Pediatric musculoskeletal ultrasound – age- and sex-related normal B-mode findings of the knee

D Windschall; R Trauzeddel; M Haller; M Krumrey-Langkammerer; A Nimtz-Talaska; R Berendes; G Ganser; C Nirschl; P Schoof; RF Trauzeddel; K Palm-Beden; H Lehmann

doi:10.1055/s-0036-1587723

Ultraschall in der Medizin - European Journal of Ultrasound, Table of Contents

Pediatric musculoskeletal ultrasound – age- and sex-related normal B-mode findings of the knee

D Windschall ¹, R Trauzeddel ², M Haller ³, M Krumrey-Langkammerer ⁴, A Nimtz-Talaska ⁵, R Berendes ⁶, G Ganser ⁷, C Nirschl ⁸, P Schoof ⁹, RF Trauzeddel ¹⁰, K Palm-Beden ⁷, H Lehmann ¹¹

¹Asklepios Klinikum Weissenfels, Kinder- und Jugendmedizin, Weissenfels, Germany
²Helios Klinikum Berlin-Buch, Department of Pediatric Rheumatology, Berlin, Germany
³Practice for Pediatrics and Pediatric Rheumatology, Gundelfingen, Germany
⁴German Center for Pediatric Rheumatology, Garmisch-Partenkirchen, Germany
⁵Practice for Pediatrics and Pediatric Rheumatology, Frankfurt (Oder), Germany
⁶St. Marien Children"s Hospital, Landshut, Germany
⁷Clinic for Pediatric Rheumatology St. Josef Stift, Sendenhorst, Germany
⁸Asklepios Klinikum Weissenfels, Weissenfels, Germany
⁹Practice for Pediatrics and Pediatric Rheumatology, Munich, Germany
¹⁰Charité University Medicine, Berlin, Germany
¹¹Clinic for Pediatrics and Neonatology, Justus Liebig-University Gießen, Gießen, Germany

Abstract

Purpose: Musculoskeletal ultrasound (MSUS) is an important tool for evaluating disease activity, therapeutic progress, and remission status of rheumatic diseases in children. Knowledge of age-related normal findings is essential when interpreting pathological findings such as those seen in juvenile idiopathic arthritis. The most commonly affected joint in childhood arthritis is the knee.

Material and methods: To evaluate normal findings of the knee joint, we recorded age-related stages of musculoskeletal development in the knee in 440 healthy children between 1 and 18 years of age using high-resolution B-mode MSUS. We determined approximate age- and sex-related norms for suprapatellar recess size, ossified patella size, and distal femoral intercondylar cartilage thickness.

Results: In almost all age groups, over 64% of children had visible fluid accumulation in the suprapatellar recess. Significant correlations were found between chronological age and the size of the suprapatellar recess and the length of the ossified patella (p < 0.05). An age-dependent decrease in intercondylar cartilage thickness of the distal femoral epiphysis was found in children between 10 and 18 years of age.

Conclusion: High-resolution B-mode MSUS is an excellent tool for assessing joint and skeletal development in children. Our reference data can be used to discriminate better between normal physiological findings and pathological abnormalities.

Fig. 1: Measurement of ossified patella