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RADR 1411
Ch.6 - Lower leg, Knee, Patella, Femur
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RADR 1411 > Ch.6 - Lower leg, Knee, Patella, Femur
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The femur is the
longest
and
strongest
bone in the body
The patella is
.5
" above the knee joint
The patellar surface is aka the
trochlear groove
or
intercondylar sulcus
The patellar surface is the
triangular
depression at the
distal
portion of the
anterior
femur.
Femur Angles:
Neck to shaft:
125
degrees
Longitudinal:
10
(
5
-
15
) degrees
Anterior:
15
-
20
degrees
The femur's medial condyle extends
lower
than the lateral condyle ( this is why we angle
5-7
degrees on lateral knees)
The posterior view of the distal femur shows its both
condyles
and the
intercondylar fossa
between them.
The medial condyle has an
adductor tubercle
on its
posterolateral
surface; this is how we can
differentiate
it from the
lateral
condyle
The patella has a
base
(superior border),
apex
(inferior surface), posterior surface (
smooth
) and an anterior surface (
rough
)
The patella only articulates with the
femur
, hence the
patellofemoral
joint
The knee joint is dependent on the
PCL
and
ACL
(ligaments) for
stability
The knee is a
synovial
joint enclosed in an articular
capsule
/
bursa
All lower limb joints except for the distal tibiofibular joint are
synovial
,
diarthrodial
(freely movable) joints
The distal tibiofibular joint is a
fibrous amphiarthrodial
(slightly movable) joint
The SID for an AP Lower Leg is
40
" but you may increase it to
44-48
AP Knee Angulations:
<
19
cm: 3-5 degrees caudad
19-24 cm: No angle, perpendicular
>24 cm: 3-5 degrees cephalad
AP Lower Leg:
SID:
40
" or
44-48
"
14x17 diagonally
1-2
" of both joints included
AP Knee:
40" SID
CR at
.5
" distal to
apex
of patella
Angle
3-5
degrees based on body habitus
Rotate leg
3-5
degrees
internally
Oblique
knees don't require an angle
A knee internal oblique
opens
up the
tibiofibular
joint while the external closes it
Lateral Knee:
CR angled
5-7
degrees
cephalad
CR
1
" distal to
medial epicondyle
Flex knee
20-30
degrees
Lateral Knee Angles:
Short with wide pelvis:
7-10
degrees
Average:
5-7
degrees
Tall with narrow pelvis:
5
degrees
AP Weight Bearing Knees are done to demonstrate the
femorotibial
joint spaces for possible
cartilage degeneration
or
arthritis
PA Axial Weight Bearing Knees (Rosenberg Method):
Knees flexed
45
degrees
CR
10
degrees caudad
Knee joint spaces and
intercondylar
fossa shown
Intercondylar Fossa Views:
Camp-Coventry
Method
Beclere
Method
Homblad
Method
Camp Coventry Method:
PT prone with lower leg flexed
40-50
degrees
CR perpendicular to
lower
leg
CR at
popliteal
line
Beclere Method:
PT supine with knee flexed
40-45
degrees
CR perpendicular to
lower
leg
CR
1
" distal to apex of patella
You should rotate the knee internally
3-5
degrees for a true PA Patella
Medio Lateral Patella:
Flex knee
5-10
degrees
CR perpendicular to
mid-femoropatellar
joint
Tangential Patella Views:
Settegast
Method
Inferiosuperior
Projection
Hughston
Method
Settegast Method:
PT may be
prone
or
seated
90
degree knee flexion
CR
15-20
degrees up to patellofemoral joint
Inferosuperior Projection:
40-45
flexion of knee
CR inferosuperiorly at
10-15
degrees from lower leg
Hughston Method:
PT
prone
Knee flexed
40
degrees
CR
15-20
degrees to lower leg at mid femopatellar joint
Distal AP Femur:
Rotate leg
5
degrees
internally
Bottom of IR
2
" below knee joint
AP Proximal Femur:
Rotate leg
15-20
degrees
internally
(femoral neck in profile)
Top of IR at ASIS level
Lateral DIstal Femur:
Flex knee
45
degrees
Bottom of IR 2" below knee joint
Lateral Proximal Femur:
True lateral
Top IR at
ASIS
kVp Ranges:
TibFib:
70
+-5
Knee/Patella:
75
+- 5
Distal Femur:
75
+- 5
Proximal Femur:
80
+- 5
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