - prevents the development of atrophy;
massage of the knee joint and lower legs - to restore blood supply and nutrition of soft tissues;
electrophoresis - activates tissue regeneration, normalization of metabolic processes;
UHF, infrared laser therapy - to relieve pain, eliminate inflammation and swelling;
magnetic therapy - restores metabolic processes and restores damaged tissue at the cellular level;
hydrogen sulfide, radon baths - for the prevention of thrombophlebitis, varicose veins, stimulation of local blood circulation.

During physiotherapy, the condition of the damaged knee joint and the degree of its motor activity are constantly assessed. You can learn more about physiotherapy methods here.

Surgery

Surgical removal of Baker's cyst of the knee joint is carried out according to certain indications:

ineffectiveness of drug and physiotherapeutic treatment;
excessively large size of the tumor;
presence of signs of rupture of the cyst membrane;
signs of necrotic changes in the popliteal fossa;
impairment of motor functions in the knee joint.

Surgical removal of the tumor is performed in one of the following ways: traditionally, using an arthroscope or laser.

Traditional removal is performed under local anesthesia. The doctor makes an incision over the cyst, isolates it and resects it. After removal, the surgical wound is inspected, the blood vessels are coagulated and sutured layer-by-layer.

Arthroscopy involves minimally invasive surgical removal of a Baker's cyst. During the operation, soft tissues are practically not injured and blood vessels are not damaged. The cyst is removed using special instruments. The entire process is displayed on the monitor, as a micro-video camera is inserted into the knee joint.

The laser provides high temperature - up to 800 ° C, with which the cyst is coagulated. The liquid contents are evacuated, and a light guide is inserted into the cyst cavity. Next, it is heated and the walls of the cavity are glued together.