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Файл:Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_5779_Библиотеки_им_академика_М_И_Перельмана
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160 Chapter 6
ANTERIOR KNEE
Suprapatellar Region
1. Patient position: Supine with the knee flexed at 30 degrees and supported on a roll/pillow
2. Probe/transducer position:
a. Long axis (LX) view/longitudinal view: Use the patella as a bony landmark to scan the
region in the LX view (Figure 6-1).
A
C
B
Figure 6 -1. LX view of the suprapatellar
region. (A) Limb positioning: supine
with the knee f lexed at 30 degrees and suppor ted on a roll/pillow. (B) Probe placement. (C) LX view of the suprapatellar
region showing the quadriceps tendon (big white arrow) and the suprapatellar fat pad (thin white arrow) separated
from the prefemoral fat pad (yellow arrow) by the thin hypoechoic capsule.
b. Short axis (SX) view/transverse view: Place the probe transversely across the quadriceps
tendon just proximal to its attachment at the patella to visualize the distal portion of the
tendon in the SX view (Figure 6-2).
A
Figure 6 -2. SX view of the suprapatellar
region. (A) Probe placement. (B) SX view
of the suprapatellar region showing the
quadriceps tendon (big white arrow)
and fat pad (thin white arrow) above
the femur.
B
Knee 161
3. Relevant anatomy: From superficial to deep, structures are visualized as skin, subcutaneous
layer, quadriceps tendon attaching to the patella, prefemoral fat pad and suprapatellar fat pad,
and femoral bony interface as the deepest structure (Figure 6-3).
Figure 6-3. Sagittal section of the knee showing relevant anatomy of the suprapatellar region.
4. Points to remember: Knee flexion at approximately 30 degrees is the optimal position to visual-
ize the anatomy of the suprapatellar region to minimize anisotropy artifact due to tendon slack.
162 Chapter 6
Quadriceps Tendon
1. Patient position: Same as the position for a suprapatellar scan, with added f lexion to take out
the tendon slack if tendons show anisotropy artifact
2. Probe/transducer position: Same as for a suprapatellar scan
3. Relevant anatomy: When scanned in the LX view, the quadriceps tendon shows a multilayer
arrangement. From superficial to deep, there are 3 layers: the rectus femoris, vastus medialis/
lateralis, and vastus intermedius (Figures 6-4 through 6-7).
AB
Figure 6-4. LX view of the quadriceps
tendon. (A) Probe placement. (B) LX
view of the quadriceps tendon showing
the multilayer arrangement of the
rectus femoris (white triangle), vastus
lateralis/medialis (red triangle), and
vastus intermedius (yellow triangle).
AB
Figure 6-5. SX view of the quadriceps
tendon. (A) Probe placement. (B) SX
view of the quadriceps tendon showing
the rectus femoris (white arrow) on top,
vastus lateralis (VL) and vastus medialis
(VM) in the middle (red arrow), and
vastus intermedius (yellow arrow) as
the deep layer.
Knee 163
Figure 6-6. Panoramic LX view of the quadriceps (white arrow).
164 Chapter 6
Figure 6 -7. Panoramic SX view of the quadriceps muscle showing the rectus femoris (white arrow), vastus lateralis (VL)
and vastus medialis (VM; red arrows), and vastus intermedius (yellow arrow).
4. Points to remember: A slack tendon may appear hypoechoic due to anisotropy. It is important
to scan the tendon in a stretched position so that the ultrasound beam strikes the tendon at 90
degrees for optimal scanning. Too much stretch should be avoided because it can obliterate the
small blood vessels in cases of neoangiogenesis and color Doppler may not show hyperemia or
positive color Doppler sign.
Knee 165
Femoral Trochlear Cartilage
1. Patient position: Supine with maximum knee flexion
2. Probe/transducer position:
a. LX view/longitudinal view: With the patella as a bony landmark, the probe is oriented
along the quadriceps tendon in the LX view (Figure 6-8).
A C
B
Figure 6-8. Femoral trochlear cartilage. (A) Limb positioning: supine with
maximum knee flexion. (B) Probe placement for the LX view. (C) Femoral
trochlear cartilage (white arrow) is seen as an anechoic structure over the
femoral bony interface.
b. SX view/transverse view: Place the probe transversely at the level just proximal to the supe-
rior border of the patella to visualize the femoral trochlear cartilage (Figure 6-9).
BA
Figure 6-9. Sunrise view of the
femoral trochlear cartilage. (A) Probe
placement for sunrise view. (B) Sunrise
view showing the anechoic cartilage
overlying the femoral bony interface.
166 Chapter 6
3. Relevant anatomy: In the SX view, the femoral trochlear cartilage appears as an anechoic
uniform area following the bony contour of the femoral trochlea. A sharp bony edge/protuberance on the medial aspect is the normal finding. Anechoic cartilage can also be seen in
the LX view.
4. Points to remember: Adding maximum flexion to the knee exposes the femoral trochlear cartilage anteriorly for sonographic visualization. If there is range of motion limitation of knee
flexion, the femoral trochlear cartilage view may be restricted.
Patellar Tendon
1. Patient position: Supine with 30-degree knee flexion
2. Probe/transducer position:
a. LX view/longitudinal view: Scan the patellar tendon longitudinally by bridging the patella
and tibial tuberosity (Figure 6-10).
A
B
Figure 6-10. LX view of the patellar tendon. (A) Probe placement. (B) LX view of the patellar tendon.
Knee 167
b. SX view/transverse view: Place the probe transversely across the patellar tendon. The ten-
don should be scanned along the length of the tendon in the SX view for complete evaluation (Figure 6-11).
A
Figure 6-11. SX view of the patellar
tendon. (A) Probe placement. (B) SX
view of the patellar tendon (white
arrow) at mid-length. (C) SX view of the
patellar tendon (white arrow) distally
over the tibia.
B
C
3. Relevant anatomy: There is a proximal bony attachment of the patellar tendon at the patella
and a distal tendon attachment at the tibial tuberosity. From superficial to deep, the structures
are visualized as skin, subcutaneous tissue, patellar tendon attaching proximally to the patella
and distally to the tibial tuberosity, and fat pad/Hoffa’s fat pad.
4. Points to remember: The patellar tendon should be scanned in the LX and SX views from its
proximal attachment site at the patella to the distal attachment site at the tibial tuberosity
(Figure 6-12).
Figure 6-12. Panoramic LX view of
the patellar tendon (white arrows).
168 Chapter 6
Anterior Bursae
1. Patient position: Supine with slight knee flexion
2. Probe/transducer position:
a. LX view/longitudinal view: The probe is placed longitudinally over the patella and
then moved distally over the patellar tendon and tibial tuberosity with light pressure
(Figure 6-13).
A
B
Figure 6-13. Anterior bursae. (A) Probe placement. (B) LX view of the anterior knee with light pressure to evaluate the
subcutaneous bursae.
b. SX view/transverse view: The SX view is only used to confirm abnormal findings in the
LX view.
Knee 169
3. Relevant anatomy: There are 2 subcutaneous bursae on the anterior aspect of the knee: the
prepatellar bursa, which is just above the patella, and the superficial infrapatellar bursa, which
is just superficial to the distal patellar tendon and tibial tuberosity. There is a deep bursa called
the deep infrapatellar bursa, which is present between the distal patellar tendon and the tibia
(Figures 6-14 through 6-16).
1
Figure 6-14. Relevant anatomy of the anterior bursae and fascial layers.
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