Ultrasonographic evaluation of soft tissue injuries of the knee with MRI correlation

Abstract

Background:Ultrasonograhy is vastly underutilized for evaluation of knee joint pathologies. With additional refinements in ultrasound technology and scanning techniques, we expect further expansion of its role in the evaluation of the knee joint injuries.. MRI is non-invasive gold standard for the diagnosis of internal derangement of knee, however the high cost and limited availability of MRI precludes its routine uses.
Aims:The purpose of this study was to assess the effectiveness of ultrasound in the diagnosis of soft tissue injuries of the knee and comparison of results with MRI.Materials & Methods: The present study included 50 patients with knee pain and suspected knee joint pathologies . For USG evaluation examination is directed to the location of maximum pain, and compared with the other limb to avoid artifacts or normal variants. For comprehensive study anatomical evaluation of knee compartments done for tendon, ligaments, osseous structures, peripheral nerves, vessels, joint effusion, fluid collection around the knee joint, patellar cortex and juxta-articular cysts. For MRI Patient was placed in supine position with the knee in a closely coupled extremity coil. The knee was externally rotated 15 to 20 degree and flexed slightly 5 to 10 degree to increase the accuracy of assessing the ACL, patellofemoral compartment and patellar alignment. Multiplaner images (axial, coronal and saggital ) obtained in T1, T2, PD , STIR and GRE sequences.Conclusion:A well performed ultrasonography, proper appreciation of relevant ultrasonographic anatomy and common knee pathologies , knowledge of pitfalls of study allow effective use of this powerful tool for evaluation of disorders of knee joint. In most cases it obviates the need for more expensive & invasive arthroscopy and the more cumbersome and expensive MRI examination. The use of high resolution sonography allow exploration of all extra-articular soft tissues injuries and meniscal injuries (intra-articular) as a first line diagnostic method and provides adjunct in assessment of cruciate ligament injuries.