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Файл:Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_5833_Библиотеки_им_академика_М_И_Перельмана.pdf
Fig. 7.7a Lower limb and probe position to evaluate the
femoral trochlear cartilage
Fig. 7.7b The sonogram shows the femoral trochlear cartilage (arrowheads). TF, femoral trochlea
7 Knee
98
Anterior Compartment
99
Fig. 7.8 Anatomical scheme of patellar retinacula.
MR, medial retinaculum; LR, lateral retinaculum;
PT, patellar tendon; F, femoris; T, tibia; F, f
ibula;
P, patella (under PT).
Fig. 7.9a Probe position to
evaluate the lateral and medial
retinacula
Fig. 7.9b The sonogram shows the medial retinaculum (arrowheads). P, patella;
mfc, medial femoral condyle; ifc, lateral femoral condyle
Fig. 7.11a Probe position to
evaluate the patellar tendon on
the short axis
Fig. 7.11b Patellar tendon scan on its short axis (arrowheads). The tendon has
a typical oval elongated section (lateral-medial is larger than the antero-poste-
rior one)
7.1.5 Patellar Tendon or Ligament
The lower limb is placed in the same position
used to evaluate the quadriceps tendon. The
patellar tendon must be evaluated using both
long and short axis scans, covering its whole
length (Figs. 7.10, 7.11b, 7.12a, b).
The Hoffa fat pad lies deep to the patellar
tendon. The deep infrapatellar bursa is located
at the lower pole of the Hoffa fat pad. In phys-
iological conditions, the bursa is distended by a
small amount of fluid and appears as a small
hypoechoic triangular area. The superficial
infrapatellar bursa is located over the distal
enthesis of the patellar tendon and cannot be
seen in physiological conditions.
7 Knee
100
Fig. 7.10 Anatomical scheme of quadriceps (QT) and
patellar (PT) tendons. F, femoris; T, tibia; Fi, fibula;
P, patella (under PT)
Anterior Compartment
101
Fig. 7.12a Probe position to evaluate the patellar
tendon on its long axis
Fig. 7.12b Two coulplead images showing the patellar tendon in all its extension (arrowheads). P, lower patellar
pole; T, anterior tibial apophysis; HFP, Hoffa’s fat pad
7.2 Medial Compartment
7.2.1 Medial Collateral Ligament
Anatomical scheme of medial collateral liga-
ment is shown in Fig. 7.13. The patient is
supine with the knee flexed to 20–30° and the
leg externally rotated (Fig. 7.14).
The medial collateral ligament is a double-
layered ligament with a slightly oblique course,
from the medial femoral condyle anteriorly to
the medial tibial aspect posteriorly. The probe
must be placed on a coronal oblique scan to
assess the ligament along its extension. Both
superficial and deep portions of the ligament
(meniscus-femoral and meniscus-tibialis bun-
dles) must be assessed (Figs. 7.15a, b).
7.2.2 Goose’s Foot Tendons
Anatomical scheme of goose’s foot tendons is
reported in Fig. 7.16. Slightly anterior to the
distal insertion of the medial collateral liga-
ment, the three tendons (sartorius, gracilis,
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102
semitendinosus) that concur to form the
goose’s foot can be seen (Figs. 7.17a, b). The
goose’s foot bursa cannot be seen in physiolog-
ical conditions. When the bursa is not distend-
ed, tendons cannot be easily distinguished one
from another.
The sartorius is a superficial muscle arising
from the anterior superior iliac spine that
runs obliquely in the anterior thigh up to the
medial tibial tubercle, where its fibers melt
with those belonging to the gracilis and
semitendinosus muscle
The gracilis lies in the medial region of the
thigh, deep to the adductor longus and mag-
nus. It arises from the pubic symphysis and
inserts on the medial tibial tubercle.
The semitendinosus is a superficial muscle
located in the posterior medial region of the
thigh. It arises from the ischiatic tuberosity
with a tendon in common with the long head
of biceps femoris and inserts on the medial
tibial tubercle.
Fig. 7.13 Anatomical scheme of the medial collateral
ligament (arrowheads). ME, medial epicondyle;
P, patella; T, tibia; Fi, f
ibula
Medial Compartment
103
Fig. 7.14 Position of lower limb for
evaluation of medial compartment
Fig. 7.15a Probe position to evaluate
the medial collateral ligament
Fig. 7.15b Superficial bundle of the medial collateral ligament (arrowheads). The asterisk shows the deep bundle of
the medial collateral ligament. m, medial meniscus.; Ti, tibia; F, femur
7 Knee
104
Fig. 7.16 Anatomical scheme of the
goose’s foot tendons. 1, sartorius; 2, gra-
cilis; 3, semimembranosus; 4, semitendi-
nosus; GM, medial head of the gastrocne-
mius muscle; GL, lateral head of the gas-
trocnemius muscle; T, tibia; PT, patellar
tendon
Fig. 7.17a Probe position to evaluate the
goose’s foot tendons on the long axis
Fig. 7.17b Tibial insertion of goose’s foot tendons (arrowheads). Ti, tibia
7.3 Lateral Compartment
7.3.1 Iliotibial Tract
Anatomical scheme of the iliotibial tract is
shown in Fig. 7.18. Patient is supine with the
knee flexed to 20–30° and slightly internally
rotated (Fig. 7.19).
The iliotibial tract can be seen by perform-
ing a longitudinal coronal oblique scan on the
lateral distal side of the knee and can be fol-
lowed up to the tibial insertion on the Gerdy’s
tubercle (Figs. 7.20a, b). Turning the probe by
90° allows for evaluation of the iliotibial tract
on the short axis (Figs. 7.21a, b).
The tensor fasciae latae muscle arises from
the outer border of the iliac crest. It courses
in the anterior lateral thigh, inserting distal-
ly on the Gerdy’s tubercle with a tendon
common to the iliotibial tract.
7.3.2 Lateral Collateral Ligament
Anatomical scheme of the lateral collateral lig-
ament and popliteus muscle is shown in Fig.
7.22. The lateral collateral ligament can be
evaluated by placing the distal edge of the
probe on the fibular head and performing a
coronal oblique scan (Figs. 7.23a, b). The liga-
ment cannot be evaluated completely with just
one scan, the probe must be moved upwards
and downwards. Deep to the proximal insertion
of the ligament, the popliteus tendon can be
seen running into its femoral groove (popliteal
hiatus).
The popliteus is a flat muscle located deep
to the plantar and the gastrocnemius mus-
cles. It arises from the external aspect of the
lateral femoral condyle and inserts on the
superior lip and the posterior surface of the
tibia.
Lateral Compartment
105
Fig. 7.18 Anatomical scheme of the iliotibial tract
(arrowheads). F, femur; P, patella; T, tibia; Fi, fibula
Fig. 7.19 Lower limb position to evaluate the lateral
compartment
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106
Fig. 7.20a Probe position to evaluate the iliotibial
tract on its long axis
Fig. 7.21a Probe position to evaluate the inser-
tional region of iliotibial tract on the short axis
Fig. 7.21b Iliotibial tract on the
short axis (arrowheads) close to the
tibial surf
ace (Ti)
Fig. 7.20b The iliotibial
tract on the long axis
(arrowheads). F, e
xternal
condyle of femur;
T, Gerdy’s tubercle
Lateral Compartment
107
Fig. 7.23a Probe position to evaluate the lateral
collateral ligament on the long axis
Fig. 7.22a Anatomical
scheme of the lateral
collateral ligament (lateral
vie
w). *, lateral collateral
ligament; LE, lateral
epicondyle; Fi, fibula;
T, tibia
Fig. 7.23b Two coupled images showing the lateral collateral ligament (arrowheads) on a long axis scan. LE, lateral
epicondyle of femur; Fi, fibular head; T, tibia; *, popliteus tendon
Fig. 7.22b Anatomical
scheme of the lateral
collateral ligament and the
popliteus muscle and
tendon (posterior vie
w).
*, lateral collateral
ligament; Po, popliteus
muscle; LE, lateral
epicondyle; Fi, fibula;
T, tibia