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The adult knee

9/19/2017

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​When are knee films indicated?
  • Trauma
  • Bony tenderness at the head of the fibula
  • Isolated patella tenderness
  • Patient unable to flex the knee to 90 degrees
  • If the patient is unable to weight bear
  • Suspected osteoarthritis
  • Detecting joint effusions
  • Infection
Picture
Standard Views:
  • AP View
Picture
  • Lateral Horizontal Beam
Picture
  • Skyline View
Picture
​ 
Systematic Approach to Adult Knee Films:
1) Know your anatomy!
Picture
Picture
​2) Check for an effusion
Picture
Picture
3) Check the main bones (tibia, femur, fibular head, and patella)

4) Check the tibio-femoral alignment -- The tibia should be within 0.5 cm of this line, otherwise it suggests a lateral tibial plateau fracture.
Picture
​▪ 5) Look at the tibial plateaus -- Fractures most commonly happen on the lateral tibial plateau
*Check for a tibial plateau avulsion from the lateral edge (Segond fracture)
Picture
6) Look for patellar tendon disruption
  - In a normal knee, the ratio is between 0.8 - 1.2 (mean value = 1)
  • If the ratio is < 0.8, the patella lies low (=patella baja)
  • If the ratio is > 1.2, the patella lies high (=patella alta)
Picture
7) Don’t forget the fabella! It’s a normal sesamoid bone of the lateral head of gastrocnemius tendon - NOT to be mistaken for a fracture or loose body
Picture
​ 
Resources and Images:
https://radiopaedia.org/articles/knee-series
https://radiopaedia.org/articles/knee-radiograph-an-approach
http://dontforgetthebubbles.com/knee-x-ray-interpretation/
http://www.radiologymasterclass.co.uk/tutorials/musculoskeletal/x-ray_trauma_lower_limb/knee_x-ray
http://www.imageinterpretation.co.uk/knee.php

By: Dr. jeremy driscoll M.D.

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  • RESIDENCY
    • About CMC
    • Curriculum
    • Benefits
    • Explore Charlotte
    • Official Site
  • FELLOWSHIP
    • EMS
    • Global EM
    • Pediatric EM
    • Toxicology >
      • Tox Faculty
      • Tox Application
    • (All Others)
  • PEOPLE
    • Program Leadership
    • PGY-3
    • PGY-2
    • PGY-1
    • Alumni
  • STUDENTS/APPLICANTS
    • Medical Students at CMC
    • EM Acting Internship
    • Healthcare Disparities Externship
    • Resident Mentorship
  • #FOAMed
    • EM GuideWire
    • CMC Imaging Mastery
    • Pediatric EM Morsels
    • Blogs, etc. >
      • CMC ECG Masters
      • Core Concepts
      • Cardiology Blog
      • Dr. Patel's Coding Blog
      • Global Health Blog
      • Ortho Blog
      • Pediatric Emergency Medicine
      • Tox Blog
  • Chiefs Corner
    • Top 20
    • Current Chiefs
    • Schedules >
      • Conference/Flashpoint
      • Block Schedule
      • ED Shift Schedule
      • AEC Moonlighting
      • Journal Club/OBP/Audits Schedule
      • Simulation
    • Resources >
      • Fox Reference Library
      • FlashPoint
      • Airway Lecture
      • Student Resources
      • PGY - 1
      • PGY - 2
      • PGY - 3
      • Simulation Reading
      • Resident Wellness
      • Resident Research
      • Resume Builder
    • Individualized Interactive Instruction