Imaging - Radiologic Evaluation of Knee, Ankle, and Foot

AP

lateral

PA "tunnel"

Tangential "sunrise" or "merchant"

What are routine radiographic views of the knee?

AP

What view is this?

AP

What view is this?

Lateral

What view is this?

Lateral

What view is this?

PA intercondylar

What view is this?

PA intercondylar

What view is this?

Tangential

What view is this?

Tangential

What view is this?

Distal femur - medial and lateral condyles

Proximal tibia - medial and lateral condyles, intercondylar eminence

Femorotibial joint space

Patellar position

Proximal fibula - head, neck, shaft

What can you see on an AP knee radiograph?

Distal femur - medial and lateral condyles

Proximal tibia - tibial tuberosity, articular surface, intercondylar

eminence

Femorotibial joint space

Patellar position (alta or baja) - length of patella

Proximal fibula - head, neck, shaft

What can you see on an lateral knee radiograph?

Distal femur - medial and lateral condyles and intercondylar fossa

Proximal tibia - medial and lateral condyles, intercondylar eminence

What can you see on an AP axial "tunnel" intercondylar fossa radiograph?

Patella - sulcus angle, congruence angle, position within

intercondylar sulcus, subtle subluxations

Femoral condyles - medial and lateral surface

What can you see on an tangential (sunrise or merchant) radiograph?

axial

sagittal

coronal

What are the planes of knee CTs and MRIs?

Meniscus lesions

Ligament injuries

Soft tissue injuries

Osteochondral abnormalities

What are common reasons to use an MRI to image a knee?

femoral condyles

patellofemoral articulation

Tibial plateau

Tibial tuberosity

What do you see on an axial view of a CT or MRI?

Patellar positioning

Patella tendon

femoral condyles

Tibia

What do you see on an sagittal view of a CT or MRI?

femur

tibia/tibial plateau

Intercondylar notch

Intercondylar eminence

What do you see on an coronal view of a CT or MRI?

Distal femur fracture

Proximal tibial fractures

Patellar dislocations

Patellar fractures

What are types of fractures and dislocations of the knee?

Joint effusion after direct blow or fall

Inability to walk without limping

Palpable tenderness over the patella or fibular head

Inability to flex the knee to 90 degrees

> 55 years old

When do you refer for a radiograph of the knee after trauma?

nondisplaced

What type of fracture does A show?

impacted

What type of fracture does B show?

displaced

What type of fracture does C show?

comminuted

What type of fracture does D show?

condylar

What type of fracture does E show?

intercondylar

What type of fracture does F show?

falling from height

car accident y

weaker bones

What causes a distal femur fracture?

ORIF

How do you treat a distal femur fracture?

wedge or split fracture of lateral aspect of plateau

Type I proximal tibial fracture

lateral wedge or split fracture

Type II proximal tibial fracture

pure compression fracture of lateral plateau

Type III proximal tibial fracture

fracture involving medial plateau

Type IV proximal tibial fracture

fracture include split elements of both the medial and lateral condyles

Type V proximal tibial fracture

complex, bicondylar fracture

Type VI proximal tibial fracture

Type VI - dissociation of metaphysis and diaphysis

What type of fracture does this show?

Type V - Bicondylar fracture

What type of fracture does this show?

Type IV - split fracture, medial plateau

What type of fracture does this show?

Type III - central depression

What type of fracture does this show?

Type II - Split depression

What type of fracture does this show?

Type I - Split

What type of fracture does this show?

depends on amount of compression of plateau and possible joint instability

How do you treat a proximal tibial fracture?

Vertical

What type of patellar fracture is 1?

transverse, nondisplaced

What type of patellar fracture is 2?

transverse, displaced

What type of patellar fracture is 3?

Comminuted nondisplaced

What type of patellar fracture is 4?

Comminuted displaced

What type of patellar fracture is 5?

Avulsed fragments

What type of patellar fracture is 6?

fall

car accident

forceful contraction of quads (avulsion)

What caused a patellar fracture?

injuries to arteries, nerves, and veins

What can dislocation or subluxation of the patella cause?

Osteochondral fracture

fracture to knee cartilage often seen in young athletes

Osteochondritis dissecans

osteochondral fracture that is now chronic, often seen in adolescent and early adulthood

Spontaneous osteonecrosis

sudden decreased blood flow to knee, often in area of WB of medial femoral condyle in older adults

shearing/turing force

What causes a meniscus tear?

MRI

What imaging is used to diagnose a meniscus tear?

normal meniscus

What type of meniscus is 1?

vertical tear

What type of meniscal tear is 2?

bucket handle tear

What type of meniscal tear is 3?

peripheral tear

What type of meniscal tear is 4?

horizontal tear

What type of meniscal tear is 5?

discoid meniscus

What type of meniscus is 6?

enlarged or thickened meniscus

What is a discoid meniscus?

stress x-ray

What type of imaging do you do see collateral injuries on?

radiograph for avulsion fracture

MRI to visualize ligaments

What type of imaging do you use to see cruciate ligaments?

Osgood-schlatters disease

enlarged and deformed tibial tubercle caused by repetitive trauma at distal tendon attachment

adolescent boys

Who is Osgood-schlatters disease most common in?

lateral radiograph

What imaging is Osgood-schlatter disease seen on?

reduction of joint space

sclerosis of subchondral bone

osteophytes at joint majins

subchondral cysts

noted varus or valgus joint deformity

What is the radiographic detection of DJD/OA?

AP ankle

What view is this?

AP ankle

What view is this?

AP oblique ankle

What view is this?

AP oblique ankle

What view is this?

lateral ankle

What view is this?

lateral ankle

What view is this?

eversion

inversion

anterior drawer

What are the three stress views of the ankle?

What view is this?

AP foot

What view is this?

Lateral foot

What view is this?

Lateral foot

What view is this?

Oblique foot

What view is this?

Oblique foot

What view is this?

ankle tendons

sinus tarsi

tibiofibular ligament

Osseous structures

What structures are seen in the axial plane of the ankle?

achilles tendon

tibiotalar joint

subtalar joint

transverse tarsal joint

plantar fascia

sinus tarsi

What structures are seen in the sagittal plane of the ankle?

deltoid ligaments

calcaneofibular ligament

tarsal tunnel

talar dome

subtalar joint

plantar fascia in cross section

What structures are seen in the coronal plane of the ankle?

bone tenderness at the Posterior edge or tip of lateral malleolus

bone tenderness at the Posterior edge or tip of medial malleolus

inability to bear weight

What are the rules of the ottawa ankle rules?

bone tenderness at the base of the 5th metatarsal

bone tenderness at the navicular

inability to bear weight

What are the rules of the ottawa foot rules?

Trimalleolar fracture

fracture of both malleoli and posterior rim of tibia

inversion

What is the most common type of ankle sprains?

avulsion fracture suspected

When would you use an image with an ankle sprian?

MRI

What is the best imaging for tendon injury?

achilles tendon

fibularis longus/brevis post inversion injury

What are examples of tendon injuries?

Hallux valgus

first metatarsal deviates medially, great toe is deviated laterally

Pes Cavus

HIgh medial longitudinal arch

Pes planus "flat foot"

Rigid or flexible classification

Clubfoot

Congenital talipes equinovarus

intersection of a line drawn along the midshaft of the 1st metatarsal and a line bisecting the talus on the lateral view of the foot

How is the talometatarsal angle formed?

Distal tibia & fibula and joint space between

Proximal talus or talar dome

Ankle mortise

What can you see in a AP ankle view?

Distal tibia & fibula

Proximal talus or talar dome

Ankle mortise

What can you see in a AP oblique ankle view?

Distal tibia anterior tubercle and posterior malleolus

Distal fibula superimposed behind the tibia and talus

Talus, calcaneus, navicular and cuboid

Joint spaces

What can you see in a lateral ankle view?

Phalanges and IP joints

Metatarsals

Tarsals

Transverse tarsal joint

Tarsometatarsal joint

What can you see in the AP foot view?

Tibia and fibula

Transverse tarsal joint

Tarsometatarsal joint

Talus and calcaneus

Tarsal sinus & subtalar joint

Ability to measure Boehler's angle and the calcaneal inclination

What can you see in a lateral foot view?