Imaging of the Knee: Techniques and Applications

Preface
Contents
Part I: Imaging Techniques
Radiography
1 Introduction
2 Radiographic Techniques
3 Radiographic Projections
3.1 “Standard” Series
3.2 Trauma Series
3.3 Degenerative Disease
4 Radiographic Measurement Techniques
4.1 Assessment of Alignment
4.2 QPR or SKI
4.3 Roentgen Stereophotogrammetric Analysis
4.4 Femoral Condyle Configuration
4.5 Patellar Position
References
Computed Tomography (CT) and CT Arthrography
1 Introduction
2 Developments in CT
2.1 Slip Rings
2.2 X-Ray Tubes
2.3 X-Ray Detectors
2.4 Helical CT
2.5 CT Fluoroscopy
2.6 Dual-Energy CT
2.7 Data Processing and Reformatted Images
3 Scan Image Quality
3.1 Internal Metalwork from Fixation Devices
3.2 Image Display: CT Number, Hounsfield Unit, Window Width, and Level
4 CT of the Knee
4.1 Anatomy
4.2 Immobilization
5 Indications
5.1 Trauma
5.2 Knee Morphology and Surgery
5.3 Patellofemoral Joint
5.3.1 Static CT of the Patellofemoral Joint
5.3.2 Dynamic CT of the Patellofemoral Joint
5.4 Articular Cartilage
5.5 Soft Tissues
6 CT Arthrography
6.1 Role and Indications
6.2 Technique
7 CT-Guided Interventions
8 Conclusion
References
Magnetic Resonance Imaging
1 Introduction
2 General Considerations
3 Basic Concepts
3.1 Signal-to-Noise Ratio
3.2 Contrast-to-Noise Ratio
3.3 Spatial Resolution
3.4 Scan Time
4 Image Contrast and Pulse Sequences
4.1 T1-Weighted Spin Echo Sequence
4.2 T2-Weighted Spin Echo Sequence
4.3 Proton Density-Weighted Spin Echo Sequence
4.4 Intermediate-Weighted Spin Echo Sequence
4.5 Fast Spin Echo Sequences
4.6 Gradient Echo Sequences
4.7 3D Sequences
4.8 Fat-Suppression Techniques
4.8.1 Inversion Recovery
4.8.2 Fat Saturation
4.8.3 Dixon Method
4.8.4 Water Excitation
4.8.5 Hybrid Techniques
4.8.6 Summary of Fat-Suppression Techniques
4.9 Diffusion-Weighted Imaging
4.10 Rapid Image Acquisition Techniques
5 Patient Positioning and Imaging Planes
5.1 Menisci
5.2 Ligaments
5.3 Bone
5.4 Hyaline Cartilage
6 MRI Protocol for Routine Examination of the Knee
7 MRI Protocols for Specific Clinical Problems
7.1 Synovitis and Inflammatory Arthritis
7.2 Bone and Soft Tissue Infections
7.3 Bone and Soft Tissue Masses
7.4 MR Arthrography
7.5 MR Neurography
7.6 Cartilage Mapping Techniques
7.7 MRI of the Postoperative Knee
8 Recent Advances
8.1 Ultrahigh Field Strength MR Imaging
8.2 Ultrashort TE Sequences
8.3 Sodium Imaging
8.4 GAG Chemical Exchange Saturation Transfer Imaging
8.5 Synthetic MRI
8.6 MR Spectroscopy
8.7 Diffusion Tensor Imaging
8.8 MR Elastography
8.9 Radiomics in MSK Imaging
9 Artifacts
9.1 Motion Artifacts
9.2 Chemical Shift Artifacts
9.3 Magic Angle Phenomenon
9.4 Truncation Artifacts
9.5 Partial Volume Averaging Artifacts
9.6 Susceptibility Artifacts
9.7 Metallic Artifacts
10 Conclusion
References
Ultrasound
1 Introduction
2 US Scanning Technique
2.1 Anterior Region
2.1.1 Suprapatellar Region
2.1.1.1 Normal US Anatomy
2.1.1.2 Selected US Pathologic Images
2.1.2 Patellar Region
2.1.2.1 Normal US Anatomy (Fig. 10)
2.1.2.2 Selected US Pathologic Images
2.1.3 Infrapatellar Region
2.1.3.1 Normal US Anatomy
2.1.3.2 Selected US Pathologic Images
2.2 Medial Aspect
2.2.1 Normal US Anatomy
2.2.2 Selected US Pathologic Images
2.3 Lateral Aspect
2.3.1 Normal US Anatomy
2.3.2 Selected US Pathologic Images (Figs. 22, 23, and 24)
2.4 Posterior Aspect
2.4.1 Posterior Aspect, Medial Region (Figs. 25, 26, and 27)
2.4.2 Posterior Aspect, Middle Region (Fig. 28)
2.4.3 Posterior Aspect, Lateral Region (Fig. 29)
2.4.3.1 Selected US Pathologic Images
3 Conclusions
References
Part II: Clinical Applications
The Pediatric Knee
1 Introduction
2 Normal Development and Variants
2.1 Normal Irregular Ossification
2.2 Fibrous Cortical Defects and Avulsive Cortical Irregularity
2.3 Fabella
2.4 Posterior Distal Femoral and Proximal Tibial Metaphyseal Stripes on MRI
2.5 Discoid Meniscus
2.6 Developmental Angulation of the Knee
3 Pathological Conditions Specific to Pediatrics
3.1 Angular/Alignment Deformities
3.1.1 Genu Recurvatum
3.1.2 Congenital Dislocation of the Knee
3.2 Skeletal Dysplasias
3.3 Trauma
3.3.1 Bony Injuries
3.3.1.1 Physeal Injuries
3.3.1.2 Tibial Spine Fracture
3.3.1.3 Patella Sleeve Fracture
3.3.1.4 Sinding-Larsen–Johansson Lesion and Osgood–Schlatter Disease
3.3.1.5 Nonaccidental Injury
3.3.2 Soft Tissue Injuries
3.3.2.1 Osteochondritis Dissecans
3.3.2.2 Impingement of Superolateral Hoffa’s Fat Pad
3.3.2.3 Cruciate Ligament Injuries
3.3.2.4 Patella Dislocation
Trochlear Dysplasia
Lateral Trochlear Inclination
Trochlear Facet Asymmetry
Trochlear Depth
Patella Alta
Distance from Tibial Tubercle to Trochlear Groove
MRI Findings After Patella Dislocation
3.4 Inflammatory
3.4.1 Juvenile Idiopathic Arthritis
3.4.2 Chronic Recurrent Multifocal Osteomyelitis (CRMO)
3.4.3 Langerhans Cell Histiocytosis
3.4.4 Hemophilia
3.4.5 Pigmented Villonodular Synovitis
3.5 Bone and Soft Tissue Tumors
References
The Knee: Bone Trauma
1 Introduction
2 Indications for Radiography in Suspected Knee Injury
3 Extra-articular Fractures
3.1 Supracondylar Fractures
3.2 Distal Femoral Physeal Fractures
3.3 Fractures of the Proximal Fibula
3.4 Proximal Tibial Physeal Fractures
3.5 Fractures of the Patella
3.5.1 Horizontal Fractures
3.5.2 Pole Fractures
3.5.3 Vertical Fractures
3.5.4 Stellate Fractures
4 Intra-articular Fractures
4.1 Femoral Condylar Fractures
4.2 Fractures of the Tibial Plateau
4.3 Fractures of the Tibial Spine and Intercondylar Eminence
4.4 Avulsion of the Tibial Tuberosity
4.5 Osgood–Schlatter Lesion
4.6 Sinding-Larsen–Johansson Disease
4.7 Marginal Avulsion Fractures
4.8 Osteochondral Fractures
5 Dislocation
5.1 Knee
5.2 Patellar Dislocation
5.3 Proximal Tibiofibular Joint
6 Fatigue Fractures
6.1 Stress Fractures
6.2 Insufficiency Fractures
6.2.1 Subchondral Insufficiency Fractures
7 Conclusion
References
Stress Injuries
1 Introduction
2 Clinical Features
3 Etiology
4 Imaging Features
4.1 Radiography
4.2 MRI
4.3 CT
4.4 Nuclear Medicine
5 Treatment
References
The Knee: The Menisci
1 Technical Considerations
2 MR Sequences
3 Normal Anatomy (Renstrom and Johnson 1990; Petersen and Tillmann 1998)
4 Parameniscal Structures Mimicking Tears
5 Significance of Signal Alterations
6 Classification and Types of Meniscal Tears
7 Indirect Signs
8 Accuracy of MRI for Meniscal Tears and Diagnostic Errors
9 MR Arthrography for Meniscal Tears
10 Management of the Meniscal Tears
11 Conclusion
References
The Cruciate and Collateral Ligaments
1 Introduction
2 Anterior Cruciate Ligament
2.1 Anatomy
2.2 Pathology
2.3 Radiology
2.3.1 Complete ACL Tears
2.3.2 ACL Ganglia
2.3.3 Partial-Thickness ACL Tears
2.3.4 Secondary Signs
2.4 Associated Injuries
3 Posterior Cruciate Ligament
3.1 Anatomy
3.2 Pathology
3.2.1 Acute Injuries
3.2.2 Secondary Signs and Associated Injuries
3.2.3 Chronic PCL Injuries
3.2.4 Mucoid Degeneration of the PCL
3.2.5 Ganglion Cysts
4 Medial Collateral Ligament Complex
4.1 Anatomy
4.2 Pathology
4.2.1 Acute Injuries
4.2.2 Chronic Injuries
4.2.3 Nontraumatic Conditions
4.3 Posteromedial Corner
4.3.1 Anatomy
4.3.2 Pathology
5 Lateral Collateral Ligament Complex
5.1 Anterolateral Stabilizers
5.2 Posterolateral Stabilizers
5.3 Pathology
6 Conclusion
References
Postoperative Meniscus
1 Epidemiology
2 Meniscal Surgery
2.1 Total Meniscectomy
2.2 Partial Meniscectomy
2.3 Meniscal Repair
2.4 Root Tear Repair
2.5 Meniscal Replacement
2.5.1 Meniscal Allograft Transplant
2.5.2 Synthetic Meniscal Grafts and Augmentation with Polyurethane and Collagen
3 MRI of Postoperative Meniscus
3.1 Magnetic Field Strength
3.2 MRI Sequences
4 Postoperative Complications
5 Imaging Modalities
5.1 Conventional MRI
5.2 Indirect MRI Arthrography
5.3 Direct MRI Arthrography
5.4 Ultrashort TE
5.5 CT Arthrography
References
The Postoperative Knee: Cruciate and Other Ligaments
1 Introduction
2 Anterior Cruciate Ligament (ACL) Surgery
2.1 Anatomical ACL Reconstruction
2.1.1 Single- and Double-Bundle ACL Reconstruction
2.1.2 Graft Selection
2.1.3 Fixation Devices
2.1.4 Tunnels
2.2 ACL Repair and Concomitant Surgeries
2.2.1 Primary Ligament Repair
2.2.2 Suture Repairs
2.2.3 Bridge-Enhanced ACL Repair
2.3 Anatomic ACL Reconstruction with Remnant Augmentation
2.4 ACL Reconstruction for Partial Tears
2.5 Extra-articular Ligament Surgeries
2.5.1 Lateral Extra-articular Tenodesis (LET)
2.5.2 Anatomic Anterolateral Ligament (ALL) Reconstruction
2.6 Fixation of ACL Bone Avulsion Injuries
2.7 Pediatric ACL Reconstruction
2.7.1 Physeal-Sparing ACL Reconstruction
2.7.2 Partial and Complete Transphyseal ACL Reconstruction
3 Posterior Cruciate Ligament (PCL) Surgery
3.1 Anatomical PCL Reconstruction (PCLR)
3.1.1 Transtibial Tunnel vs. Tibial Inlay Techniques, Graft Fixation
3.1.2 Single Bundle vs. Double Bundle
3.1.3 Graft Selection and Fixation
3.2 Repair of PCL Avulsion Injuries
4 Medial Knee Ligament Surgery
5 Lateral Knee/Posterolateral Corner (PLC) Surgery
5.1 Anatomical PLC Reconstruction
5.2 Nonanatomical PLC Reconstruction (Larson Fibular Sling)
6 Imaging Techniques
6.1 Radiography
6.2 Computed Tomography (CT)
6.3 Magnetic Resonance Imaging (MRI)
7 Expected Appearances
7.1 Grafts
7.2 Harvest Sites
7.3 Tunnels and Fixation Devices
8 Complications
8.1 Graft Complications
8.1.1 Graft Tear
8.1.2 Impingement
8.2 Tunnel and Fixation Hardware Complications
8.3 Arthrofibrosis
8.4 Donor Site Abnormalities
9 Conclusion
References
The Postoperative Knee: Arthroplasty, Arthrodesis, Osteotomy
1 Introduction
2 Normal Arthroplasty Appearance
2.1 Arthroplasty Types
3 Complications
3.1 Infection
3.2 Aseptic Loosening
3.3 Osteolysis
3.4 Polyethylene Wear
3.5 Instability
3.6 Fractures
3.7 Patellar Complications
4 Knee Osteotomy
4.1 Blount Disease
4.2 Tibial Tuberosity Transfer
5 Knee Arthrodesis
6 Conclusion
References
Patellar and Quadriceps Mechanism: Clinical, Imaging, and Surgical Considerations
1 Patellar and Quadriceps Mechanism Anatomy
1.1 Embryology
1.2 Anatomy
1.3 Soft Tissue Restraints
1.4 Biomechanics
2 Clinical Findings
3 Imaging
3.1 Radiography
3.1.1 AP View
3.1.2 Lateral View
3.1.3 Axial
4 Pathologic Conditions, Imaging, and Treatment
4.1 Patellofemoral Pain Syndrome
4.2 Patellar Instability
4.3 Symptomatic Bipartite Patella
4.4 Osteochondritis Dissecans/Chondral Defects
4.5 Quadriceps and Patellar Tendinopathy and Rupture
4.6 Osgood–Schlatter Disease
4.7 Sinding-Larsen–Johannsen Disease
4.8 Post-op Failure and Iatrogenic Conditions
References
Infection
1 Introduction
2 Pediatric Native Knee Infection
3 Adult Native Knee Infection
4 Prosthetic Knee Infection
References
Arthritis
1 Introduction
2 Imaging Overview
3 Osteoarthritis
3.1 Overview
3.2 Conventional Radiographs
3.3 Advanced Imaging
3.3.1 MRI
3.3.1.1 Joint Effusion
3.3.1.2 Synovitis
3.3.1.3 Periarticular Cysts and Bursitis
3.3.1.4 Intra-articular Osteochondral (Loose) Bodies
3.3.1.5 Ligaments and Tendons
3.3.2 Ultrasound
4 Calcium Pyrophosphate Dihydrate (CPPD) Arthritis
4.1 Overview
4.2 Imaging Features
4.2.1 Conventional Radiographs
4.2.2 CT
4.2.3 MRI
4.2.4 Ultrasound
5 Gout as It Affects the Knee
5.1 Overview
5.2 Imaging
6 Rheumatoid Arthritis as It Affects the Knee
6.1 Overview
6.2 Imaging
6.2.1 Conventional Radiograph
6.3 Imaging with Advanced Modalities
7 Spondyloarthritides as They Affect the Knee
7.1 Overview
7.2 Imaging
8 Synovial Proliferation Associated with Arthritis
8.1 Synovial Osteochondromatosis
8.2 Pigmented Villonodular Synovitis
8.3 Lipoma Arborescens
9 Hemophilic Arthropathy
9.1 Overview
9.2 Imaging
10 Conclusion
References
Tumors and Tumorlike Lesions
1 Introduction
2 Detection
3 Diagnosis
3.1 Diagnosis of Bone Tumors
3.2 Diagnosis of Soft Tissue Tumors
3.3 CT and MR Imaging in Diagnosis
4 Surgical Staging
5 Imaging Follow-Up
6 Bone Tumors
6.1 Benign Bone Tumors
6.1.1 Osseous Tumors
6.1.1.1 Osteoma
6.1.1.2 Bone Islands
6.1.1.3 Osteoid Osteoma
6.1.2 Cartilaginous Tumors
6.1.2.1 Enchondroma
6.1.2.2 Chondromyxoid Fibroma
6.1.2.3 Chondroblastoma
6.1.2.4 Osteochondroma
6.1.3 Fibrogenic Tumors of Bone
6.1.3.1 Desmoplastic Fibroma
6.1.4 Osteoclastic Giant Cell-Rich Tumors
6.1.4.1 Nonossifying Fibromas/Fibrous Cortical Defects
6.1.4.2 Benign Fibrous Histiocytoma
6.1.4.3 Giant Cell Tumor of Bone
6.1.4.4 Aneurysmal Bone Cyst (ABC)
6.1.5 Other Mesenchymal Tumors of Bone
6.1.5.1 Lipomatous Tumors
6.1.5.2 Simple Bone Cyst (SBC)
6.1.5.3 Fibrous Dysplasia
6.1.5.4 Osteofibrous Dysplasia
6.2 Malignant Bone Tumors
6.2.1 Osseous Tumors
6.2.1.1 Osteosarcoma
6.2.2 Cartilaginous Tumors
6.2.3 Fibrous Tumors
6.2.4 Undifferentiated Small Round Cell Tumors of Bone
6.2.4.1 Ewing’s Sarcoma
6.2.4.2 Primary Lymphoma of Bone
6.3 Patellar Tumors
7 Soft Tissue Tumors
7.1 Benign Soft Tissue Tumors
7.2 Malignant Soft Tissue Tumors
7.2.1 Synovial Sarcoma
7.2.2 Dedifferentiated Liposarcoma
7.2.3 Myxoid Liposarcoma
8 Joint Tumors
8.1 Benign Joint Tumors
8.1.1 Bursae, Ganglia, and Synovial Cysts
8.1.1.1 Pigmented Villonodular Synovitis
8.1.1.2 Synovial (Osteo)chondromatosis
8.1.1.3 Lipoma Arborescens
8.1.1.4 Synovial Lipoma
8.1.1.5 Synovial Hemangioma
8.1.1.6 Intracapsular/Para-articular Chondromas
8.2 Malignant Joint Tumors
8.2.1 Synovial Sarcoma
8.2.2 Synovial Chondrosarcoma
9 Tumorlike Lesions of Bone
9.1 Periosteal Desmoid
9.2 Stress Fractures
9.3 Inflammatory Conditions
9.4 Brown Tumors
References