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4/5/2019
1
Hip and Knee US
Levon N. Nazarian, MD
Professor of Radiology
Thomas Jefferson University Hospital
Disclosures
• None relevant to this
presentation
Educational Objectives
• Following the presentation, participant should be able to:
–Describe the hip and knee US examination
– Identify common hip and knee pathologies seen on US
Hip Ultrasound Examination
• Hip Joint
• Iliopsoas
• Hamstring tendon origin
• Greater trochanter
• Adductor tendons
• Hernias
Hip Joint
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Normal Hip
Head
Neck
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Hip Effusion Hip Injection
Vessels Guarding Anterior Hip Hip Injection Lateral
Approach
Normal Hip Labrum Hip Labral Tear
A
F
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Hip Labral Cyst
A
F
Hip Paralabral Cyst
Hip Paralabral Cyst Iliopsoas
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Iliopsoas Tendinosis Iliopsoas Bursitis
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Iliopsoas Bursitis Iliopsoas Bursitis
Normal Iliopsoas Motion Snapping Iliopsoas Tendon
Snapping Iliopsoas Tendon:
Harmonic ImagingAdductor Tendons
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Normal Adductor Tendon
L
B
M
Adductor Tendinosis
Adductor Longus Muscle Tear Hamstring Origin
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Proximal Hamstring
Tendinosis
Proximal Hamstring
Tendinosis
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Proximal Hamstring
Tendinosis/ Tear25-Year-Old Woman With
Increasing Sciatica
25-Year-Old Woman With
Increasing Sciatica
25-Year-Old Woman With
Increasing Sciatica
25-Year-Old Woman With
Increasing Sciatica
TUBFx
Snapping Gluteus Maximus
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GTPS Pain Pattern
Anesth Analg 2009; 108: 1662-1670
Greater Trochanteric Pain
Syndrome• Tendinosis of one or all of the following
(“rotator cuff of the hip”):
– Gluteus medius
– Gluteus minimus
• Iliotibial band friction
• Greater trochanteric bursitis is usually
reactive… RARELY primary
Pfirrmann C W A et al. Radiology 2001;221:469-477
©2001 by Radiological Society of North America
Greater Trochanter Anatomy Greater Trochanter
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Normal Gluteus Minimus Normal Gluteus Medius
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Normal ITB Gluteus Medius Tendinosis
GT
Gluteus Medius Tendinosis Gluteus Medius Tear
GT
Gluteus Minimus Tear
GT
ITB Tendinosis
GT
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Snapping IT Band Greater Trochanteric Bursitis
GT
Indirect Inguinal Hernia
Indirect Inguinal Hernia:
ReducibleInguinal Hernia: Not Reducible
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Knee Ultrasound
Examination
• Anterior
• Medial
• Posterior
• Lateral
Knee Ultrasound
Examination
• Anterior
–Knee joint
–Quadriceps tendon
–Patellar tendon
–Prepatellar bursa
Suprapatellar Scan Knee Effusion from OA
“Lipoma Arborescens” Intercondylar Notch
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Osteoarthritis
Lat Med
Knee Joint Intraarticular Body
CPPD in Knee
Lateral Meniscus Femoral Cartilage
Calcific Quadriceps Tendinosis
Patella
Quadriceps Tear Quadriceps Tear
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Patellar Tendon Normal Patellar Tendon
Prepatellar BursitisPatellar Tendinosis
(Jumper’s Knee)
Patellar Tendinosis Axial View
Knee Ultrasound
Examination
• Medial
–Medial meniscus
–Medial collateral ligament
–Pes anserinus
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Medial Knee: Deep Anatomy Normal Medial Meniscus
Medial Meniscus TearExtruded Torn Medial
Meniscus
Medial Meniscal Cyst Normal MCL
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MCL TearPes Anserinus
Pes Anserine Bursitis Knee Ultrasound
Examination
• Posterior
–Baker’s cyst
–PCL
Posterior Medial Knee
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Popliteal (Baker’s) CystAnatomy
• Fluid in gastrocnemius -
semimembranosus bursa
(medial popliteal fossa)
• Communicates with joint:
> 50% of adults
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Baker’s CystRuptured Baker’s Cyst
Baker’s Cyst with Pannus Loose Bodies in Baker’s Cyst
PCL Ganglion Cyst Knee Ultrasound
Examination
• Lateral
– Iliotibial band
– Biceps femoris tendon
– Lateral collateral ligament
– Lateral Meniscus
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Normal ITB Insertion
Tibia
ITB Bursitis
Femur
Normal Lateral Collateral
Ligament
Fib
Normal Biceps Femoris
Tendon
Fib
Biceps FemorisTendinosis
Fibula
Lateral Meniscal Cyst
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Conclusion
• MRI is the test of choice for internal
derangement of the hip and knee
• US has important complementary
role, especially for imaging
surrounding soft tissue structures,
dynamic imaging, and guiding
interventions
