Anatomy and ultrasound imaging of the tibial collateral ligament: A narrative review

Abstract

Medial knee pain is commonplace in clinical practice and ultrasound assessment of the tibial collateral ligament-medial meniscus complex is increasingly becoming a valuable examination tool in the outpatient setting. In the pertinent literature, basic sonographic protocols have been proposed to evaluate the medial compartment of the knee joint. Using high-frequency ultrasound probes and high-level ultrasound machines; we matched the histo-anatomical features of the tibial collateral ligamentmedial meniscus complex and its different sonographic patterns in physiological/ pathological conditions to define a standardized (layer-by-layer) sonographic approach. Moreover, high-sensitive power Doppler assessments have also been performed to evaluate the nearby microcirculation. Modern ultrasound equipment appears to provide optimal "sonographic dissection" of the tibial collateral ligamentmedial meniscus complex for its various physiological/pathological patterns. Likewise, high-sensitive power Doppler allows clear visualization of the microcirculation as regards the local ligamentous and capsular structures. In clinical practice, using adequate technological equipment, a detailed sonographic assessment of the tibial collateral ligament-medial meniscus complex can be performed. High-frequency B-mode ultrasound imaging and high-sensitive power Doppler perfusion patterns can be matched/integrated with the clinical findings to optimize the management of patients with medial knee pain.

Anatomy and Sonographic Examination for Lateral Epicondylitis: EURO-MUSCULUS/USPRM* Approach

“…Indeed, a normal appearing ligament on grayscale can display pathological perfusion due to mechanical overload, healing process, or inflammatory changes (Video 14, Supplemental Digital Content 14, http://links.lww.com/PHM/B791). 34 Lastly, in patients with massive injury of the RCL also involving the other components of the lateral stabilizing complex (AL and/or lateral ulnar collateral ligament); the lateral instability of the radial head can be promptly evaluated by performing dynamic US assessment during active/passive pronation and supination of the forearm (Video 15, Supplemental Digital Content 15, http://links.lww.com/PHM/B792). 4 …”

EURO-MUSCULUS/USPRM Dynamic Ultrasound Protocols for Knee

“…Involvement of the meniscofemoral ligament is more frequent and dynamic examination under valgus stress would be noteworthy, especially for partial-thickness tears. Further detailed examination of this area can be done as described previously, also/especially the histological junction between the medial meniscus and the meniscofemoral or meniscotibial ligament after trauma 20 . While a reproducible anechoic gap is the hallmark for tears, attachment site calcifications might also develop (i.e., Pellegrini-Stieda syndrome) and hamper the movement during valgus stress.…”

Ultrasound imaging of bone fractures

“…For instance, in non-displaced torus forearm fractures (i.e., Buckle fractures) and “greenstick” fractures, it has been shown that US is comparable to XR for both diagnosis and management [ 4 , 5 ]; moreover, several authors have demonstrated the pivotal role of US in the diagnosis of costal cartilage injuries in the pediatric population [ 2 , 6 , 7 ]. US is already widely used in musculoskeletal imaging for the assessment of superficial soft tissue illnesses [ 8 , 9 ], articular and periarticular pathologies [ 10 ], muscle disorders [ 11 , 12 ], nerve injuries [ 13 ], and tendinopathies [ 14 ].…”