AJR 2002; 178:1437-1444
© American Roentgen Ray Society
Sonography of the Medial and Lateral Tendons and Ligaments of the Knee: The Use of Bony Landmarks as an Easy Method for Identification
Michel De Maeseneer1,
Kurt Vanderdood1,
Stefaan Marcelis2,
Wael Shabana1 and
Michel Osteaux1
1 Department of Radiology, Vrije Universiteit Brussel, Laerbeeklaan 101, 1090
Jette, Belgium 8700.
2 Department of Radiology, Sint-Andriesziekenhuis, Tielt, Belgium.
Received March 19, 2001;
accepted after revision November 30, 2001.
Address correspondence to M. De Maeseneer.
Abstract
OBJECTIVE. Our purpose was to describe the use of bony landmarks in
the evaluation of the medial and lateral ligaments and tendons of the knee on
sonography and to evaluate the value of this approach in healthy
volunteers.
MATERIALS AND METHODS. Anatomic slices obtained in cadaveric
specimens were inspected for the presence of bony landmarks on the medial and
lateral aspects of the knee. Then sonography was performed on 40 knees of 20
healthy volunteers by two musculoskeletal radiologists who independently rated
the visualization of bony landmarks and adjacent ligaments and tendons on a
5-point grading scale.
RESULTS. Bony landmarks on the lateral aspect of the knee include
Gerdy's tubercle on the tibia and the sulcus for the popliteal tendon on the
femur. Landmarks on the medial aspect of the knee include the medial
epicondyle on the femur and the sulcus for the semimembranosus tendon on the
tibia. Visualization of all landmarks was rated in the good to excellent
range, and agreement between observers ranged from 92.5% to 100%.
CONCLUSION. Bony landmarks can be identified in healthy adults on
the medial and lateral aspects of the knee and may serve as reference points
for identification of most medial and lateral tendons and ligaments.
Introduction
Sonography is increasingly used in the assessment of superficially located
soft-tissue structures of the musculoskeletal system
[1,2,3].
Previous reports have addressed the use of sonography in the assessment of
abnormal conditions of the knee
[2,3,4],
although emphasis was often placed on fluid-containing lesions such as joint
effusions, Baker's cysts, and meniscal cysts. Few studies have addressed the
assessment of the tendons and ligaments of the knee using sonography
[5,6,7].
Even the experienced radiologist may find it difficult to identify the medial
and lateral ligaments and tendons on sonography in every patient. Precise
identification of ligaments and tendons is essential to identifying and
locating abnormalities relative to these structures.
During knee trauma, the medial collateral ligament may be affected; tears
in this ligament can be diagnosed on sonography
[6]. Other abnormal conditions
on the medial side of the knee that may be diagnosed using sonography include
meniscal cysts, pes anserinus bursitis, and semimembranosus bursitis
[4,
8,
9]. On the lateral aspect of
the knee, the iliotibial band is affected in patients with iliotibial band
friction syndrome [10,
11]. Injuries of the
posterolateral structures include tears of the popliteal tendon, lateral
collateral ligament, and biceps tendon
[12,
13].
We developed a systematic approach to the sonographic imaging of the medial
and lateral sides of the knee that is based on our observations of structures
in cadaveric slices. Our approach makes use of the presence of bony landmarks
on the distal femur and the proximal tibia. The bony landmarks on the lateral
aspect of the knee include a small protuberance of the cortex—designated
"Gerdy's tubercle"—on the tibia and the sulcus for the
popliteal tendon on the femur. The landmarks on the medial side of the knee
include the femoral epicondyle on the femur and the sulcus for the
semimembranosus tendon on the posteromedial aspect of the tibia. Once the
sonography transducer is placed at the bony landmark, identification of the
various ligaments and tendons can be made almost automatically (Fig.
1A,1B,1C,1D,1E,1F).
In our study, the first aim was to identify the bony landmarks on anatomic
slices of the knee and to indirectly correlate the findings from these slices
with those on MR images and sonograms. The second aim was to investigate the
detection of bony landmarks and soft-tissue structures in healthy
volunteers.
View larger version (19K):
[in this window]
[in a new window]
[as a PowerPoint slide]
|
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 this window]
[in a new window]
[as a PowerPoint slide]
|
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 this window]
[in a new window]
[as a PowerPoint slide]
|
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 this window]
[in a new window]
[as a PowerPoint slide]
|
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 this window]
[in a new window]
[as a PowerPoint slide]
|
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 this window]
[in a new window]
[as a PowerPoint slide]
|
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).
|
|
Materials and Methods
From the department of anatomy at one of our institutions, we obtained
anatomic slices of the knee from six cadaveric specimens. These specimens had
been used in a previous imaging project; correlating MR images for these
slices were also available
[14]. The slices had been
prepared by sectioning deep-frozen cadaveric knees into 3-mm-thick slices with
a band saw (NSV, Modena, Italy). Representative slices depicting the bony
landmarks were selected by the principal investigator and then photographed.
The medial side of an additional cadaveric specimen obtained from an elderly
subject was dissected to show the location of the insertions of the pes
anserinus tendons relative to the medial collateral ligament.
Two musculoskeletal radiologists independently evaluated both knees of 20
asymptomatic volunteers (14 men and six women) using sonography. The age of
the volunteers ranged from 18 to 53 years (mean age, 31 years). They had no
clinical symptoms related to the knee at the time of the examination and did
not recall any previous episode of knee trauma that required a surgical or
arthroscopic procedure. All examinations were performed on a clinical
sonography system (Prosound 5500; Aloka, Tokyo, Japan) using a 10-MHz
transducer. The transducer was first placed over the expected location of the
bony landmark, and the visualization of the landmark was graded on a 5-point
scale (1, not visualized; 2, moderate visualization; 3, good visualization; 4,
very good visualization; and 5, excellent visualization).
As the transducer was positioned over each landmark, the observers
systematically recorded the visualization of the ligaments and tendons (Figs.
1A,1B,1C,1D,1E,1F
and 2). The iliotibial band was
evaluated at the level of Gerdy's tubercle on the lateral aspect of the tibia.
At the popliteal sulcus level, the popliteal tendon, lateral collateral
ligament, and biceps tendon were investigated. At the level of the medial
femoral epicondyle, the superficial and deep medial collateral ligaments
(femoral and tibial extensions) and the pes anserinus were evaluated. When the
transducer was placed along the superficial medial collateral ligament in the
coronal plane, the pes anserinus could be visualized by moving the transducer
inferiorly and slightly anteriorly over the medial tibial cortex. At the level
of the semimembranosus sulcus, the semimembranosus, gracilis, and
semitendinosus tendons were studied, as well as the posteromedial aspect of
the meniscus.
Using the same grading scale as they used for the landmarks, the observers
rated the visualization of each ligament and tendon. A mean score for each
landmark and soft-tissue structure was calculated for each investigator
separately. Agreement between the grades assigned by both observers was also
calculated (overall percentage of agreement). For this calculation, agreement
was considered to be present when the scores from both observers were the same
or only one grade apart.
To provide a correlation between MR images and sonograms, we recruited a
volunteer (not included in the numeric analysis) to undergo both MR imaging
and sonography of his right knee. Proton density—weighted MR images were
obtained in the coronal and transverse planes on a 1.5-T clinical system
(Vision; Siemens, Erlangen, Germany). The MR imaging parameters were TR/TE,
2900/15; signals averaged, 2; section thickness, 3 mm; matrix size, 252
x 512; and field of view, 150 x 240. Sonography was performed with
a 12-MHz transducer. The MR images and sonograms obtained in this volunteer
were compared with respect to visualization of landmarks and soft-tissue
structures.
Results
On the coronal anatomic slices, Gerdy's tubercle was easily recognizable as
a protuberance along the anterolateral aspect of the tibia. The iliotibial
tract, which on the anatomic slices consisted of two separate layers, was
found to terminate on this bony protuberance (Figs.
3 and
4A,4B).
Also on coronal anatomic slices of the knee, a sulcus was evident at the
posterolateral femoral condyle. The popliteal tendon originated from this
sulcus and then penetrated the meniscus through the popliteal hiatus. Along
the superficial aspect of the popliteal tendon, the lateral collateral
ligament was revealed as a 3-mm-thick white bandlike structure coursing in an
oblique direction from the anterosuperior to the posteroinferior position
(Figs. 5 and
6A,6B,6C).
View larger version (170K):
[in this window]
[in a new window]
[as a PowerPoint slide]
|
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 this window]
[in a new window]
[as a PowerPoint slide]
|
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).
|
|
On the transverse anatomic slices, the medial femoral epicondyle could be
identified as a small bony protuberance along the middle third of the medial
aspect of the femoral condyle. This protuberance was less well recognized on
coronal slices, however. The location of the insertion of the femoral portion
of the superficial medial collateral ligament was observed to be on the medial
epicondyle. The anterior edge of the medial collateral ligament was sharply
demarcated from fatty tissue (Figs.
7,8A,8B,8C,8D,9).
At anatomic dissection, the pes anserinus tendons were observed to insert onto
the tibia anteroinferiorly to the tibial attachment of the superficial medial
collateral ligament (Figs. 9
and 10). On the coronal
anatomic slices obtained along the posterior third of the medial side of the
knee, the anterior termination of the semimembranosus tendon was found in a
large sulcus in the tibial cortex. More superficially and inferiorly, the
gracilis and semitendinosus tendons could be recognized, whereas superiorly
the posterior horn of the medial meniscus was easily distinguished from
adjacent fatty tissue (Figs.
11 and
12A,12B).
View larger version (166K):
[in this window]
[in a new window]
[as a PowerPoint slide]
|
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 (154K):
[in this window]
[in a new window]
[as a PowerPoint slide]
|
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 (129K):
[in this window]
[in a new window]
[as a PowerPoint slide]
|
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 this window]
[in a new window]
[as a PowerPoint slide]
|
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 this window]
[in a new window]
[as a PowerPoint slide]
|
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.
|
|
The visualization scores for landmarks, ligaments, and tendons are
summarized in Table 1. The
visualization scores for all four landmarks were in the very good to excellent
range. Visualizations of the superficial medial collateral ligament, pes
anserinus, semimembranosus tendon, iliotibial band, popliteal tendon, and
biceps tendon also were rated in the very good to excellent range.
Visualizations of the meniscofemoral ligament, gracilis tendon, posteromedial
meniscus, and lateral collateral ligament were rated in the good to very good
range, whereas scores for visualizations of the meniscotibial ligament and
semitendinosus tendon were in the moderate to good range.
Agreement between observers ranged from 92.5% to 100% for the bony
landmarks (Table 2). Agreement
was more than or equal to 90% for visualizations of the medial collateral
ligament, pes anserinus, semimembranosus tendon, iliotibial tract, popliteal
tendon, and biceps tendon. Agreement was equal to or more than 70% for
visualizations of the meniscofemoral extension, gracilis tendon, posteromedial
meniscus, and lateral collateral ligament. Agreement was 55% for
visualizations of the meniscotibial extension, and 47.5% for visualizations of
the semitendinosus tendon. The bony landmarks as visualized on the MR images
of the "benchmark" volunteer correlated well with findings on
sonography.
View this table:
[in this window]
[in a new window]
|
TABLE 2 Percentage of Agreement Between Two Observers on Quality of
Visualization of Bony Landmarks, Ligaments, and Tendons on Sonography
|
|
Discussion
At our institutions, a typical sonographic examination of the knee is
accomplished in three phases. The examination starts with the patient in a
supine position with the foot on the examination table and the knee flexed at
a 30° angle. The anterior aspect of the knee is examined in the sagittal
and transverse planes, with an emphasis on the quadriceps and patellar tendon.
The suprapatellar recess also is examined with the knee in this position. This
portion of the examination usually presents little difficulty, even to the
inexperienced radiologist. For the second phase of the examination, the
patient remains in a supine position, but the leg is placed on the table with
the knee fully extended. In this position, the medial and lateral aspects of
the knee are examined using the landmark approach that is the subject of this
article. This part of the examination generally is more difficult, and we
developed the landmark approach in an attempt to systematize and simplify this
phase of the examination. Finally, the patient is placed in a prone position,
and the posteromedial aspect of the knee is examined for the presence of a
Baker's cyst.
When the sonography transducer is placed in the coronal plane at the
anterolateral aspect of the tibia, Gerdy's tubercle is easily depicted, as
shown by our observations in the volunteers. The iliotibial band inserts
directly onto Gerdy's tubercle and is depicted on sonograms as a hyperechoic
3-mm-thick bandlike structure. The iliotibial band consists anatomically of
two layers, but these may be difficult to identify on sonography (Figs.
3 and
4A,4B).
In patients with iliotibial band friction syndrome, a bursa may have formed
between the femoral condyle and the iliotibial tract, or periligamentous fluid
collections may be apparent
[10,
11].
The popliteal tendon originates in a sulcus along the posterolateral aspect
of the femur (Fig. 5). When
the sonography transducer is placed in the coronal plane along the
posterolateral aspect of the knee, the sulcus is easily identifiable as a
depression in the femoral cortex
[13]. The tendon of the
popliteus muscle is located in this sulcus. Depending on the angle of the
incident sonographic beam, considerable anisotropic artifact may be evident in
the popliteal tendon, and thus its echogenicity may vary from hypoechoic to
hyperechoic. Once the sulcus for the popliteal tendon has been identified, the
lateral collateral ligament can also be recognized. The lateral collateral
ligament corresponds to a hyperechoic band that is 3-4 mm thick, originating
on the lateral femur and terminating on the fibular head. The lateral
collateral ligament courses over the sulcus for the popliteal tendon and is
located superficially in relation to the tendon. The lateral collateral
ligament can be easily followed distally, where it fuses with the biceps
tendon.
The medial femoral epicondyle corresponds to a small protrusion on the
medial aspect of the femur, located about 3 cm superior to the level of the
joint space. On transverse anatomic slices, this small bony protrusion is
triangular. We found that when the transducer was placed in the transverse
plane along the medial aspect of the femur, the medial epicondyle could be
accurately identified in most of our volunteers.
The superior part of the superficial medial collateral ligament inserts
onto the femoral epicondyle. On transverse sonograms, the medial collateral
ligament can appear as a bandlike structure that is slightly hypoechoic
relative to adjacent fatty tissue. The anterior margin of the medial
collateral ligament is sharply demarcated from the hyperechoic fatty tissue
[14,
15]. The superficial medial
collateral ligament fuses posteriorly with the capsule. From the transverse
plane, the transducer can be turned in the coronal plane to obtain a coronal
section of the medial collateral ligament. The medial collateral ligament has
a three-layered aspect on sonography, with a hyperechoic superficial layer, a
hypoechoic intermediate layer, and a hyperechoic deep layer (Fig.
8A,8B,8C,8D).
The superficial layer corresponds to the superficial medial collateral
ligament, the intermediate layer corresponds to fatty tissue or a fluid-filled
medial collateral ligament bursa, and the deep layer corresponds to the deep
medial collateral ligament, including the meniscofemoral and meniscotibial
extensions [16].
The presence of anisotropy causes variable echogenicity of the superficial
and deep medial collateral ligament. Our findings show that the superficial
portion of the medial collateral ligament is easily recognized in most
patients. Agreement and visualization scores were lower for the deep portion
of the medial collateral ligament, especially for the meniscotibial portion, a
finding that indicates that the latter may be more difficult to identify on
sonography. When the transducer is moved from over the joint line to a more
anteroinferior position along the tibial cortex, a coronal section through the
pes anserinus can be obtained.
The insertion of the pes anserinus is made up of portions of the sartorius,
gracilis, and semitendinosus tendons. The intermingling of tendons occurring
at the insertion of the pes anserinus onto the tibia shows considerable
anatomic variability [17].
Therefore, at the insertion, discernment of the different components that make
up the pes anserinus can be difficult. The pes anserinus bursa, which is not
usually seen in healthy adults, may be evident adjacent to the pes anserinus
tendons when inflamed
[18].
The semimembranosus tendon shows several terminations at the posteromedial
aspect of the knee. One of the main terminations inserts into a sulcus on the
posteromedial aspect of the tibia
[9,
19]. When the transducer is
placed in the coronal plane along the posterior third of the medial side of
the knee, this sulcus can be easily identified as a focal depression of the
hyperechoic cortical line (Fig.
12A,12B).
The semimembranosus tendon in this sulcus is depicted on sonography as a
hyperechoic structure, although the tendon may show considerable anisotropy
artifact. Semimembranosus bursitis may be diagnosed in patients with a fluid
effusion visible adjacent to the tendon insertion
[9,
20]. More inferior in relation
to the semimembranosus tendon, the gracilis and semitendinosus tendons may be
depicted as oval structures. Visualization of the semitendinosus tendon,
however, appears to be quite difficult on sonography in this location, as
shown by our results in the volunteers. In our experience, the semitendinosus
tendon is more easily visualized along the posterior aspect of the medial
femoral condyle, where it is located superficially relative to the
semimembranosus tendon.
Superior to the sulcus for the semimembranosus tendon, the posteromedial
aspect of the meniscus is evident. This area of the meniscus is commonly
involved with meniscal tears, and adjacent meniscal cysts may be identified as
perimeniscal hypoechoic collections
[4].
Some limitations apply to our investigation. The presence of landmarks was
not systematically evaluated in a large number of cadaveric specimens.
Representative examples were selected from among existing cadaveric slices.
Hence, we did not take all possible anatomic variants into account.
Nevertheless, sonograms obtained in our volunteers consistently showed that
the landmarks were present in most individuals.
The mean age of the volunteers included in our study was 31 years, and it
might be argued that the landmarks would be more difficult to identify in
elderly patients with osteoarthritis. However, we believe that the mean age of
our volunteers is representative of the patient population who typically
undergoes sonography of the knee. In addition, we believe that the findings
obtained in our population of volunteers can be extrapolated to the general
adult population.
Our examinations in volunteers were performed with a 10-MHz transducer. The
use of a 12-MHz transducer may have resulted in better visualization scores
than those obtained in our study. We did not assess imaging of abnormal
ligaments and tendons, and sonography of injured soft-tissue structures may
give different results than those in our study. In our experience, however,
the presence of edema and thickening in soft-tissue injuries makes detection
of soft-tissue structures easier. In addition, we could not entirely exclude
the possibility that some of the volunteers may have had knee abnormalities
that influenced visualizations of structures because they may not have
remembered previous episodes of knee trauma.
In summary, the use of four bony landmarks along the medial and lateral
aspects of the knee, including Gerdy's tubercle, the sulcus for the popliteal
tendon, the medial epicondyle, and the sulcus for the semimembranosus tendon,
may help one to accurately identify most medial and lateral tendons and
ligaments of the knee.
Acknowledgments
We thank Eddy Broodtaerts for the photographic work and J. P. Clarijs from
the Department of Experimental Anatomy.
References
-
Hashimoto BE, Kramer DJ, Wiitala L. Applications of musculoskeletal
sonography. J Clin Ultrasound
1999;27:293
-318[Medline]
-
Grobbelaar N, Bouffard JA. Sonography of the knee: a pictorial
review. Semin Ultrasound CT MR
2000;21:231
-274[Medline]
-
Gary SD, Kaplan PA, Dussault RG. Imaging of the knee: current
status. Orthop Clin North Am
1997;28:643
-658[Medline]
-
De Flaviis LD, Scaglione P, Nessi R, Albisetti W. Ultrasound in
degenerative cystic meniscal disease of the knee. Skeletal
Radiol 1990;19:441
-445[Medline]
-
De Flaviis L, Nessi R, Leonardi M, Ulivi M. Dynamic ultrasonography
of capsulo-ligamentous knee joint traumas. J Clin
Ultrasound 1988;16:487
-492[Medline]
-
Lee JI, Song IS, Jung YB, et al. Medial collateral ligament
injuries of the knee: ultrasonographic findings. J Ultrasound
Med 1996;15:621
-625[Abstract]
-
Friedl W, Glaser F. Dynamic sonography in the diagnosis of ligament
and meniscal injuries of the knee. Arch Orthop Trauma
Surg 1991;110:132
-138
-
Uson J, Aguado P, Bernad M, et al. Pes anserinus tendino-bursitis:
what are we talking about? Scand J Rheumatol
2000;29:184
-186[Medline]
-
Hennigan SP, Shneck CD, Mesgarzadeh M, Clancy M. The
semimembranosus—tibial collateral ligament bursa: anatomical study and
magnetic resonance imaging. J Bone Joint Surg Am
1994;76:1322
-1327[Abstract/Free Full Text]
-
Muhle C, Ahn JM, Yeh LR, et al. Iliotibial band friction syndrome:
MR imaging findings in 16 patients and MR arthrographic study of six cadaveric
knees. Radiology
1999;212:103
-110[Abstract/Free Full Text]
-
Nishimura G, Yamato M, Tamai K, Takahashi J, Uetani M. MR findings
in iliotibial band syndrome. Skeletal Radiol
1997;26:533
-537[Medline]
-
Recondo JA, Salvador E, Villanua JA, Barrera MC, Gervas C, Alustiza
JM. Lateral stabilizing structures of the knee: functional anatomy assessed
with MR imaging. RadioGraphics
2000;20[suppl]:S91
-S102[Abstract/Free Full Text]
-
Brown TR, Quinn SF, Wensel JP, Kim JH, Demlow T. Diagnosis of
popliteus injuries with MR imaging. Skeletal Radiol
1995;24:511
-514[Medline]
-
De Maeseneer M, Van Roy F, Lenchik L, Barbaix E, De Ridder F,
Osteaux M. Three layers of the medial capsular and supporting structures of
the knee: MR imaging—anatomic correlation.
RadioGraphics
2000;20[suppl]:S83
-S89[Abstract/Free Full Text]
-
Warren LF, Marshall JL. The supporting structures and layers on the
medial side of the knee. J Bone Joint Surg Am
1979;61:56
-62[Abstract/Free Full Text]
-
Chhem RK, Cardinal E. Musculoskeletal
ultrasound. New York: Wiley-Liss, 1999:166
-
Ivey M, Prud'homme J. Anatomic variations of the pes anserinus: a
cadaver study. Orthopedics
1993;16:601
-606[Medline]
-
Forbes JR, Helms CA, Janzen DL. Acute pes anserinus bursitis: MR
imaging. Radiology
1995;194:525
-527[Abstract/Free Full Text]
-
Loredo RA, Hodler J, Pedowitz R, Yeh LR, Trudell D, Resnick D.
Posteromedial corner of the knee: MR imaging with gross anatomic correlation.
Skeletal Radiol
1999;28:305
-311[Medline]
-
Rothstein CP, Laorr A, Helms CA, Tirman PF.
Semimembranosus—tibial collateral ligament bursitis: MR imaging
findings. AJR
1996;166:875
-877[Abstract/Free Full Text]
CiteULike 
Complore 
Connotea 
Del.icio.us 
Digg 
Reddit 
Technorati What's this?
Top
Abstract
Introduction
