Knee Arthrography

178 Pages·1980·6.61 MB·English

by  Dennis J. Stoker F.R.C.P.

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