From SonoSite MSK Ultrasound Course, Pacific Medical, Tracy CA, February 2012

1. Ultrasound of the Knee
Alan M. Hirahara, M.D., FRCS(C)
Board Certified in Orthopaedic Surgery & Orthopaedic Sports Medicine
Specializing in arthroscopic shoulder surgery
Medical Director Team Physician Consultant
Sacramento State Athletics Sacramento River Cats Oakland A’s
MiLB - AAA

2. Ultrasound Technique - Anterior
• Quadriceps tendon
• Patellar tendon
• Patella
• Trochlea
• Femoral condyles
• ACL

3. Quadriceps Tendon - Longitudinal
• Leg position: 30o Flexion with bolster
• Tip: Superior to patella
• MRI equivalent: Sagittal plane

4. Quadriceps Tendon - Transverse
• Leg position: 30o Flexion with bolster
• Tip: Find longitudinal view and turn probe 90o
• MRI equivalent: Axial plane

5. Quadriceps – Poor Technique
• Leg position: Extension
• Problem: Concave tendon & false positive for tendon tear
• Solutions: Angle transducer perpendicular to tendon
Bend knee to 30o

6. Patellar Tendon - Longitudinal
• Leg position: 30o Flexion with bolster
• Tip: Superior to patella
• MRI equivalent: Sagittal plane

7. Patellar Tendon - Transverse
• Leg position: 30o Flexion with bolster
• Tip: Find longitudinal view and turn probe 90o
• MRI equivalent: Axial plane

8. Patellar Tendon – Long / Sup vs Inf
• Superior: More common area of tendonopathy
• Inferior: May see evidence of Osgood-Schlatter dz

9. Patellar Tendinosis

10. Partial Patellar Tendon Tear

11. Patellar Tendon Rupture

12. Patellar Tendon Repair

13. Patellar Tendon Repair

14. Trochlea
• Leg position: Full Flexion
• Tip: Superior to patella
• MRI equivalent: Axial plane

15. Femoral Condyles - Anterior
• Leg position: Full Flexion
• Tip: Superior to patella
• MRI equivalent: Sagittal plane

16. MFC Chondral Lesion

17. ACL
• Leg position: Full Flexion
• Tip: Transpatellar tendon, tilt probe in plane with ligament
• MRI equivalent: Sagittal plane

18. Ultrasound Technique - Medial
• Medial meniscus
• MCL
• MPFL
• Pes anserine bursae *

19. MCL
• Leg position: 30o Flexion; Hip externally rotated
• Tip: Find medial epicondyle and follow to joint
• MRI equivalent: Frontal plane

20. MCL Tear

21. MCL Tear

22. MCL Tear

23. Medial Meniscus
• Leg position: 30o Flexion; Hip externally rotated
• Tip: After finding medial meniscus, follow joint anterior / posterior
• MRI equivalent: Frontal plane

24. Medial Meniscus Tear

25. Post-op Medial Menisectomy

26. MPFL
• Leg position: 30o Flexion; Hip externally rotated
• Tip: Mid-patella and follow medial to adductor tubercle
• MRI equivalent: Axial plane

27. MPFL Strain

28. Ultrasound Technique - Lateral
• IT band
• LCL
• Lateral meniscus
• Posterolateral corner
• Popliteus

29. LCL
• Leg position: 30o Flexion; Hip internally rotated
• Tip: Find fibular head and follow to lateral epicondyle
• MRI equivalent: Frontal plane

30. LCL Sprain

31. IT Band
• Leg position: Extension; Hip internally rotated
• Tip: Find Gerdy’s tubercle and follow proximally
• MRI equivalent: Frontal plane

32. Lateral Meniscus
• Leg position: Extension; Hip internally rotated
• Tip: Find lateral joint line. Stay perpendicular to joint line
• MRI equivalent: Frontal plane

33. Lateral Meniscus Tear

34. Lateral Meniscus Tear

35. Popliteus
• Leg position: 30o Flexion; Hip internally rotated
• Tip: Angle probe, find groove in condyle laterally under LCL
• MRI equivalent: Frontal plane

36. Ultrasound Technique - Posterior
• Menisci
• PCL
• Pes anserine
– Sartorius, Gracilis, Semitendinosus
• Semimembranosus
• Biceps femoris
• Gastrocnemius
• Femoral condyles
• Popliteal artery & vein
• Tibial & Peroneal nerves

37. Posterior Mensici
• Leg position: Prone, extension
• Tip: Find joint line and move over medial knee
• MRI equivalent: Sagittal plane

38. Posterior Medial Meniscus Tear

39. Posterior Medial Meniscus Tear

40. Baker’s Cyst & Loose Body

41. Posterior Condyles
• Leg position: Prone, extension
• Tip: Find meniscus then move superior
• MRI equivalent: Sagittal plane

42. PCL
• Leg position: Prone, extension
• Tip: Find joint line and move central. Will find medial to popliteal a.
• MRI equivalent: Sagittal plane

43. NV Structures - Transverse
• Leg position: Prone, extension
• Tip: Center of posterior knee. Compression to identify artery/vein
• Use CPD to identify artery/vein
• MRI equivalent: Axial plane

44. NV Structures - Longitudinal
• Leg position: Prone, extension
• Tip: Find NV transverse plane then turn probe 90o
• MRI equivalent: Sagittal plane