- Ultrasound can be carried out not only according to indications, when there is a suspicion of pathology or it has already been identified - the study can also be carried out for preventive purposes in the absence of complaints. For example, examination of the knee joint is indicated for professional athletes, especially gymnasts, runners, basketball players, skiers, bodybuilders, etc. Their occupation can cause chronic trauma to the joint, when no discomfort is felt, but the tissues are gradually deformed. If this condition is not detected early, the changes can become severe and cause significant limitations in mobility.
- 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.
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:
Advantages and disadvantages of the procedure
This medical procedure has clear advantages, which are as follows:
Of the minuses, we can only note the limitation of the examination area, as well as the need to conduct research and interpretation only by experienced doctors.
Rehabilitation after knee arthroscopy
For the procedure to be successful, the patient must strictly follow the orthopedist's recommendations. It is important to ease the operation on your leg for a few weeks, which will likely mean you will need to use crutches. It is advisable to practice walking on crutches at least a little before surgery.
During recovery, the patient should avoid physical activity. However, this does not mean a complete renunciation of activities. After arthroscopy, it is important to perform exercises under the supervision of a physical therapist to strengthen and stretch the muscles and improve joint stabilization. Recovery from the procedure may take up to 6 weeks. Full recovery takes about 12 weeks, but this depends on the individual.
Following your doctor's instructions may protect against complications after arthroscopy. Pain, swelling and bruising are the most common symptoms after the procedure, but deep vein thrombosis or bacterial infections may occur in some cases. The reason for such side effects is, as a rule, too early stress on the operated joints.
Restrictions on performing ultrasound of the knee joint
As such, there are no contraindications to this manipulation. But still, in some cases, diagnostics may not be informative enough. For example, this occurs when the joint is completely immobile. If the skin has serious damage, for example, severe burns or abrasions, the results may also be distorted, and the examination process may be unpleasant for the patient.
Also, ultrasound of the knee joint is not recommended for people suffering from varying degrees of obesity. In this case, experts suggest giving preference to other diagnostic methods, for example, magnetic resonance imaging or arthroscopy.
What are the benefits of treatment?
Compared to other methods that require full opening of the knee joint, arthroscopy is relatively less invasive, which is a great advantage for the patient. The incisions made during the procedure are painless, and the scars after them are small. After such a procedure, the patient can be discharged from the hospital within 1-2 days. Orthopedists choose to perform arthroscopy because it is more accurate than other imaging methods. In addition, arthroscopy allows you to evaluate the functioning of the joints during movement.
Algorithm for performing ultrasound of the knee joint
No special preparation is required for the procedure.
As mentioned above, the knee joint has a complex structure. For this reason, diagnosis is carried out in several projections:
Front position. A person lies down on a flat couch with his legs extended forward. The doctor moves the sensor along the front area of the knee joint. In this position, it is possible to examine the patellar ligaments, the condition of the joint capsule and fatty tissue in this area.
Lateral position or medial. The ultrasound sensor is placed on the inner surface of the knee joint. The specialist examines the condition of the meniscus and collateral ligaments, and assesses the fluid level in the joints.
Next comes the lateral position. To ensure the reliability of the test results, the doctor asks the patient to bend the limb. In this position, the specialist examines the condition of the fascia from below, the meniscus from the outside, the tendons and joint capsule from the side.
Lastly, the patient should lie on his stomach, and an ultrasound diagnostic specialist will examine the condition of the neurovascular bundle. At this time, the sensor is located in the popliteal fossa. This is how the head of the calf muscles, the meniscus from the back, adjacent muscles and ligaments are examined.
What does knee bursitis look like on an MRI?
Several bags protect the knee joint from damage
The superficial infrapatellar bursa is located between the tibial tuberosity and the overlying skin, while the deep one is limited to the posterior aspect of the patellar tendon and the tibia. Highlight:
- Superficial infrapatellar bursitis
MRI of the knee: the bursa is located under the skin above the tibial tuberosity (arrow)
Superficial infrapatellar bursitis, also called priest's knee, occurs due to inflammation and fluid accumulation from chronic pressure. Clinically, there is palpable swelling below the kneecap. Initially there may be no pain.
On MRI, the pathology appears as a fluid mass protruding in front of the patellar tendon (arrow).
When visualizing, bursitis is differentiated from subcutaneous edema, the latter representing diffuse (not localized with clear boundaries) fluid deposition over the entire surface of the knee.
- Deep infrapatellar bursitis
Inflammation of the deep infrapatellar bursa on an MRI scan (arrow)
On MRI, deep infrapatellar bursitis appears as a triangular collection of fluid behind the patellar tendon. When detected in adolescents, the inflamed bursa is differentiated from Osgood-Schlatter disease, which is characterized by signal hyperintensity. Infrapatellar bursitis most often develops when falling on your knees. Tilers, builders, and maids are susceptible to pathology.
- Prepatellar bursitis
Inflammation of the anterior subcutaneous prepatellar bursa on MRI (arrow)
The prepatellar bursa is a three-component structure. The superficial compartment is located between the subcutaneous tissue and the continuation of the lata fascia of the thigh, the middle one is between the transverse superficial and intermediate oblique fascia. The deep is limited by the oblique connective tissue membrane and the longitudinal fibers of the rectus femoris tendon. Inflammation of the said synovial bursa occurs from prolonged kneeling; the pathology is recorded with gout. The main clinical manifestations are pain and swelling. Chronic trauma leads to inflammation and hemorrhagic bursitis. On MRI, prepatellar bursitis appears as an oval fluid formation between the subcutaneous tissue and the patella.
Bursitis of the medial collateral ligament of the knee joint on MRI (arrow)
Magnetic resonance scanning shows the exact location and size of the inflammatory process. Depending on the location of the affected synovial bursa, the following are most often distinguished: supra-, pre-, and infrapatellar bursitis.
Normal knee joint according to ultrasound
During the diagnostic procedure, the specialist pays attention to the condition of the knee joint, tissues and ligaments in this area. If there are no pathological processes, the conclusion states the following:
- The contours of the joint are clear, no anomalies or organic changes were detected;
- Hyaline cartilage is in normal condition and has a homogeneous structure;
- There are no bone osteophytes;
- Hypoechogenicity of joint capsules and inversions, absence of effusion;
- Absence of synovial membrane on ultrasound images;
- No soft tissue swelling is observed.
An ultrasound examination of the knee joint is carried out by an ultrasound diagnostician, who also deciphers the data for the conclusion. The results obtained are interpreted by the doctor who referred the patient for diagnosis. After the examination, in some cases, images are also provided that must be attached to the patient’s medical record.
Decoding the research results
The patient receives an interpretation of the ultrasound diagnostics within 10-15 minutes after the procedure. Normally, all surfaces should be smooth and clear, the joint capsules look like hypoechoic structures. The doctor pays attention to the uniformity of hyaline cartilage and the quality of tissue nutrition. There should be no inflammatory effusion inside.
The ultrasound examination method allows you to detect:
- signs of infectious and inflammatory processes;
- age-related and post-traumatic changes;
- hematomas;
- degenerative-destructive changes;
- deterioration of blood circulation and nutrition of cartilage tissue;
- cysts, tumors, metastases;
- dislocations, fractures, ligament tears, meniscus injuries.
To interpret the resulting images, the specialist must have knowledge of the anatomical features of the structure of the knees and the blood circulation of nearby tissues. The CONSTANTA Clinic employs experienced diagnosticians who are well acquainted with the common problems of this anatomical zone and successfully carry out differential diagnosis, providing reliable examination results.
Damage to tendons and ligaments
Injuries to the tendon-ligamentous system occur during sports activities, falls, rare jumps and awkward movements. Ultrasound makes it possible to assess the integrity of connective tissue and detect hematomas. With partial ruptures, the contours of the tendon are preserved, but a hypoechoic zone is noticeable at the site of injury. It can also be seen between bone fragments when the patella is fractured.
Meniscus injuries
The menisci can be damaged by sudden rotation of the tibia, excessive flexion or extension of the limbs. In the first days after injury, sharp pain occurs and movement is limited. The skin is swollen and hyperemic. In this condition, the patient needs urgent medical attention. If conservative therapy is ineffective, meniscectomy must be performed. When the menisci are damaged, their contours are disrupted, hypoechoic areas and extraneous stripes appear. The appearance of effusion inside the joint is characteristic. Diagnostics must be carried out as soon as possible in order to assess the severity of the condition and, for certain indications, carry out therapeutic and diagnostic arthroscopy.
Rheumatoid arthritis
This disease is accompanied by destructive changes, the formation of osteophytes, subcutaneous nodules and nerve damage. The disease is chronic. Patients complain of morning stiffness in the joints and constant pain. Inside the knee joint, exudate accumulates, contractures and characteristic deformities appear. During the examination, specialists detect osteophytes, effusion, narrowing of the joint space and thinning of hyaline cartilage.
Fluid in the knee joint: causes and treatment
Knee diarthrosis is the second, after the hip, in size and importance in the human body. When moving, it takes on the entire weight of the body, therefore it is susceptible to wear, destruction and injury like no other. Traumatologists daily encounter knee problems in patients caused by illnesses and injuries, stress and falls. One of the serious problems is considered to be synovitis - the collection of effusion in the diarthrosis cavity. And if there is additional swelling, pain and swelling, we can say with complete confidence that excess joint fluid has accumulated in it. The special term “synovitis” itself comes from the direct name of the lubricating thicket of the joints – synovium. It is considered a rather dangerous disorder, and in case of it it is better not to postpone a visit to the clinic. It won’t hurt to figure out why synovitis occurs, how to fight it, what measures to take and what it threatens.