Skip to main content
SpringerLink
Log in

Ultrasound of the Knee

  • Chapter
  • First Online:
Musculoskeletal Ultrasound in Rheumatology Review

  • 1027 Accesses

Abstract

The knee is an accessible and relatively anatomically straightforward joint for ultrasonographic assessment. In this chapter, the nine standard anatomical views and two important additional views are discussed and demonstrated. Transducer positioning and patient positioning tips to obtain and optimize these images are discussed for the 11 views; followed by a review of general pathologic findings with a focus on structures specific to the knee. Disease-specific findings at the knee, such as those of rheumatoid arthritis and osteoarthritis, are discussed, as well as reliability of ultrasound, scoring systems, and indications and use of ultrasound for knee injections.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 119.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 159.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. McAlindon T, Kissin E, Nazarian L, et al. American College of Rheumatology report on reasonable use of musculoskeletal ultrasonography in rheumatology clinical practice. Arthritis Care Res (Hoboken). 2012;64(11):1625–40.

    Article  Google Scholar 

  2. D’Agostino M, Said-Nahal R, Hacquard-Bouder C, et al. Assessment of peripheral enthesitis in the spondyloarthropathies by ultrasonography combined with power Doppler: a cross-sectional study. Arthritis Rheum. 2003;48(2):523–33.

    Article  PubMed  Google Scholar 

  3. Mallinson P, Reagan A, Coupal T, et al. The distribution of urate deposition within the extremities in gout: a review of dual – energy CT cases. Skelet Radiol. 2014;43(3):277–81.

    Article  Google Scholar 

  4. Peiteado D, De Miguel E, Villalba A, et al. Value of a short four-joint ultrasound test for gout diagnosis: a pilot study. Clin Exp Rheumatol. 2012;30(6):830–7.

    PubMed  Google Scholar 

  5. Backhaus M, Burmester GR, Gerber T, et al. Guidelines for musculoskeletal ultrasound in rheumatology. Ann Rheum Dis. 2001;60(7):641–9.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  6. Terslev L, D'Agostino MA, Brossard M, et al. Which knee and probe position determines the final diagnosis of knee inflammation by ultrasound? Results from a European Multicenter Study. Ultraschall Med. 2012;33(7):E173–8.

    PubMed  CAS  Google Scholar 

  7. Naredo E, Cabero F, Palop MJ, et al. Ultrasonographic findings in knee osteoarthritis: a comparative study with clinical and radiographic assessment. Osteoarthr Cartil. 2005;13(7):568–74.

    Article  CAS  Google Scholar 

  8. Hong BY, Lim SH, Cho YR, et al. Detection of knee effusion by ultrasonography. Am J Phys Med Rehabil. 2010;89(9):715–21.

    Article  PubMed  Google Scholar 

  9. Zayat AS, Freeston JE, Conaghan PG. Does joint position affect US findings in inflammatory arthritis? Rheumatology (Oxford). 2012;51(5):921–5.

    Article  Google Scholar 

  10. Gutierrez M, Filippucci E, Grassi W, Rosemffet M. Intratendinous power Doppler changes related to patient position in seronegative spondyloarthritis. J Rheumatol. 2010;37(5):1057–9.

    Article  PubMed  Google Scholar 

  11. Kissin E, Demarco P, Malone D, Bakewell C et al. The rheumatologist. Sound feedback for ultrasound training. 2018.; https://www.the-rheumatologist.org/article/ultrasound-training-tips-pitfalls/

  12. Wakefield RJ, Balint PV, Szkudlarek M, et al. Musculoskeletal ultrasound including definitions for ultrasonographic pathology. J Rheumatol. 2005;32(12):2485–7.

    PubMed  Google Scholar 

  13. Riente L, Delle Sedie A, Filippucci E, et al. Ultrasound Imaging for the rheumatologist XXVII. Sonographic assessment of the knee in patients with rheumatoid arthritis. Clin Exp Rheumatol. 2010;28(3):300–3.

    PubMed  Google Scholar 

  14. Najm A, Orr C, Gallagher L, et al. Knee joint synovitis: study of correlations and diagnostic performances of ultrasonography compared with histopathology. RMD Open. 2018;4(1):e000616.

    Article  PubMed  PubMed Central  Google Scholar 

  15. Naredo E, Batlle-Gualda E, Garcia-Vivar ML, et al. Power Doppler ultrasonography assessment of entheses in spondyloarthropathies: response to therapy of entheseal abnormalities. J Rheumatol. 2010;37(10):2110–7.

    Article  PubMed  Google Scholar 

  16. Frediani B, Falsetti P, Storri L, et al. Ultrasound and clinical evaluation of quadricipital tendon enthesitis in patients with psoriatic arthritis and rheumatoid arthritis. Clin Rheumatol. 2002;21(4):294–8.

    Article  PubMed  CAS  Google Scholar 

  17. Vlad V, Iagnocco A. Ultrasound of the knee in rheumatology. Med Ultrason. 2012;14(4):318–25.

    PubMed  Google Scholar 

  18. Dey A, Godsiff SP, Pandey R. Acute calcific tendinitis mimicking patella tendon rupture. Injury Extra. 2004;35(12):104–7.

    Article  Google Scholar 

  19. Ward EE, Jacobson JA, Fessell DP, et al. Sonographic detection of Baker’s cysts: comparison with MR imaging. AJR Am J Roentgenol. 2001;176(2):373–80.

    Article  PubMed  CAS  Google Scholar 

  20. Andonopoulos AP, Yarmenitis S, Sfountouris H, et al. Baker’s cyst in rheumatoid arthritis: an ultrasonographic study with a high resolution technique. Clin Exp Rheumatol. 1995;13(5):633–6.

    PubMed  CAS  Google Scholar 

  21. Rupp S, Seil R, Jochum P, Kohn D. Popliteal cysts in adults. Prevalence, associated intraarticular lesions, and results after arthroscopic treatment. Am J Sports Med. 2002;30(1):112–5.

    Article  PubMed  Google Scholar 

  22. Ostergaard M, Court-Payen M, Gideon P, et al. Ultrasonography in arthritis of the knee. A comparison with MR imaging. Acta Radiol. 1995;36(1):19–26.

    Article  PubMed  CAS  Google Scholar 

  23. Bakewell C, Dugowson C. Baker’s cyst in a patient with rheumatoid arthritis. NEJM. 2009;361(11):1098.

    Article  PubMed  CAS  Google Scholar 

  24. Razek AA, Fouda NS, Elmetwaley N, Elbogdady E. Sonography of the knee joint. J Ultrasound. 2009;12(2):53–60.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  25. Algergawy S, Haliem T, Al-Shaer O. Clinical, laboratory, and ultrasound assessment of the knee in juvenile rheumatoid arthritis. Clin Med Insights Arthritis Musculoskelet Disord. 2011;4:21–7.

    Article  PubMed  PubMed Central  Google Scholar 

  26. Yucesoy C, Genc G, Bal A, et al. Ultrasonographic assessment of knee in patients with rheumatoid arthritis: is it an effective imaging method for initial evaluation? Arch Rheumatol. 2011;26(2):120–6.

    Google Scholar 

  27. Vreju F, Ciurea M, Rosu A, et al. Power Doppler sonography, a non-invasive method of assessment of the synovial inflammation in patients with early rheumatoid arthritis. Romanian J Morphol Embryol. 2011;52(2):637–43.

    Google Scholar 

  28. Kondo Y, Suzuki K, Inoue Y, et al. Significant association between joint ultrasonographic parameters and synovial inflammatory factors in rheumatoid arthritis. Arthritis Res Ther. 2019;21(1):14.

    Article  PubMed  PubMed Central  Google Scholar 

  29. Iagnocco A, Perella C, Naredo E, et al. Etanercept in the treatment of rheumatoid arthritis: clinical follow-up over one year by ultrasonography. Clin Rheumatol. 2008;27(4):491–6.

    Article  PubMed  Google Scholar 

  30. Iagnocco A, Filippucci E, Perella C, et al. Clinical and ultrasonographic monitoring of response to adalimumab treatment in rheumatoid arthritis. J Rheumatol. 2008;35(1):35–40.

    PubMed  Google Scholar 

  31. Epis O, Filippucci E, Delle Sedie A, et al. Clinical and ultrasound evaluation of the response to tocilizumab treatment in patients with rheumatoid arthritis: a case series. Rheumatol Int. 2014;34(5):737–42.

    Article  PubMed  CAS  Google Scholar 

  32. Conaghan PG, D’Agostino MA, Le Bars M, et al. Clinical and ultrasonographic predictors of joint replacement for knee osteoarthritis: results from a large, 3-year, prospective EULAR study. Ann Rheum Dis. 2010;69(4):644–7.

    Article  PubMed  CAS  Google Scholar 

  33. Wu PT, Shao CJ, Wu KC, et al. Pain in patients with equal radiographic grades of osteoarthritis in both knees: the value of gray scale ultrasound. Osteoarthr Cartil. 2012;20(12):1507–13.

    Article  Google Scholar 

  34. Hall M, Doherty S, Courtney P, et al. Ultrasound detected synovial change and pain response following intra-articular injection of corticosteroid and a placebo in symptomatic osteoarthritic knees: a pilot study. Ann Rheum Dis. 2014;73(8):1590–1.

    Article  PubMed  Google Scholar 

  35. Schmidt WA, Schmidt H, Schicke B, Gromnica-Ihle E. Standard reference values for musculoskeletal ultrasonography. Ann Rheum Dis. 2004;63(8):988–94.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  36. Naredo E, Acebes C, Moller I, et al. Ultrasound validity in the measurement of knee cartilage thickness. Ann Rheum Dis. 2009;68(8):1322–7.

    Article  PubMed  CAS  Google Scholar 

  37. Saarakkala S, Waris P, Waris V, et al. Diagnostic performance of knee ultrasonography for detecting degenerative changes of articular cartilage. Osteoarthr Cartil. 2012;20(5):376–81.

    Article  CAS  Google Scholar 

  38. Lehtinen A, Taavitsainen M, Leirisalo-Repo M. Sonographic analysis of enthesopathy in the lower extremities of patients with spondyloarthropathy. Clin Exp Rheumatol. 1994;12(2):143–8.

    PubMed  CAS  Google Scholar 

  39. Balint PV, Kane D, Wilson H, et al. Ultrasonography of entheseal insertions in the lower limb in spondyloarthropathy. Ann Rheum Dis. 2002;61(10):905–10.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  40. Balint P, Terslev L, Aegerter P, et al. Reliability of a consensus-based ultrasound definition and scoring for enthesitis in spondyloarthritis and psoriatic arthritis: an OMERACT US initiative. Ann Rheum Dis. 2018;77(12):1730–5.

    Article  PubMed  Google Scholar 

  41. Tom S, Zhong Y, Cook R, et al. Development of a preliminary ultrasonographic enthesitis score in psoriatic arthritis – GRAPPA Ultrasound working group. J Rheumatol. 2019;46(4):384–90.

    Article  PubMed  Google Scholar 

  42. D'Agostino MA. Ultrasound imaging in spondyloarthropathies. Best Pract Res Clin Rheumatol. 2010;24(5):693–700.

    Article  PubMed  Google Scholar 

  43. Aydin S. 2018 GRAPPA (Group for Research and Assessment of Psoriasis and Psoriatic Arthritis Annual Meeting 2018, Toronto, Canada.

    Google Scholar 

  44. Solmaz D, Bakirci S, Kimyon G, et al. The impact of having family history of psoriasis or psoriatic arthritis on psoriatic disease. Arthritis Care Res. 2019; https://doi.org/10.1002/acr.23836.

  45. Eder L, Jayakar J, Thavaneswaran A, et al. Is the Madrid Sonographic Enthesitis Index useful for differentiating psoriatic arthritis from psoriasis alone and healthy controls? J Rheumatol. 2014;41(3):466–72.

    Article  PubMed  Google Scholar 

  46. D’Agostino M, Olivieri I. Enthesitis. Best Prac Res Clin Rheumatol. 2006;20(3):473–86.

    Article  Google Scholar 

  47. Fiocco U, Ferro F, Vezzu M, et al. Rheumatoid and psoriatic knee synovitis: clinical, grey scale, and power Doppler ultrasound assessment of the response to etanercept. Ann Rheum Dis. 2005;64(6):899–905.

    Article  PubMed  CAS  Google Scholar 

  48. Thiele RG, Schlesinger N. Diagnosis of gout by ultrasound. Rheumatology (Oxford). 2007;46(7):1116–21.

    Article  CAS  Google Scholar 

  49. Löffler C, Sattier H, Peters L, et al. Distinguishing gouty arthritis from calcium pyrophosphate deposition disease and other arthritides. J Rheumatol. 2015;42(3):513–20.

    Article  PubMed  Google Scholar 

  50. Russell E, Checa A. Potential pitfalls in the diagnosis of crystal-induced arthritis and in the sonographic measurement of hyaline cartilage due to the presence of joint effusion. J Clin Rheumatol. 2013;19(2):98–100.

    Article  PubMed  Google Scholar 

  51. Thiele RG. Role of ultrasound and other advanced imaging in the diagnosis and management of gout. Curr Rheumatol Rep. 2011;13(2):146–53.

    Article  PubMed  Google Scholar 

  52. Fritz J, Henes J, Fuld M, et al. Dual-energy computed tomography of the knee, ankle, and foot: noninvasive diagnosis of gout and quantification of monosodium urate in tendons and ligaments. Semin Musculoskel Radiol. 2016;20(1):130–6.

    Article  Google Scholar 

  53. Yuan Y, Liu C, Xiang X, Yuan TL, et al. Ultrasound scans and dual energy CT identify tendons as preferred anatomical location of MSU crystal depositions in gouty joints. Rheumatol Int. 2018;38(5):801–11.

    Article  PubMed  CAS  Google Scholar 

  54. Matteo A, Filippucci E, Cipolletta E, et al. The popliteal groove region: a new target for the detection of monosodium urate crystal deposits in patients with gout. An ultrasound study. Joint Bone Spine. 2019;86(1):89–94.

    Article  PubMed  CAS  Google Scholar 

  55. Coari G, Iagnocco A, Zoppini A. Chondrocalcinosis: sonographic study of the knee. Clin Rheumatol. 1995;14(5):511–4.

    Article  PubMed  CAS  Google Scholar 

  56. Delle Sedie A, Riente L, Iagnocco A, et al. Ultrasound imaging for the rheumatologist X. Ultrasound imaging in crystal-related arthropathies. Clin Exp Rheumatol. 2007;25(4):513–7.

    PubMed  CAS  Google Scholar 

  57. Filippou G, Frediani B, Gallo A, et al. A “new” technique for the diagnosis of chondrocalcinosis of the knee: sensitivity and specificity of high-frequency ultrasonography. Ann Rheum Dis. 2007;66(8):1126–8.

    Article  PubMed  PubMed Central  Google Scholar 

  58. Frediani B, Filippou G, Falsetti P, et al. Diagnosis of calcium pyrophosphate dihydrate crystal deposition disease: ultrasonographic criteria proposed. Ann Rheum Dis. 2005;64(4):638–40.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  59. Thiele RG, Schlesinger N. Ultrasonography shows disappearance of monosodium urate crystal deposition on hyaline cartilage after sustained normouricemia is achieved. Rheumatol Int. 2010;30(4):495–503.

    Article  PubMed  Google Scholar 

  60. Uysal F, Akbal A, Gokmen F, et al. Prevalence of pes anserine bursitis in symptomatic osteoarthritis patients: an ultrasonographic prospective study. Clin Rheumatol. 2015;34(3):529–33.

    Article  PubMed  Google Scholar 

  61. Bevers K, Zweers MC, van den Ende CH, et al. Ultrasonographic analysis in knee osteoarthritis: evaluation of inter-observer reliability. Clin Exp Rheumatol. 2012;30(5):673–8.

    PubMed  Google Scholar 

  62. Hartung W, Kellner H, Strunk J, et al. Development and evaluation of a novel ultrasound score for large joints in rheumatoid arthritis: one year of experience in daily clinical practice. Arthritis Care Res (Hoboken). 2012;64(5):675–82.

    Article  Google Scholar 

  63. Park Y, Lee SC, Nam HS, et al. Comparison of sonographically guided intra-articular injections at 3 different sites of the knee. J Ultrasound Med. 2011;30(12):1669–76.

    Article  PubMed  Google Scholar 

  64. Curtiss HM, Finnoff JT, Peck E, et al. Accuracy of ultrasound-guided and palpation-guided knee injections by an experienced and less-experienced injector using a superolateral approach: a cadaveric study. PM R. 2011;3(6):507–15.

    Article  PubMed  Google Scholar 

  65. Berkoff DJ, Miller LE, Block JE. Clinical utility of ultrasound guidance for intra-articular knee injections: a review. Clin Interv Aging. 2012;7:89–95.

    PubMed  PubMed Central  Google Scholar 

  66. Sibbitt WL Jr, Peisajovich A, Michael AA, et al. Does sonographic needle guidance affect the clinical outcome of intraarticular injections? J Rheumatol. 2009;36(9):1892–902.

    Article  PubMed  Google Scholar 

  67. Sibbitt WL Jr, Band PA, Kettwich LG, et al. A randomized controlled trial evaluating the cost-effectiveness of sonographic guidance for intra-articular injection of the osteoarthritic knee. J Clin Rheumatol. 2011;17(8):409–15.

    Article  PubMed  Google Scholar 

  68. Maricar N, Parkes MJ, Callaghan MJ, et al. Where and how to inject the knee – a systematic review. Semin Arthritis Rheum. 2013;43(2):195–203.

    Article  PubMed  PubMed Central  Google Scholar 

  69. Mandl P, Brossard M, Aegerter P, et al. Ultrasound evaluation of fluid in knee recesses at varying degrees of flexion. Arthritis Care Res (Hoboken). 2012 May;64(5):773–9.

    Article  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Rheumatology, Intermountain Medical Group, Salt Lake Clinic, Salt Lake City, UT, USA

    Catherine J. Bakewell

  2. Division of Rheumatology, University of Utah, Salt Lake City, UT, USA

    Gary A. Kunkel

  3. Thurston Arthritis Research Center and Division of Rheumatology, Allergy, and Immunology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA

    Amanda E. Nelson

Authors
  1. Catherine J. Bakewell
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Gary A. Kunkel
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Amanda E. Nelson
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Catherine J. Bakewell .

Editor information

Editors and Affiliations

  1. Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA

    Minna J. Kohler

Rights and permissions

Reprints and permissions

Copyright information

© 2021 Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Bakewell, C.J., Kunkel, G.A., Nelson, A.E. (2021). Ultrasound of the Knee. In: Kohler, M.J. (eds) Musculoskeletal Ultrasound in Rheumatology Review. Springer, Cham. https://doi.org/10.1007/978-3-030-73555-5_7

Download citation

  • DOI: https://doi.org/10.1007/978-3-030-73555-5_7

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-73554-8

  • Online ISBN: 978-3-030-73555-5

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation