E2697. Knee Impingement: Topographical Multimodality Clinico-Imaging Approach and Role of Ultrasound-Guided Interventions
  1. Amit Katyan; Vardhman Mahavir Medical College and Safdarjung Hospital
  2. Dharmender Singh; Vardhman Mahavir Medical College and Safdarjung Hospital
  3. Kanchan Nigam; Vardhman Mahavir Medical College and Safdarjung Hospital
The close anatomic proximity of osseo-ligamentous structures predisposes the knee joint to repetitive injury induced impingement syndromes, one of the most common causes of knee pain in young adults. Knee impingement is a great mimic and is often missed at both imaging and even arthroscopy. A topographical clinico-radiological approach classifying the knee joint into anterior, medial, lateral and posterior compartments allows diligent diagnosis and planning interventional management.

Educational Goals / Teaching Points
To propose a schematic protocol for static and dynamic ultrasound examination of knee, illustrate ultrasound (US), color Doppler and MR appearances of impingement syndrome affecting different compartment of the knee joint, and describe appropriate clinical and US guided interventions for management of knee impingement syndrome.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
US knee is performed using a 12 - 18 MHZ transducer in a position that enables maximum exposure of the knee compartment under assessment. Dynamic US provides a unique opportunity for directly evaluating mobility of tendons, and ligaments in relation to the fat pad. In addition, excellent visualization of abnormal fluid within fat pad and bursae, is an indirect evidence of impingement syndrome on US. MRI is excellent the diagnosis for plica impingement. Treatment for knee impingement can be conservative, image guided interventional therapy or surgical. Appropriate guided interventions include steroid injection for bursitis and US-guided hydro-dissection of suprapatellar fat impingement.

A topographical multimodality imaging approach, appropriate patient stratification, and US guided interventional therapy are essential pillars for accurate timely diagnosis and management of knee impingement.