The Lateral Knee Radiograph: A Detailed Review

Abstract

Initial imaging evaluation for a variety of knee pathologies often begins with a radiographic series. Depending on the specific indication, this will include at least two different projections of the knee. In most cases, these are the anteroposterior and lateral radiographs of the affected knee, and sometimes with the contralateral knee for comparison. Typically, knee pathologies visible on lateral view can also be appreciated on the anteroposterior view. However, several pathologic processes occur in anatomic locations typically obscured on other projections because of superimposed osseous structures. Examples of these pathologies include injuries involving the quadriceps or patellar tendons, avulsion fractures involving anterior or posterior structures, and many soft-tissue injuries. Knowledge of the relevant anatomy and typical pathologies typically visualized on the lateral radiograph of the knee is imperative to avoid overlooking these disease processes.

Keywords

lateral knee radiograph - lateral knee anatomy - extensor mechanism injury - avulsion injuries of the knee - fractures of the knee

Publikationsverlauf

Eingereicht: 15. Juli 2021

Angenommen: 16. November 2021

Artikel online veröffentlicht:
21. Januar 2022

• References

• 1 Crim J, Manaster BJ, Rosenberg ZS. Imaging Anatomy: Knee, Ankle, Foot. 2nd ed.. Philadelphia, PA: Elsevier Health Sciences; 2017: 4-72
• 2 Labusca L, Zugun-Eloae F. The unexplored role of intra-articular adipose tissue in the homeostasis and pathology of articular joints. Front Vet Sci 2018; 5: 35
• 3 Pao DG. The lateral femoral notch sign. Radiology 2001; 219 (03) 800-801
• 4 Wissman RD, Stensby D, Koolwal J, Silva P, Golzy M. The deep medial femoral sulcus sign: does it exist?. Skeletal Radiol 2021; 50 (03) 571-578
• 5 Laor T, Jaramillo D. MR imaging insights into skeletal maturation: what is normal?. Radiology 2009; 250 (01) 28-38
• 6 Nguyen JC, Markhardt BK, Merrow AC, Dwek JR. Imaging of pediatric growth plate disturbances. Radiographics 2017; 37 (06) 1791-1812
• 7 Howell SM, Chen J, Hull ML. Variability of the location of the tibial tubercle affects the rotational alignment of the tibial component in kinematically aligned total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 2013; 21 (10) 2288-2295
• 8 Olewnik Ł, Gonera B, Podgórski M, Polguj M, Jezierski H, Topol M. A proposal for a new classification of pes anserinus morphology. Knee Surg Sports Traumatol Arthrosc 2019; 27 (09) 2984-2993
• 9 Gottsegen CJ, Eyer BA, White EA, Learch TJ, Forrester D. Avulsion fractures of the knee: imaging findings and clinical significance. Radiographics 2008; 28 (06) 1755-1770
• 10 Sutro CJ, Pomeranz MM, Simon SM. Fabella (sesamoid in the lateral head of the gastrocnemius). Arch Surg 1935; 30 (05) 777-782
• 11 Schweitzer ME, Falk A, Berthoty D, Mitchell M, Resnick D. Knee effusion: normal distribution of fluid. Am J Roentgenol 1992; 159 (02) 361-363
• 12 Pope JD, Bitar YE, Plexousakis MP. Quadriceps tendon rupture. In: StatPearls. Treasure Island, FL: StatPearls Publishing LLC; 2021
• 13 Bencardino JT, Rosenberg ZS, Brown RR, Hassankhani A, Lustrin ES, Beltran J. Traumatic musculotendinous injuries of the knee: diagnosis with MR imaging. Radiographics 2000; S103-S120
• 14 Li Y, Yu H, Huang B, Zhang W, Wang Y, Liu X. Upper pole sleeve fracture of the patella secondary to patellar dislocation: a case report. Medicine (Baltimore) 2019; 98 (24) e16011
• 15 Gholve PA, Scher DM, Khakharia S, Widmann RF, Green DW. Osgood Schlatter syndrome. Curr Opin Pediatr 2007; 19 (01) 44-50
• 16 Yu JS, Petersilge C, Sartoris DJ, Pathria MN, Resnick D. MR imaging of injuries of the extensor mechanism of the knee. Radiographics 1994; 14 (03) 541-551
• 17 Dupuis CS, Westra SJ, Makris J, Wallace EC. Injuries and conditions of the extensor mechanism of the pediatric knee. Radiographics 2009; 29 (03) 877-886
• 18 Rosenthal RK, Levine DB. Fragmentation of the distal pole of the patella in spastic cerebral palsy. J Bone Joint Surg Am 1977; 59 (07) 934-939
• 19 Yu JS, Bosch E, Pathria MN. et al. Deep lateral femoral sulcus: study of 124 patients with anterior cruciate ligament tear. Emerg Radiol 1995; 2 (03) 129-134
• 20 Cobby MJ, Schweitzer ME, Resnick D. The deep lateral femoral notch: an indirect sign of a torn anterior cruciate ligament. Radiology 1992; 184 (03) 855-858
• 21 Saad A, Almeer G, Azzopardi C, Gupta H, Botchu R. New secondary sign of ACL tear – the medial femoral notch sign (Gupta-Botchu sign). Indian J Med Sci 2021; 73: 124-126
• 22 Pai SK, Aslam Pervez N, Radcliffe G. Osteochondral avulsion fracture of the femoral origin of the anterior cruciate ligament in an 11-year-old child. Case Rep Med 2012; 2012: 506798
• 23 Wiley JJ, Baxter MP. Tibial spine fractures in children. Clin Orthop Relat Res 1990; (255) 54-60
• 24 Noyes FR, DeLucas JL, Torvik PJ. Biomechanics of anterior cruciate ligament failure: an analysis of strain-rate sensitivity and mechanisms of failure in primates. J Bone Joint Surg Am 1974; 56 (02) 236-253
• 25 White EA, Patel DB, Matcuk GR. et al. Cruciate ligament avulsion fractures: anatomy, biomechanics, injury patterns, and approach to management. Emerg Radiol 2013; 20 (05) 429-440
• 26 Chan KK, Resnick D, Goodwin D, Seeger LL. Posteromedial tibial plateau injury including avulsion fracture of the semimembranous tendon insertion site: ancillary sign of anterior cruciate ligament tear at MR imaging. Radiology 1999; 211 (03) 754-758
• 27 Barreto AR, Chagas-Neto FA, Crema MD. et al. Fracture of the fabella: a rare injury in knee trauma. Case Rep Radiol 2012; 2012: 390150
• 28 Zhou F, Zhang F, Deng G. et al. Fabella fracture with radiological imaging: a case report. Trauma Case Rep 2017; 12: 19-23
• 29 Segal A, Miller TT, Krauss ES. Fabellar snapping as a cause of knee pain after total knee replacement: assessment using dynamic sonography. Am J Roentgenol 2004; 183 (02) 352-354
• 30 Van Seymortier P, Ryckaert A, Verdonk P, Almqvist KF, Verdonk R. Traumatic proximal tibiofibular dislocation. Am J Sports Med 2008; 36 (04) 793-798
• 31 Horan J, Quin G. Proximal tibiofibular dislocation. Emerg Med J 2006; 23 (05) e33