Abstract
Background: Ultrasonography is a noninvasive imaging modality used for the assessment of the musculoskeletal system. It can provide clinically useful information on a wide range of pathologic conditions affecting components of the knee joint, including the tendons, ligaments, muscles, synovial space, articular cartilage, and surrounding soft tissues. Now our concern of this study is to find out the modality of investigation of choice with accuracy, promptness and cost effectiveness.
Materials & Methods: In this prospective interventional comparative study patients of all age group of either sex attending the orthopaedic OPD of IPGMER & SSKM Hospital with clinical features suggestive of soft tissue around knee were included in the study during the period of Feb 2008 to Aug 2009. Sonography technique for evaluation of soft tissue injuries of knee as per AIUM 2007 (American Institute of Ultrasound in Medicine) standard protocols for knee joint sonography- The examination is divided into 4 quadrants (anterior, medial, lateral and posterior).
Results: Maximum number of patients belonged to 20-30 age group, which was comprised 36% of the whole study group. The average age of the study group was 32. Male subjects were showing definite male preponderance. In 64% of cases right knee joint was involved. Out of 100 patients, 48 cases showed ACL tears, 22 patients showed PCL tear arthroscopically. Out of 48 ACL tears confirmed by arthroscopy the diagnosis by USG was just 21 out of 48.
Conclusion: Ultrasound is a reliable, noninvasive method for diagnosing injuries to the tendons, ligaments, and muscles of the knee. It is important to recognize the limitations of this method for examining the menisci and bony lesions. In experienced hands, ultrasonography can play an important role in the assessment of pathologic conditions involving the knee joint.
Keywords: Soft tissue injuries, Menisci, Ligaments, Knee joint, USG, Arthroscopy, Diagnosis.
References
1. Kharaz YA, Canty-Laird EG, Tew SR, Comerford EJ. Variations in internal structure, composition and protein distribution between intra- and extra-articular knee ligaments and tendons. J Anat. 2018 Jun;232(6):943-955.
2. Gupta M, Goyal PK, Singh P, Sharma A. Morphology of Intra-articular Structures and Histology of Menisci of Knee Joint. Int J Appl Basic Med Res. 2018 Apr-Jun;8(2):96-99.
3. Razek A.A.K.A., Fouda N.S., Elmetwaley N, Elbogdady E. Sonography of the knee joint. Journal of Ultrasound 2009; 12: 53e60.
4. Kabiraj SP, Pradhan P, Deb S. An ultrasonographic study of the anatomy and pathology of tendons and review of literature. J Anat. Soc. India 2002;51(1): 3-9.
5. Newman JS1, Adler RS, Bude RO, Rubin JM. Detection of soft-tissue hyperemia: value of power Doppler sonography. AJR Am J Roentgenol. 1994 Aug; 163(2):385-9.
6. Ostlere S. Imaging the knee. Imaging 2003; 15:217e41.
7. Ptasznik R, Feller J, Bartlett J, Fitt G, Mitchell A, Hennessy O. The value of sonography in the diagnosis of traumatic rupture of the anterior cruciate ligament of the knee. AJR Am J Roentgenol 1995; 164:1461e3.
8. Cho KH, Lee DC, Chhem RK, et al. Normal and acutely torn posterior cruciate ligament of the knee at US evaluation: preliminary experience. Radiology 2001; 219:375e80.
9. Katz JN, Brownlee SA, Jones MH. The role of arthroscopy in the management of knee osteoarthritis. Best Pract Res Clin Rheumatol. 2014;28(1):143–156.
10. West JA, Amin NH. In-office arthroscopy for the evaluation of chronic knee pain: A case report. SAGE Open Med Case Rep. 2017; 5:2050313X17740992.
11. Lintner S, Shawen S, Lohnes J, Levy A, Garrett W. Local anesthesia in outpatient knee arthroscopy: a comparison of efficacy and cost. Arthroscopy. 1996 Aug; 12(4):482-8.
12. Neal BA, Ting D, Bonczynski JJ, Yasuda K. Evaluation of meniscal click for detecting meniscal tears in stifles with cranial cruciate ligament disease. Vet Surg. 2015 Feb;44(2):191-4.
13. Iossifidis A. Knee arthroscopy under local anaesthesia: results and evaluation of patients' satisfaction. Injury. 1996 Jan;27(1):43-4.
14. Itoh H, Kurosaka M, Yoshiya S, Ichihashi N, Mizuno K. Evaluation of functional deficits determined by four different hop tests in patients with anterior cruciate ligament deficiency. Knee Surg Sports Traumatol Arthrosc. 1998;6(4):241-5.
15. Takahashi T, Tanaka M, Ikeuchi M, SadahiroT, Tani T. Pain in arthroscopic knee surgery under local anesthesia. Acta Orthop Scand. 2004 Oct;75(5):580-3.
16. Palmer WE. Magnetic resonance imaging of knee trauma: biomechanical approach. Top Magn Reson Imaging. 2003 Apr;14(2):161-78.
17. Makris EA, Hadidi P, Athanasiou KA. The knee meniscus: structure-function, patho-physiology, current repair techniques, and prospects for regeneration. Biomaterials 2011;32(30):7411–7431.
18. Cavanaugh JT, Killian SE. Rehabilitation following meniscal repair. Curr Rev Musculoskelet Med. 2012;5(1):46–58.
19. Azzoni R, Cabitza P.Is there a role for sonography in the diagnosis of tears of the knee menisci? J Clin Ultrasound. 2002 Oct;30(8):472-6.
20. Najafi J, Bagheri S, Lahiji FA. The value of sonography with micro convex probes in diagnosing meniscal tears compared with arthroscopy. J Ultrasound Med. 2006 May;25(5):593-7.
21. Ptasznik R. Ultrasound in acute and chronic knee injury. Radiol Clin North Am. 1999 Jul;37(4):797-830.
22. Chen L, Kim PD, Ahmad CS, Levine WN. Medial collateral ligament injuries of the knee: current treatment concepts. Curr Rev Musculoskelet Med. 2007;1(2):108–113.
23. Peltier A, Lording T, Maubisson L, Ballis R, Neyret P, Lustig S. The role of the meniscotibial ligament in posteromedial rotational knee stability. Knee Surg Sports Traumatol Arthrosc. 2015 Oct;23(10): 2967-73.
24. Lorbach O, Kieb M, Herbort M, Weyers I, Raschke M, Engelhardt M. The influence of the medial meniscus in different conditions on anterior tibial translation in the anterior cruciate deficient knee. Int Orthop. 2015 Apr;39(4):681-7.
25. Makris EA, Hadidi P, Athanasiou KA. The knee meniscus: structure-function, pathophysiology, current repair techniques, and prospects for regeneration Biomaterials. 2011;32(30):7411–7431.
26. Walker PS, Erkman MJ. The role of the menisci in force transmission across the knee. Clin Orthop Relat Res. 1975;109: 184–92.
27. Phisitkul P, James SL, Wolf BR, Amendola A. MCL injuries of the knee: current concepts review. Iowa Orthop J. 2006;26:77–90.
Fox AJ, Bedi A, Rodeo SA. The basic science of human knee menisci: structure, composition, and function. Sports Health. 2012;4(4):340–351.
Corresponding Author
Dr Subrat Prasad
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