ultrasound findings of the knee joint at khartoum teaching hospital ...

Ozean Journal of Applied Sciences 5(4), 2012
DISCUSSION
In this study, the commonest clinical complains were found to be knee joint pain and swelling. This was
similar towhat was observed by (Verena & Sarah, 2001).In our series of 100 patients whoundergone U/S
of their knees, more females presented for U/S of the knee than males. In the light of the fact that obesity
is one of the main indications of knee joint pain, the vast majority of the patients are females. At the same
time, it is known that a number of women present with arthropathies followingpregnancy, obesity and
post-menopausal osteoporosis (Hannan et al., 2000).
Spectrums of MUS knee findings were demonstrated. Although the authors found degenerative bone
erosion and osteophyte occurred in patients of 40 years and above.These findingswere differed from
(Harry & Joseph, 1999) study that reported itis usually uncommon in the age group 41-50. U/S was able
todetect early degenerative processes where plain radiographs were reportedly normal.
The incidence of Baker's cysts in our study group was (64.6%) of knees. This finding was higher than the
findings reported by (Naredo et al., 2005) in a population based study where Baker’s cysts were detected
in (22%) of knees in Spanish patients, andalsowas higher than prevalence reportedby(Fam, Wilson, &
Holmberg, 1982), where they noted a (42%) rate in German population. The authors believe that the high
prevalence rate ofBaker's cysts were due to the reasons that the number of women represented 57% of the
sample with an average age above forty, these reasons are compatible with different severities of knee
osteoarthritis (OA) lead to the develop of suchcysts.
Study done by (Eric, Jacobson, David, Curtis, & Mamix, 2001) had shown that identification of fluid
between the semimembranosus andmedial gastrocnemius tendons in communication with posterior knee
cysts indicates Baker's cysts with100% accuracy. In this study, these features were demonstrated in all
cases where the Baker’s cysts werefound.
Effusions were seen in (8.7%) of scanned knees. U/S has a high accuracy foridentification and
characterization of joint effusions (Chhem & Beauregard, 1995). Bursitis was reported in (2.4%) cases.
Bursitis has been reported to be due to kneeling in the upright posture. It was characteristically noted that
more females got the bursitis compared to males. Presence of increased flow on color or power Doppler
imaging or tenderness during transducer palpation noted by (Ptasznik, 1999) which was an indicative of
an inflammatory state consistent with true bursitis.
Ultrasonographic detection of synovitis in the knee has already been reported (Karim et al., 2004). Our
findings reported (7.0%) cases of synovitis, further suggest that measurement of synovial thickness is an
adequate method of quantifying synovitis.MRI is now considered to be the most valuable methodfor
monitoring synovitis (Peterfy, 2003). Ultrasonography allows less comprehensiveanatomical coverage
within individual joints, buthas the advantages of higher resolution of soft tissuearchitecture. It is also
readily available, costs less, and maybe undertaken by rheumatologists.
Although the relation between synovitis and joint damageremains controversial (Ostergaard et al., 1999),
recent MRI studies have shown thateffective suppression of synovitis can reverse structuraldamage and
that there is a threshold level of synovitis forthe progression of bony damage (Conaghan et al., 2003). It
could be confirmed that using standardised anatomical guidelines, thecombined grey scale and power
Doppler ultrasonographicmethod has indeed shown itself to be sensitive in detectingtime dependent
rheumatoid and synovialchanges (synovitis) in individual joints in response to therapy, parallelingchanges
in disease activity.
A percentage of (2.4%) of meniscal degeneration and tear was detected in patients. Reports reveal that
majority of cases developed knee joint meniscal tears because the meniscus has such important functions
in load bearing and stability of the knee, loss of this structure in the young is associated with significant
degenerative changes which may be depicted on U/S in addition to meniscal pathology (Maffuli,
Petricciuolo & Pintore, 1991).Such justification exactly matches our findings in this study.Observations at
U/S and patient clinical history about tendon tear (0.8%) were similar to results obtained by (Rasmussen,
1999). Wherethe major causative factors of such condition was due to traumatic origin resulting in
avulsion of fragments of cartilage and bone from the tibial tuberosity.
Limitation of this study was the inherentoperator dependence in the acquisition of the sonographic data
and images. In addition,MRI imaging was not used as the gold standard in our study.
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