S3_L2 Anatomy & Radiologic Evaluation of the Knee Flashcards by MindMed Official

TRUE OR FALSE: An internal oblique view of the knee requires the lower extremity to be rotated internally at 45 degrees.

True

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TRUE OR FALSE: The central ray, when doing a sunrise view of the patella, is directed thru the patellofemoral joint space.

True

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TRUE OR FALSE: At 6 years of age the patella is fully ossified on the routine lateral view of the knee.

False

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TRUE OR FALSE: On CT scan of the knee, the scanning plan is aligned with the distal femoral articulating surface.

False

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The tangential view (sunrise view) demonstrates the ff, except
A. Axial view of patellofemoral joint space
B. Articular surface of patella and femur
C. Intercondylar eminence of the tibia
D. None

C. Intercondylar eminence of the tibia

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The posteroanterior axial view (tunnel view) demonstrates the ff, except
A. Intercondylar Fossa
B. Posterior aspects of the femoral and tibial condyles
C. Intercondylar eminence of the tibia
D. None

D. None

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The posteroanterior axial view (tunnel view) demonstrates the ff, except
A. Tibial Plateaus
B. Loose bodies
C. Osteochondral defects
D. None

D. None

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The knee lateral view demonstrates the ff, except
A. Patello-femoral Joint
B. Suprapatellar bursa
C. Quadriceps tendon
D. Patella tendon
E. None

E. None

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The knee AP view demonstrates the ff, except
A. Femur
B. Proximal Tibia
C. Femorotibial Articulation
D. Head of Fibula
E. None

E. None

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True of the external oblique view, except
A. Leg is externally rotated 45 degrees, , central ray at mid-joint
B. Demonstrates medial femoral condyle
C. Demonstrates lateral femoral condyle
D. None

C. Demonstrates lateral femoral condyle

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True of the internal oblique view, except
A. Leg is internally rotated 15 degrees, central ray at mid-joint
B. Demonstrates lateral femoral condyle
C. Demonstrates fibular head
D. None

A. Leg is internally rotated 15 degrees, central ray at mid-joint

Correct answer: Leg is internally rotated 45 degrees, central ray at mid-joint

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TRUE OR FALSE: CT Scan is indicated for evaluation of tibial plateau depression fractures and of any condition typically seen by MRI if MRI is contraindicated.

True

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Modified TF
A. The basic CT protocol for the knee is from the infrapatellar region to the proximal tibia.
B. The scanning plane is aligned with tibial plateaus.

A. The basic CT protocol for the knee is from the suprapatellar region to the proximal tibia.

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Anatomy sequence on MRI

Axial plane
Coronal plane
Sagittal plane

A. Proton density
B. T1-weighted
C. Gradient echo

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Fluid sensitive sequence on MRI

Axial plane
Coronal plane
Sagittal plane

A. T2 fat saturation
B. Short Tau Inversion Recovery

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TRUE OR FALSE: The basic MRI protocol for the knee is from the quadriceps tendon to the tibial tuberosity.

True

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Imaging modality used to identify recurrent or residual tears post meniscectomy.
A. X-ray
B. CT Scan
C. CT Arthrogram
D. MRI Arthrogram

D. MRI Arthrogram

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The ff. are structures seen best on the axial MRI, except
A. Baker’s Cyst
B. Popliteus muscle tendon
C. Pes Anserine muscle and tendon
D. General muscle bulk
E. None

E. None

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The ff. are structures seen best on the coronal MRI, except
A. Collateral ligaments
B. Menisci
C. Articular Cartilage
D. None

D. None

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The ff. are structures seen best on the axial MRI, except
A. Articular cartilage
B. Lateral patellofemoral ligament
C. Patella Retinacula
D. ACL and PCL
E. Joint Effusion
F. None

B. Lateral patellofemoral ligament

Correct answer: Medial patellofemoral ligament is seen best on the axial plane

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The ff. are structures seen best on the coronal MRI, except
A. Bone bruises
B. ACL and PCL
C. Popliteus tendon
D. None

D. None

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The ff. are structures seen best on the sagittal MRI, except
A. Menisci
B. ACL
C. PCL
D. Flexor mechanism
E. None

D. Flexor mechanism

Correct answer: Extensor mechanism is seen best on the sagittal plane

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The ff. are structures seen best on the sagittal MRI, except
A. Hoffa’s fat pad
B. Articular cartilage
C. Bone Marrow
D. None

D. None

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Modified TF
A. The meniscus has a high signal wedge shape on all sequences on MRI.
B. The meniscus appears hypointense on MRI when torn.

A. The meniscus has a low signal wedge shape on all sequences on MRI.
B. The meniscus appears hyperintense on MRI when torn.

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Modified TF A. The quadriceps muscle-tendon-patella-ligament-tibial interface comprises the extensor mechanism. B. Abnormalities to this mechanism include inflammation, discontinuity, fragmentation, and avulsions.

Modified TF A. On MRI, bone bruises or marrow edema presents as a white, bright signal. B. Fractures, on the other hand, appear as low signal lines.

TRUE OR FALSE: Avascular necrosis is represented by serpentine low signal lines that define margins between normal and avascular bone on the MRI.

True

The following conditions warrant MRI, except A. Extensor mechanism abnormalities B. Synovial disorders C. Meniscal disorders D. Ligament abnormalities E. None

E. None

The following conditions warrant MRI, except A. Marrow abnormalities B. Staging of conditions, such as arthritides C. Loose bodies and impinging structures, plica D. Hoffa’s syndrome E. None

E. None

TRUE OR FALSE: Hoffa's syndrome is characterized by an inflamed infrapatellar fat pad.

True

Modified TF A. The tibiofibular joint is the articulation of the lateral aspect of the tibia and the fibular head. B. This joint does not participate in the weight bearing region of the knee.

Modified TF A. The patella is visible at 3 y/o. B. The head of fibula appears at 4 y/o.

FF ## Footnote A. The patella is visible at **4** y/o. B. The head of fibula appears at **3** y/o.

Modified TF A. Physeal plate fusion occurs post-puberty, at around 16-18 y/o. B. Women reach skeletal maturity earlier than men.

Modified TF A. At birth, the secondary epiphyseal centers of the distal femur and proximal tibia are present. B. The secondary epiphyseal center for the head of the fibula does not appear until approximately 3 years of age.

TRUE OR FALSE: The patella articulates with the trochlear groove of femur, forming the patellofemoral joint.

True

TRUE OR FALSE: The femorotibial joint is formed by the articulation of the distal femur and proximal tibia.

True

Modified TF A. The patella should sit in the femoral sulcus on the axial CT scan. B. The patellofemoral space should have smooth chondral surfaces on the axial and lateral CT scan views.

Modified TF A. The medial collateral ligament is the prime knee stabilizer against valgus stress. B. The lateral collateral ligament prevents varus stress to the knee.

Patient is in supine with knee extended. The central ray is directed inferior to the distal pole of the patella, passing through the femorotibial joint space, perpendicular to imaging receptor. A. Knee AP view B. Knee Lateral view C. PA axial view of intercondylar fossa (Tunnel) D. Tangential view (Sunrise)

A. Knee AP view

Patient is in lateral cubitus position. The central ray is directed to the knee joint and angled 5-7 degrees cephalad. This slight angulation will prevent the joint space from being obscured by the magnified image of the medial femoral condyle. A. Knee AP view B. Knee Lateral view C. PA axial view of intercondylar fossa (Tunnel) D. Tangential view (Sunrise)

B. Knee Lateral view

The patient is prone and the knee is flexed approximate 40 degrees in this projection. The central ray is angled caudad 40 degrees and directed posteroanteriorly through the joint. A. Knee AP view B. Knee Lateral view C. PA axial view of intercondylar fossa (Tunnel) D. Tangential view (Sunrise)

C. PA axial view of intercondylar fossa (Tunnel)

The patient is positioned supine and the knee is flexed 45 degrees. The X-ray beam enters parallel to the patellofemoral joint space or tangentially across the joint surface. The beam may enter in a superoinferior direction (the Merchant view) or an inferosuperior direction. A. Knee AP view B. Knee Lateral view C. PA axial view of intercondylar fossa (Tunnel) D. Tangential view (Sunrise)

D. Tangential view (Sunrise)

The central ray is directed through the patellofemoral joint space, parallel to the joint surfaces. A. Knee AP view B. Knee Lateral view C. PA axial view of intercondylar fossa (Tunnel) D. Tangential view (Sunrise)

D. Tangential view (Sunrise)

It is the angle between lines drawn from the highest points of the femoral condyles to the deepest point of the trochlear groove. This angle can be seen in the tangential view.

Sulcus angle

Normal value of sulcus angle

138 degrees (+/- 6 degrees) ## Footnote NOTE: Shallow sulcus angles (those with greater measurements) may be related to recurrent patellar dislocations.

This angle helps to define the position of the patella within the intercondylar sulcus. It can seen on the tangential view.

Congruence angle

What is the average congruence angle in normal subjects according to Alan C. Merchant's study?

-6 degrees

TRUE OR FALSE: A congruence angle of +16 degrees or more was associated with lateral patellar subluxation or other patellofemoral disorders.

True

Modified TF: Tunnel view A. The tibial articular surface should be partially visible. B. Both tibial spines of the intercondylar eminence should be visible.

Modified TF: Tunnel view A. The fibular head is partially superimposed over the proximal tibia. B. The intercondylar fossa should appear open and its surface well visualized.

Modified TF: Tunnel view A. Osteochondral defects or erosions secondary to blood in the joint may cause the intercondylar fossa to assume a squared-off shape, instead of an inverted U. B. The patella is superimposed behind the distal femur.

Modified TF: Knee AP view A. The patella is superimposed behind the distal femur. B. The inferior pole (apex) of the patella normally lies at the level of the joint line but does not cross it.

FT ## Footnote A. The patella is superimposed **over** the distal femur. Note: If the patella crosses the joint line → patella baja; if the patella is seen clearly on either side → (+) dislocation

Modified TF: Knee AP view A. The lateral half of the fibular head is superimposed behind the tibia. B. The articular surface of the tibial plateau is seen end-on with only minimal surface area visualized.

FT ## Footnote A. The **medial** half of the fibular head is superimposed behind the tibia.

Modified TF: Knee AP view A. The long axes of the femur and tibia are normally in alignment. B. The femorotibial radiographic joint space is normally well defined on both the medial and lateral compartments, with the interspaces equal in height.

TT ## Footnote NOTE: Uneven spaces → narrow space → degenerative changes → possible OA

Modified TF: Knee AP view A. The normal radiographic contrast between the bones and soft tissues are evident. B. Trabecular markings and cortical margins appear distinct.

TT ## Footnote NOTE: Indentations seen signify infections or tumors

Modified TF: Knee lateral view A. Abnormally superior positioning of the patella is termed patella alta. B. Abnormally inferior positioning of the patella is termed patella baja or patella infera.

Modified TF: Knee lateral view A. The suprapatellar bursa is represented as a thin, radiolucent strip just posterior to the quadriceps tendon. B. The bursa becomes distended with joint effusion and images as an oval-shaped density in the presence of joint injury.

Modified TF: Knee lateral view A. Normally the length of the patella (from base to apex) equals the length of the patellar ligament (patellar apex to tibial tuberosity. B. Normal variance does not exceed 20%.

TT ## Footnote NOTE: More than 20% variation indicates an abnormal patellar position.

Modified TF: Tangential view A. On this view, the medial and lateral facets of the patella are visible. B. The lateral facet normally is larger than the medial and may show a more steeply sloped contour.

TF ## Footnote B. The **medial** facet normally is larger than the **lateral** and may show a more steeply sloped contour.

This view can be used to detect subtle subluxations of the patella. A. Knee AP view B. Knee Lateral view C. Tangential view / sunrise view D. Tunnel / PA axial view of intercondylar fossa

C. Tangential view / sunrise view

Modified TF: Tangential view A. The articular surface of the patella should be smooth and distinct. B. Two superimposed borders may be imaged because of the irregular topography of the articular surface.

It is identified as the groove between the distal femoral condyles. It is seen on the sunrise view.

intercondylar sulcus

Modified TF A. In the axial CT scan, hypertrophy or fragmentation of the tibial tuberosity due to Osgood-Schlatter’s traction apophysitis can be assessed. B. The patellofemoral articulation and tilting, narrowing, osteophytes, and osteochondral defects may also be evaluated in this view.

TT ## Footnote NOTE: Osgood-Schlatter’s traction apophysitis is common in adolescence

Modified TF A. In the axial CT scan, the tibial plateau can be assessed for depression or split fracture. B. An example is the Segond avulsion fracture at the lateral aspect of the femur that is associated with ACL tears.

Modified TF A. In the sagittal CT scan, the position of the patella can be assessed. B. A high patellar position infers a torn patellar ligament, while a low position infers a torn quadriceps tendon.

TRUE OR FALSE: In the sagittal CT scan, fragmentation and ossification at the superior patella and patellar tendon can be seen in cases of Sinding-Larsen-Johansson disease.

False Correct answer: In the sagittal CT scan, fragmentation and ossification at the **inferior** patella and patellar tendon can be seen in cases of Sinding-Larsen-Johansson disease.

Arises from the tibial plateau just anterior to the intercondylar eminence and attaches to the posterior medial aspect of the lateral femoral condyle. A. ACL B. PCL C. Patellar ligament D. MCL E. LCL

A. ACL

Originates from the tibial intercondylar eminence and attaches to the lateral aspect of the medial femoral condyle. A. ACL B. PCL C. Patellar ligament D. MCL E. LCL

B. PCL

Extra-articular ligament that attaches proximally to the lateral epicondyle of femur and attaches to the fibular head A. ACL B. PCL C. Patellar ligament D. MCL E. LCL

E. LCL (Also known as fibular collateral ligament)

Originates from the medial epicondyle of femur and attaches to the medial surface of tibia. It blends with the capsule and meniscus. A. ACL B. PCL C. Patellar ligament D. MCL E. LCL

D. MCL (Also known as Tibial Collateral Ligament)

1. Prevents posterior translation of tibia over femur 2. Prevents anterior translation of tibia over femur A. ACL B. PCL C. Patellar ligament D. MCL E. LCL

1. B 2. A

Attaches from the apex of patella to the tibial tuberosity. It is the continuation of quadriceps tendon. A. ACL B. PCL C. Patellar ligament D. MCL E. LCL

C. Patellar ligament

Modified TF: Knee Lateral view A. The tibial medial and lateral condyles are superimposed on one another. B. The intercondylar eminence projects above the tibial plateau and is partly superimposed by the femoral condyles.

Modified TF: Knee Lateral view A. The fabella is noted in up to 18% of the population. B. When present, it will be seen as a small, oval-shaped density in the posterior soft tissues.

TT ## Footnote NOTE: Abnormal conditions, such as joint effusion or arthritis, may displace the fabella.

What is the small sesamoid bone located in the posterior joint capsule at the insertion of the lateral head of the gastrocnemius muscle?

Fabella

Identify the 2 measurements Alan Merchant described that can be used to determine normal positioning of the patella in the Sunrise view

1. Congruence angle 2. Sulcus angle

TRUE OR FALSE: Intractable & persistent pain in the knee is an indication for a routine radiologic evaluation.

True

Modified TF: Knee Lateral view A. The knee is flexed approximately 40 degrees for a standard lateral. B. The X-ray beam is directed through the knee in a medial-to-lateral direction; thus a portion of the fibular head is superimposed behind the tibia.

FT ## Footnote A. The knee is flexed approximately **20** degrees for a standard lateral.

Modified TF: Knee Lateral view A. In the true lateral positioning, the femoral condyles will appear almost entirely superimposed over one another. B. However, magnification of the medial condyle will cause its line image to appear slightly inferior to the lateral condyle.

The ff. can be assessed in the coronal CT scan, except A. Intercondylar Notch B. Femoral Condyles C. Interconydlar or condylar split fractures D. Intercondylar Eminence E. Lateral Tibial Plateau F. None of the above

F. None of the above

TRUE OR FALSE: The Segond Fracture or lateral capsule sign is a curvilinear fracture line at the lateral tibial plateau highly associated with ACL tears.

True

Modified TF A. Osteochondral lesions will appear as radiolucent defects or reactive sclerotic patches. B. These lesions are most common at the lateral femoral condyle.

TF ## Footnote B. These lesions are most common at the **medial** femoral condyle.

TRUE OR FALSE: Fractures of the intercondylar eminence occur in children or adolescent as an avulsion fracture at the site of ACL attachment.

True

Modified TF A. The knee has ~145º of flexion. B. Tibial rotation (medial and lateral) is ~45º.

Modified TF A. To form the congruence angle, a reference line is first drawn bisecting the sulcus angle. B. A second line is drawn from the apex of the sulcus angle to the most posterior or lowest point on the patellar articular ridge

TT ## Footnote NOTE: * If the second line is **medial** to the reference line, the resultant congruence angle formed is assigned a **negative value**. * If the second line is **lateral** to the reference line, the resultant congruence angle is assigned a **positive value.**

S3_L2 Anatomy & Radiologic Evaluation of the Knee Flashcards

(85 cards)