Acute Knee Imaging

It is important to ask for the correct views, "tib and fib" gives a projection with very little useful information about the knee!

The Rule of Two's1

Two Views: One view is one too few!
Two Joints: Above and below*
Two Sides: Compare sides in difficult cases (Radiologist approval required)
Two Abnormalities: Always look for the second injury
Two Occasions: Compare with old films if at all possible
Two Studies: Always re-check after the application of POP or after manipulation
Two Opinions: Set up a red dot system or show films to a colleague
Two Records: Write down what you see!
Two Specialists: Ensure trauma films are reported by a radiologist
Two Examinations: Try a second modality if the clinical findings and simple x-rays do not correlate

*This does not apply to a knee joint injury if there is no long bone fracture

ABC's of Reviewing x-rays

A: Adequate images? Alignment? Anatomical variants

B: Bones; Normal outline? Normal texture? fracture lines? Avulsion fractures?

C: Cartilage & Joint; Osteochondral fractures? Loose bodies? Fluid levels? Air in the joint?

s: Soft tissues; Abnormal Swelling? Patella Tendon Disruption? Quads Tendon Disruption?