Review Article

Skeletal Radiology

, Volume 43, Issue 8, pp 1025-1039

Ultrasound of the knee with emphasis on the detailed anatomy of anterior, medial, and lateral structures

  • Michel De MaeseneerAffiliated withDepartment of Radiology, University Hospital BrusselsDepartment of Experimental Anatomy, Free University BrusselsDepartment of Radiology, Vrije Universiteit Brussel Email author 
  • , Stefaan MarcelisAffiliated withDepartment of Radiology, Sint Andries Ziekenhuis
  • , Cedric BouletAffiliated withDepartment of Radiology, University Hospital Brussels
  • , Mimoun KichouhAffiliated withDepartment of Radiology, University Hospital Brussels
  • , Maryam ShahabpourAffiliated withDepartment of Radiology, University Hospital Brussels
  • , Johan de MeyAffiliated withDepartment of Radiology, University Hospital Brussels
  • , Erik CattrysseAffiliated withDepartment of Experimental Anatomy, Free University Brussels

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Abstract

Objective

To describe the detailed ultrasound anatomy of the anterior, medial, and lateral aspects of the knee and present the ultrasound examination technique used.

Materials and Methods

We present ultrasound using images of patients, volunteer subjects, and cadaveric specimens. We correlate ultrasound images with images of anatomical sections and dissections.

Results

The distal quadriceps tendon is made up of different laminas that can be seen with ultrasound. One to five laminas may be observed. The medial retinaculum is made up of three anatomical layers: the fascia, an intermediate layer, and the capsular layer. At the level of the medial patellofemoral ligament (MPFL) one to three layers may be observed with ultrasound. The medial supporting structures are made up of the medial collateral ligament and posterior oblique ligament. At the level of the medial collateral ligament (MCL), the superficial band, as well as the deeper meniscofemoral and meniscotibial bands can be discerned with ultrasound. The posterior part, corresponding to the posterior oblique ligament (POL), also can be visualized. Along the posteromedial aspect of the knee the semimembranosus tendon has several insertions including an anterior arm, direct arm, and oblique popliteal arm. These arms can be differentiated with ultrasound. Along the lateral aspect of the knee the iliotibial band and adjacent joint recesses can be assessed. The fibular collateral ligament is encircled by the anterior arms of the distal biceps tendon. Along the posterolateral corner, the fabellofibular, popliteofibular, and arcuate ligaments can be visualized.

Conclusion

The anatomy of the anterior, medial, and lateral supporting structures of the knee is more complex than is usually thought. Ultrasound, with its exquisite resolution, allows an accurate assessment of anatomical detail. Knowledge of detailed anatomy and a systematic technique are prerequisites for a successful ultrasound examination of the knee.

Keywords

Ultrasound Knee Ligaments Tendons