Knee Arthrography PDF
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Knee Arthrography Knee Arthrography Dennis J. Stoker F.R.C.P., F.R.C.R. Consultant Radiologist Royal National Orthopaedic and St. George's Hospitals London Director of Radiological Studies The Institute of Orthopaedics London 1980 SPRINGER-SCIENCE+BUSINESS MEDIA, B.V. © 1980 D.J.Stoker Originally published by Chapman and Hali in 1980 Softcover reprint of the hardcover 1s t edition 1980 ISBN 978-0-412-21860-6 Ali rights reserved. No part of. this book may be reprinted, or reproduced or utilized in any form or by any electronic, mechanical or other means, now known or hereafter invented, including photocopying and recording, or in any information storage or retrieval system, without permission in writing from the publisher British Library Cataloguing in Publication Data Stoker, Dennis J Knee arthrography. 1. Knee-Radiography 1. Title 617'.582'07572 RC932 80-40619 ISBN 978-0-412-21860-6 ISBN 978-1-4899-3160-3 (eBook) DOI 10.1007/978-1-4899-3160-3 Contents Foreword vii Preface IX Acknowledgements xi 1 Arthrography of the Knee 1 2 Anatomy of the Knee Joint 8 3 Clinico-pathological Considerations: Indications and Contra-indications 21 4 Technique 33 5 The Normal Arthrogram 52 6 Interpretation -The Abnormal Arthrogram 62 7 Accuracy, Results, Sources of Diagnostic Error: Illustrative cases 94 8 Chondral and Osteochondral Lesions 145 Index 165 TO ANNE Foreword Of the joints of the body commonly afflicted by serious pathology the knee is the most accessible. Because it is so accessible drastic treatment may be undertaken prematurely and incorrectly. This does not threaten life but may cause permanent morbidity. Dr Stoker has set about examining this joint in depth as a radiologist. As a direct result the surgeon will be helped to make a correct diagnosis and avoid pitfalls, by a diagnostic procedure that is of little inconvenience to a patient. Arthrography is not new but a fresh appraisal is timely. This is not to suggest that there can be any slackening in clinical examination, or that other methods of examination do not have a place. But there are knee joint problems, particularly in teenage girls, in which a clinical diagnosis is very difficult, but must be made exactly. Arthrography must be accepted as a very useful method of examination of the knee joint and an essential one in certain circumstances. More radiologists should be interested in undertaking this examination and surgeons should ask for it. E.L. Trickey, F.R.C.S. Royal National Orthopaedic Hospital Stanmore Preface A growing interest in arthrography of the knee has been evident in the United Kingdom during the last 5 to 7 years; the advantages offered by the technique have been appreciated by radiologists, orthopaedic surgeons and especially all those involved in the practice of sports medicine. Although the use of arthrography is more widespread in North America and parts of continental Europe, this is not necessarily a reflection of a lesser awareness of its benefits, but rather of a general shortage of qualified radiologists and a need, therefore, to apply a series of priorities to the radiological service commitment in the United Kingdom. I am, in fact, often approached by radiologists who wish to set up an arthrographic service and need advice about technique, in addition to those who have started to undertake knee arthrograms and have met difficulties in the achievement of a high standard in radiographic quality. Many articles have been published on various facets of the arthrographic procedure, but few manuals on the whole technique of arthrography. This is not to neglect the outstanding monograph by Ricklin, Riittiman and del Buono, to whom I, and many other established arthrographers, owe a tremendous debt. In an attempt to answer some of the questions posed, I have produced this monograph. A detailed technique is described, from which the emergent arthrographer may deviate, as his experience grows, by adaptation to meet his own local facilities and his increasing proficiency. The illustrations of arthrograms cannot and, indeed, should not be comprehensive; sufficient illustrations have been included to cover most of the routine and common difficult areas. This book is intended primarily for radiologists. It can be read with benefit by the other member of the arthrographic team, the radiographer, for whom arthrography supplies an involvement greater than most other contrast examinations. The satisfaction of the examination, as with many other radiological techniques, lies in the solution of a clinical problem to the benefit of the patient. The radiologist who achieves any success with arthrography should, therefore, find that a closer relationship as a member of the diagnostic team leads to better sequent information x Preface from the referring clinician. The orthopaedic surgeon who reads this book, and I hope that many will, can thereby appreciate what follows his signing of the request from, and the care taken by the radiologist to ensure that the information in his report is based upon accurate observation in an impeccable technique. Acknowledgements It would not be possible to mention the names of all those, without whose help and encouragement, the production of this book would not have been possible. To those whose names I omit, I apologize in advance. I am grateful to my radiological colleagues at the Royal National Orthopaedic Hospital, Dr Ronald Murray and Dr Malcolm Chapman, for encouraging me to take up this investigation and for making it possible for me to attend other centres where the technique was already well established. I owe a great debt to Robert Freiberger, M.D., of the Hospital for Special Surgery, New York, for his help and advice and for convincing me of the great value of the investigation on the basis of his extensive experience. I must thank also Paul Butt, M.D., previously of Montreal General Hospital, for easily convincing me that the fluoroscopic spot-film technique was superior to the purely radiographic methods in earlier use. I am grateful to all orthopaedic surgeons and other clinicians who have referred their patients to me for arthrography; in particular, I must thank Mr Lorden Trickey, F.R.C.S., who was my primary support in the early days when the technique was evolving, quality was variable and accuracy was very much less predictable than at present. The ability to correlate the radiographic findings with clinical, arthroscopic and operative findings, and to discuss the studies subsequent ly, is an indication of team-work from which the patient can only benefit. The success of the technique described here depends primarily on the radiographers, who may remember nostalgically the relatively quiet times in the department before knee arthrography took off. I must thank especially Mr Bill Stripp, M.S.R., Superintendent Radiographer at the Town Hospital of the Royal National Orthopaedic Hospital, for his unfailing good humour in establishing and maintaining the radiographic quality, and for his inventiveness in the solution of technical problems. At the Country branch of the Hospital, my thanks are due to Miss Mary Manhire, M.S.R., Superintendent Radiographer until1977, whose help was invaluable in the early years. My thanks are also due to Mrs Ann Smith, M.S.R., now Superintendent Radiographer at the Country branch of the Hospital, but earlier, the radiographer mainly assigned to help in the establishment of an
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