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Sonography of the Medial and Lateral Tendons and Ligaments of the Knee: The Use of Bony Landmarks as an Easy Method for Identification

¹ Department of Radiology, Vrije Universiteit Brussel, Laerbeeklaan 101, 1090 Jette, Belgium 8700.
² Department of Radiology, Sint-Andriesziekenhuis, Tielt, Belgium.

View larger version (19K): [in a new window]   Fig. 1A. —Schematic line drawings illustrate landmark approach to correctly identifying medial and lateral tendons and ligaments of knee. With sonography transducer placed in coronal plane at anterolateral aspect of tibia, Gerdy's tubercle (arrow) and iliotibial band (arrowheads) can be seen.

View larger version (31K): [in a new window]   Fig. 1B. —Schematic line drawings illustrate landmark approach to correctly identifying medial and lateral tendons and ligaments of knee. With transducer placed in coronal plane at posterolateral aspect of femur, sulcus for popliteal tendon (arrow) can be detected as well as popliteal tendon (arrowheads), lateral collateral ligament (L), and biceps tendon (B).

View larger version (15K): [in a new window]   Fig. 1C. —Schematic line drawings illustrate landmark approach to correctly identifying medial and lateral tendons and ligaments of knee. Transverse sonographic section obtained at medial femoral condyle allows identification of femoral epicondyle (arrow) and adjacent medial collateral ligament (arrowheads).

View larger version (24K): [in a new window]   Fig. 1D. —Schematic line drawings illustrate landmark approach to correctly identifying medial and lateral tendons and ligaments of knee. With transducer then turned back in coronal plane, medial collateral ligament (arrowheads) is shown in its long axis.

View larger version (14K): [in a new window]   Fig. 1E. —Schematic line drawings illustrate landmark approach to correctly identifying medial and lateral tendons and ligaments of knee. When transducer is moved anteroinferiorly, pes anserinus (arrowheads) is visualized at its insertion.

View larger version (18K): [in a new window]   Fig. 1F. —Schematic line drawings illustrate landmark approach to correctly identifying medial and lateral tendons and ligaments of knee. Sonographic section obtained along posteromedial aspect of knee shows sulcus for semimembranosus tendon (arrow) and tendon itself (S).

View larger version (114K): [in a new window]   Fig. 2. —Photograph of lateral (L) and medial (M) aspects of knee of 34-year-old man shows transducer positions 1-4 for obtaining principal coronal sections illustrated in Figure 1A,1B,1C,1D,1E,1F.

View larger version (137K): [in a new window]   Fig. 3. —Photograph of anatomic section from cadaver shows Gerdy's tubercle (long arrow) and iliotibial band (short arrows).

View larger version (147K): [in a new window]   Fig. 4A. —Gerdy's tubercle in 34-year-old man. Coronal MR image (TR/TE, 2900/15) shows Gerdy's tubercle (black arrow) and iliotibial band (white arrows).

View larger version (125K): [in a new window]   Fig. 4B. —Gerdy's tubercle in 34-year-old man. Sonogram corresponding to A reveals Gerdy's tubercle (long arrows) and iliotibial band (short arrows).

View larger version (153K): [in a new window]   Fig. 5. —Photograph of anatomic slice from cadaver shows sulcus for popliteal tendon (arrowheads), lateral collateral ligament (arrows), and popliteus tendon (star).

View larger version (170K): [in a new window]   Fig. 6A. —Sulcus for popliteal tendon in 34-year-old man. Coronal MR image (TR/TE, 2900/15) reveals sulcus for popliteal tendon (arrowheads), lateral collateral ligament (straight arrows), and popliteal tendon (curved arrow).

View larger version (117K): [in a new window]   Fig. 6B. —Sulcus for popliteal tendon in 34-year-old man. Corresponding sonogram shows sulcus for popliteal tendon (long arrows), popliteal tendon (asterisks), and proximal portion of lateral collateral ligament (short arrows).

View larger version (117K): [in a new window]   Fig. 6C. —Sulcus for popliteal tendon in 34-year-old man. Corresponding sonogram shows distal portion of lateral collateral ligament (arrowheads) adjacent to fibular head (f).

View larger version (133K): [in a new window]   Fig. 7. —Photograph of transverse anatomic slice from cadaver shows femoral epicondyle (arrow) as well as adjacent medial collateral ligament (arrowheads).

View larger version (131K): [in a new window]   Fig. 8A. —Femoral epicondyle in 34-year-old man. Transverse MR image (TR/TE, 2900/15) shows femoral epicondyle (arrow) and medial collateral ligament (arrowheads).

View larger version (119K): [in a new window]   Fig. 8B. —Femoral epicondyle in 34-year-old man. Transverse sonogram corresponding to A shows femoral epicondyle (long arrows) and medial collateral ligament (short arrows).

View larger version (166K): [in a new window]   Fig. 8C. —Femoral epicondyle in 34-year-old man. Coronal MR image (2900/15) shows superficial medial collateral ligament (arrowheads) and meniscofemoral (f) and meniscotibial (arrow) portion of deep medial collateral ligament.

View larger version (99K): [in a new window]   Fig. 8D. —Femoral epicondyle in 34-year-old man. Sonogram corresponding to C shows superficial (arrows) and deep (stars) medial collateral ligament as well as meniscus (m).

View larger version (154K): [in a new window]   Fig. 9. —Photograph of anatomic slice of medial side of knee of cadaver shows pes anserinus adjacent to inferior aspect of medial collateral ligament (M). Anterior margin (arrowheads) of superficial medial collateral ligament is outlined. Gracilis (curved arrow) and sartorius (straight arrow) tendons are seen. Semitendinosus tendon is located deep in relation to the sartorius (not shown).

View larger version (137K): [in a new window]   Fig. 10. —Coronal sonogram obtained in 34-year-old man through pes anserinus (short arrows) shows anteromedial tibial cortex (long arrows).

View larger version (129K): [in a new window]   Fig. 11. —Photograph of coronal anatomic slice from cadaver shows sulcus for semi-membranosus tendon (short straight arrows). Also note semimembranosus tendon (arrowheads) and gracilis tendon (curved arrow). Posteromedial meniscus is also visible (long straight arrow).

View larger version (158K): [in a new window]   Fig. 12A. —Sulcus for semimembranosus in 34-year-old man. MR image (TR/TE, 2900/15) reveals posteromedial meniscus (bowed arrow) and sulcus for semimembranosus (arrowheads) in addition to semimembranosus (star), gracilis (curved arrow), and semitendinosus (short arrow) tendons.

View larger version (168K): [in a new window]   Fig. 12B. —Sulcus for semimembranosus in 34-year-old man. Corresponding sonogram shows semimembranosus tendon (long arrows) located in sulcus (small short arrows) as hypoechoic. Gracilis tendon (large short arrows) also is delineated.

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