Procedures Knee & Patella

Front 1

Axial View
Distal Femur and patella
Label

Back 1

A. patellar surface
(intercondylar sulcus)
(trochlear groove)
B. Patellofemoral Joint
C. Lateral Epicondyle
D. Lateral Condyle
E. Intercondylar fossa
F. Medial Condyle
G. Medial Epicondyle

Front 2

Distal Femur and patella- lateral view

Back 2

A. Patellar Surface
B. Patella (Sesamoid bone)
C. popiteal surface

Front 3

Knee joint and proximal tibiofibular joint

Back 3

A. Femur
B. Posterior cruciate ligament (PCL)
C. Fibular lateral collateral ligament (LCL)
D. Tendon of popliteus muscle
E. Lateral meniscus
F. Proximal tibiofibular joint
G. Fibula
H. Anterior cruciate ligament (ACL)
I. infrapatellar fat
J. Patellar Ligament
K. Tibia

Front 4

Right knee Joint

Back 4

A. Patellar surface
B. Femur
C. Posterior cruciate ligament (PCL)
D. Medial Condyle
E. Medial meniscus
F. Transverse ligament
G. tibal (medial) collateral ligament (MCL)
H. Tibia
I. Anterior cruciate ligament (ACL)
J. lateral condyle
K. Lateral meniscus
L. fibular lateral collateral ligament (LCL)
M. Fibula

Front 5

Label
Patella

Back 5

A. Base (superior border)
B. Apex (inferior surface)
C. Base (superior border)
D. Posterior surface (smooth)
E. Anterior surface (rough)

Front 6

Label
Tangential projection
(femoropatellar joint)

Back 6

A. Patella
B. Femoropatellar joint
C. Lateral condyle
D. Patellar surface
E. Medial condyle

Front 7

Label the AP knee

Back 7

A. Medial and Lateral intercondylar tubercles, entensions of intercondylar eminence (tibial spine)
B. lateral epicondyle of femur
C. lateral condyle of femur
D. Lateral condyle of tibia
E.Articular facets of tibia / tibial plateau
F. Medial condyle of tibia
G.medial condyle of femur
H. Medial epicondyle of femur
I. Patella (seen through femur)

Front 8

Laternal knee, true lateral

Back 8

A. base of patella
B. Apex of patella
C. Tibial tuberosity
D. Neck of Fibula
E. Head of fibula
F. Apex (styloid process) of head of fibula
G. Superimposed medial and lateral condyles
H. Patellar surface (intercondylar culcus or trochlear groove)

Front 9

The patella is _______ or _______ above the knee joint. ( think distance )

Back 9

1/2 inch or 1.25 cm

Front 10

What does sulcus mean?

Back 10

groove or depression

Front 11

What does trochlea mean?

Back 11

pulley or pulley shaped structure

Front 12

The patellar surface is also referred to as _________ and _________

Back 12

intercondylar sulcus and trochlear groove.

Front 13

What separates the two condyles of the femur?

Back 13

intercondylar fossa

Front 14

What is directly above the intercondylar fossa?

Back 14

popliteal surface

Front 15

Why must the CR be angled 5 to 7 degrees cephalad for a lateral knee?

Back 15

Because the medial condyle of the femur extends lower than the lateral condyle, the angle causes the two condyles to be directly superimposed when the femur is parallel to the IR.

Front 16

Of the anterior and posterior surfaces of the patella, which one is rough and which one is smooth?

Back 16

Posterior surface is smooth
Anterior surface is rough

Front 17

What is present on the posterolateral aspect of the medial condyle?

Back 17

Adductor tubercle

Front 18

answer the following questions about this image.

1.)What does this image look like compared to a true lateral?
2.)How can this be corrected?

Back 18

1.)- Fibular head less superimposed by tibia.
- The adductor tubercle is not in profile.
2.) the knee is over-rotated toward the IR, so rotate the knee and patella away from IR, medially.

Front 19

Answer the following

1.) What does this image look like compared to a true lateral?
2.) What needs to be done to correct this image?

Back 19

1.) The fibular head is completely superimposed by tibia
2.) This knee is under-rotated away from the IR - so rotate the knee and patella toward the IR laterally.

Front 20

1.) What does this image look like compared to a true lateral?
2.) What can be done to fix this position?

Back 20

1.) You can see the adductor tubercle, which is posterior on the medial condyle.
2.) This position is under rotated, the condyles should be superimposed, so rotate the knee toward the IR, laterally

Front 21

Which two ligaments of the knee help stabilize the knee from the anterior and posterior perspective.

Back 21

Cruciates

Front 22

What is the upper, or superior portion of the patella called?

Back 22

Base

Front 23

Which condition can cause the tibial tuberosity to be pulled away from the tibial shaft?

Back 23

Osgood-Schlatter disease

Front 24

Which joint should be open or almost open for a well positioned AP oblique knee projection with medial rotation?

Back 24

Medial oblique AP knee
Proximal Tibiofibular joint space open

Front 25

Which imaginary plane should be placed parallel to the IR for an AP projection of the knee?

Back 25

Interepicondylar

Front 26

How much should the knee be rotated internally for the AP knee projection?

Back 26

3-5 degrees

Front 27

How should the patella be demonstrated on a AP medially rotated OBL projection of the knee?

Back 27

Around half of the patella should be seen free of superimposition ( same with lateral OBL projection)

Front 28

If a patients ASIS to table measurement is 19-24 inches how should the CR be angled for an AP knee projection

Back 28

Perpendicular

Front 29

If a patients ASIS to table measurement is 25cm and above, how should the CR be angled for an AP knee projection.

Back 29

5 degrees Cephalic

Front 30

If a patients ASIS to table measurement is 18cm and below, how should the CR be angled for an AP knee projection.

Back 30

5 degrees Caudal

Front 31

How much should the knee be flexed for a true lateral projection?

Back 31

20-30 degrees

Front 32

How much should the CR be angled for a lateral knee projection? Where should the CR be placed?
How much should the knee be flexed?

Back 32

5 TO 7 degrees caphalad
1in. Distal to medial epicondyle
True lateral, flexed 20-30°

Front 33

Describe what makes this projection a TRUE lateral knee?

Back 33

Femoral condyles superimposed
Patella in profile (indicates no rotation)
Patellofemoral joint space open

Front 34

1.)What is the projection displayed above?
2.)How much should the knee be flexed for this projection?
3.)The CR should be perpendicular to what for this projection?

Back 34

1.)*Camp Coventry, Intercondylar Fossa PA Axial knee
2.) 40 to 50 degree flexion of the knee
3.) The CR should be perpendicular to the lower leg

Front 35

For the Camp Coventry Projection, when the knee is flexed 40 degrees, the CR is angled _______ degrees. When the knee is flexed 50 degrees, the CR is angled ______ degrees.

Back 35

40, 50

Front 36

1.) What is the projection in the picture above?
2.)How many degrees should the patient lean forward for this projection
3.) What is the CR angle and position for this projection?

Back 36

1.) Holmblad method
2.)20 to 30 degrees forward
3.) CR perpendicular to IR at midpopliteal crease

Front 37

When critiquing a lateral / medial OBL AP knee, how should the joint space appear.

Back 37

The joint space should appear unequal

Front 38

How much should the knee be flexed for a lateral patella.

Back 38

5 to 10 degrees

Front 39

Name this projection.

Pt. prone 45° knee flexion
CR 15-20° from long axis of lower leg at midfemoropatellar joint.

Back 39

Tangential (axial or sunrise/skyline) Patella
Hughston Method

Front 40

This projection can be performed using a wheelchair or lowered radiographic table.

Back 40

Holmblad method (variation)

Front 41

This projection requires 90 degrees knee flexion

Back 41

Settegast method

Front 42

Name this projection

- knee is flexed 40⁰ - 45 ⁰

-10 -15° angle from lower legs to be tangential to femoropatellar joint

IR on mid-thigh, tilted to be perpendicular to x-ray beam

Back 42

infrosuperior (Tangental, sunrise)

Front 43

Name this projection

Prone
My knee is flexed 40-50°
40-50° caudal angle, perpendicular to lower leg
40 ° flex = 40 ° cr angle

Back 43

Camp Coventry

(tunnel view, intercondylar fossa)

Front 44

Name this projection

My knee is flexed 45 °
I am prone
The Cr is 15 to 20° from the long axis of the lower leg, to midfemoropatella joint
I am a patella projection

Back 44

Hughston Method (Tangental)

Front 45

I am supine
The IR is resting about 12 inches below the knee
There is an apparatus usually used to hold the IR
My knee is flexed 40 degrees

Back 45

Merchant ( Tangental )

Front 46

A young male patient comes to the radiology department with a clinical history of Osgood-Schlatter disease. Which single projection of the basic knee series will best demonstrate this condition?

Back 46

Lateral knee projection

best demonstrates any separation of the tibial tuberosity from the shaft of the tibia

Front 47

A radiograph of a mediolateral knee projection demonstrates that the medial femoral condyle is projected inferior to the lateral condyle. What can the technologist do to correct this problem during the repeat exposure?

Back 47

By angling the central ray 5 - 7 degrees cephalad, the medial femoral condyle will be superimposed with the lateral condyle.

Front 48

A radiograph of the lateral patella reveals that the patella is drawn tightly against the intercondylar sulcus. Which position modification should be performed during the repeat?

Back 48

decrease the amount of flexion of the knee

Front 49

What is another term for the intercondyloid eminence?

Back 49

intercondylar tubercles

Front 50

which structures serve as shock absorbers within the knee joint

Back 50

menisci

Front 51

An AP knee radiograph reveals that the joint spaces are not equally open and the proximal fibula is superimposed over the tibia. Which specific positioning error lead to this radiographic outcome?

Back 51

Lateral rotation of the lower limb

Front 52

What are the 4 main ligaments of the knee joint?

Back 52

Fibular lateral collateral ligament (LCL)
Tibial medial collateral ligament (MCL)
Anterior Cruciate Ligament (ACL)
Posterior Cruciate Ligament (PCL)

Front 53

What are the two joints of the knee?

Back 53

femorotibial joint
patellofemoral joint

Front 54

What is the classification of the knee joint

Back 54

synovial

diarthrodial (freely movable)

Front 55

1.) Which projection is this?
2.) What criteria make this a good projection?

Back 55

1.) Merchant bilateral Method
Tangential projection patella
(axial or sunrise/skyline)
2.) Intercondylar sulcus and the patella are visualized with the femoropatellar joint space open.

Front 56

Is this a medial or lateral oblique knee? How can you tell?

Back 56

Lateral OBL knee
Fibula superimposed over midtibia

Front 57

Which projection is demonstrated ?
Is this an acceptable image, why or why not?

Back 57

PA axial projection tunnel view knee

Yes it is acceptable because ..

1.) Intercondylar fossa in profile
2.)No rotation
3.)Articular facets and intercondylar eminence well visualized
4.)Optimal exposure factors

Front 58

Overflexion of knee draws patella into _________________

Back 58

intercondylar sulcus.