Features of the structure of the knee joint. Knee joint - anatomy and detailed structure Anatomical structure of the knee joint in children

In the human body, the knee joint is the largest joint. The structure of the knee joint is so complex and at the same time strong that traumatic dislocations of the lower leg occur extremely rarely. If we compare other dislocations, then damage to the knee joint accounts for only 2-3% of all cases. Such low rates are explained by the anatomical and physiological characteristics of the knee joint.

In the medical literature, the knee joint is classified as biaxial, condylar, complex and compound.

Bones of the knee joint

The knee joint is a combination of the surface of the tibia, the femoral condyle, and the patella.

The entire surface of the articular bone is covered with hyaline cartilage, which performs a protective function. Thanks to it, the friction of the articular surfaces that articulate with each other is reduced. As for the thickness of hyaline cartilage on the condyles of bones, it is characterized by its heterogeneity. In men, this indicator is 4 on the lateral condyle and 4.5 on the medial. The thickness of hyaline cartilage in women is different and has slightly lower values. As for the tibia, it is also covered with cartilage.

Knee joint ligaments

Ligaments perform a strengthening function. The femur and tibia are firmly attached by cruciate ligaments. The anterior and posterior ligaments of the knee joint are located inside the articular capsule, that is, they are intra-articular.

Intra-articular ligaments consist of the following ligaments:

• oblique arcuate;
• fibular and tibial collateral;
• lateral and medial patellar ligaments.

Cartilaginous layers

The fact that the knee joint has a complex structure, as it includes many component parts, has already been mentioned above. The upper part of the tibia is connected to a layer of cartilage called the meniscus.

The knee joint has two such menisci. They are internal and external, and are respectively called medial and lateral. Their main function is to distribute the load on the surface of the tibia. Thanks to their elasticity, the menisci help absorb movement.

The menisci, just like the ligaments, perform the function of stabilizing the articular surface, limiting mobility, and monitoring the position of the knee, the latter being performed thanks to certain receptors.

The cartilaginous layers are attached to the joint capsule with the help of tibial ligaments. The medial menisci, in turn, are additionally attached to the internal collateral ligament.

Warnings! It must be remembered that the medial menisci, due to their lack of mobility, are often damaged and torn.

In young children, the cartilage layers of the knee joint are filled with blood vessels. With age, they remain only in the outer part of the cartilage, while a slight inward movement remains. Almost the entire part of the meniscus is “nourished” by the synovial fluid, and the rest by the bloodstream.

Bursa

The structure of the knee joint also consists of an articular cavity, which is hermetically surrounded by an articular capsule attached to the bones. The outside of the bag is tightly covered with fibrous tissue, which allows it to protect the knee from external damage. The reduced pressure inside the bursa helps maintain the bone in a closed position.

Muscles of the knee joint

To properly restore the knee joint, you need to know its structure. The knee joint is made up of the following muscles::

• Tailoring. It is this muscle that allows the lower leg and thigh to flex, as well as externally rotate the thigh.
• Four-headed. Already from the name itself, it becomes clear that this muscle has four heads - the rectus femoris, medialis, vastus lateralis and vastus intermedius muscles. It is one of the largest muscles in the human body. Extension of the lower leg, that is, straightening of the leg, is performed due to the contraction of all four heads. Knee flexion occurs when the rectus muscle contracts.
• Thin. Thanks to it, the leg rotates inward during ankle flexion.
• Double-headed. Allows you to straighten your hip and also bend your leg at the knee. The outward rotation of the tibia is facilitated by the bent position of this muscle.
• Semitendinosus. Takes part in hip extension and shin flexion. It also plays an important role in the process of torso extension.
• Semi-membranous. Performs the function of flexing the ankle and rotating it inward. It is indispensable when pulling back the knee joint capsule as it bends.
• Calf. Takes part in the process of bending the knee and ankle joint of the foot.
• Plantar. Its functions resemble those of the gastrocnemius muscle.

The mobility of the knee joint is very high. If these indicators are measured, they will be as follows:

• 130° — flexion in the active phase;
• 160° — flexion in the passive phase;
• 10-12° - maximum extension.

The knee joint is complex in structure, large, and one of the most important joints in the body. Every day he undergoes significant stress - he bends and unbends, and supports the weight of the body. To understand the mechanism of its dysfunction, you need not only to examine the knee in person or from a photo - it is important to know the anatomy.

The knee joint is formed by voluminous tubular bones - the femur and tibia. The first is on top, the second is below it. The structure of the knee is complemented by the patella; it is a small round bone, otherwise it is often called the patella.

The characteristics of the main bones are:

• The femur is the largest component of the musculoskeletal system, capable of holding many muscle fibers. It is its lower part (distal) that forms the human knee. To connect to the second bone, the femur has medial and lateral condyles.
• Tibia - belongs to the bone structure of the lower leg along with the fibula. In the upper zone it has epiphyses - proximal, distal. The first forms the tibial plateau, with the outer and inner parts of which the condyles of the femur are connected.

The condyles have one more task - they form a “corridor” or “channel” along which the patella moves during walking and other movements. The correct name for the canal is the patellofemoral recess.

All articular surfaces are covered with a thin cartilaginous layer. This is the hyaline cartilage of the knee joint, which is responsible for the shock-absorbing function. It prevents the limb from suffering from sudden movements, impacts, smoothes out friction and vertical loads (it is because of the destruction of cartilage that pain and other unpleasant sensations appear during arthrosis). The normal thickness of cartilage is about 4 mm, it is uniform in structure and has a smooth surface.

Also, the structure of the knees is complemented by menisci - strong cartilaginous elements that are located under the condyles and are named accordingly. They look similar to hyaline cartilage, but are denser. Without menisci, it is impossible to give balance to the limb, because they help distribute the load on the leg throughout the tibial plateau. The main task of these structures is to prevent the load from exceeding one side of the plateau, and for this purpose they are thicker at the periphery than at the center. Injuries and other lesions of the menisci lead to rapid wear and tear of the entire joint apparatus.

The anatomy of the knee joint includes not only hard structures, but also soft tissues. So, inside the articular cavity and on its outer side there are ligaments - formations of connective tissue cells. Their job is to hold the bones together, to prevent the joint from becoming loose and moving laterally.

There are several ligaments at the knee joint. Inside the knee itself there are the following ligaments:

• Anterior cruciate. It originates from the external condyle of the femur and reaches the anterior part of the internal meniscus. It does not allow excessive extension.
• Posterior cruciate. Directed from the second condyle to the lateral meniscus, much smaller in size than the anterior one. Its role is to prevent strong flexion of the lower limb.
• Transverse. It goes from one meniscus to another, intended to further strengthen the entire “structure”.

The outer side also has its own ligaments - collateral. The middle (medial) is protection against dislocation of the joint, the lateral supports the back of the joint. There is also the popliteal ligament and the patellar ligament, which complement the functions of the others.

The activity of the leg is given by muscle fibers, which are combined into groups. There are flexors that help bend the knee joint during movement, these are located on the back of the thigh and below. There are also extensors - muscles that draw the hip back and run along the front of the leg.

The largest muscle is the quadriceps muscle, which is located on the thigh area. The front part of the thigh is precisely formed by this muscle, and the latter, in turn, consists of 4 muscle bundles surrounded by fascia (films). Next to it is the sartorius muscle group, which runs to the top of the tibia.

Other leg muscles that help stabilize the knee:

• Thin. Runs from the pubis to the tibial plateau.
• Major adductor. From the pelvis it runs along the front of the leg directly to the joint capsule.
• Double-headed. From the ischium it is directed towards the fibula.
• Semitendinosus. It is located parallel to the previous one.
• Semi-membranous. Attached to the sheath of the popliteus muscle.

The elements of the knee are so numerous that it is difficult to list them. The most important role in the work of the lower extremities belongs to the bursae of the knee joint - slit-like cavities bounded by the synovial membrane. Inside them there is a fluid called synovial (intra-articular).

Children have fewer bags than adults - it increases with age. The dimensions of these cavities also increase, because the limb apparatus is forced to adapt to the conditions of existence. In people, the number of bags can be different; some of them are connected to the joint cavity and “feed” on its fluid.

Here are the main synovial bursae of the knee joint:

• Subpatellar;
• Prepatellar subcutaneous and fascial;
• Deep patella;
• Suprapatella;
• Popliteal;
• Subtendinous;
• Brodie bag, etc.

The bags are responsible for improving the gliding of bone surfaces and muscle movement, as well as for nourishing the periarticular tissue. Since their pathologies are very common, during diagnosis they pay special attention to the size, presence of swelling, fluid condition and other important indicators.

The structure of the human knee joint cannot be accurately described without the joint capsule. It is intended to connect together all the numerous articulation elements. Other tasks of the capsule:

• Protection from strong flexion and extension.
• Maintaining the required volume of intra-articular fluid, which nourishes cartilage tissue.
• Providing a certain shape to the joint.
• Protection from injury and any external negative influences.

The capsule is quite thin, but it fully performs its functions. This is ensured due to its special structure. Inside it there is a synovial membrane, which produces synovial fluid - a thick white mass. The liquid consists of the polysaccharide hyaluronate and a number of other substances. It is this polysaccharide that is deposited in cartilage and maintains its shape and thickness.

When inflammation occurs in a joint, the synovial membrane takes the blow - it limits the affected area and prevents it from spreading further. The synovial membrane has villi that enhance fluid production. On the outside, the capsule consists of a fibrous layer represented by collagen fibers. The function of this shell is to give strength to the joint.

Blood supply and innervation

The nerve fibers in the knee area are complex and intertwined. Nerve trunks - the fibular, branches of the sciatic, tibial, as well as their various branches and roots - are responsible for the structure of the human knee and ensuring its sensitivity. The nerves pass inside the muscles, in the menisci - along the periphery, penetrating inside. If the nerves are damaged, the function of the entire joint is impaired.

There are four large feeding arteries in this anatomical zone of the body - femoral, anterior tibial, deep, popliteal. They connect in certain areas and form 13 plexuses. If one of the vessels is damaged, others will take over its tasks. Superficial and deep veins drain blood. Diseases of the blood vessels over time affect the quality of hyaline cartilage and lead to damage to the entire knee. Orthopedists, neurologists, and surgeons treat joint diseases.

Age-related timing of the onset of ossification of the patella and head of the fibula. The centers of ossification of both named anatomical formations appear almost simultaneously in the interval from 3 1/2 to 4 1/2 years. Ossification of the patella occurs from multiple centers of ossification, the head of the fibula - due to a single center. During this age period, there is also another change in the ratio of the rates of ossification of the medial and lateral condyles of the femur. It consists in a more rapid increase in the vertical size of the bone part of the lateral condyle compared to an increase in this size of the bone part of the medial condyle.

Rice. 48. Radiographs of the knee joint in standard projections of a 4-year-old child (explanation in the text).

^ X-ray in posterior projection (Fig. 48, a). The shape of the metaphyses of the femur and tibia remains the same. The condyles of the femur are clearly expressed, as is the intercondylar recess. The height of the lateral condyle is greater than the height of the medial one. The above applies only to the bony part of the condyles. Shown in Fig. 48, and a pneumoarthrogram of the knee joint indicates a typical anatomical form of the cartilaginous model of the femoral epiphysis, characterized by a predominance of the height of the medial condyle. The medial surface of the medial condyle of the femur has a wavy outline, which is explained by the activation of the growth zone before the appearance of additional centers of ossification of the marginal parts of the epiphysis. In the central part of the epiphysis of the femur, an area of ​​uneven sclerosis can be traced, which is the result of a projection layering of ossification points of the patella. The conventional X-ray joint space is irregular in shape, the height of its medial section is almost 1.5 times greater than the height of the lateral section. The ratio of the height of the central section of the x-ray joint space to the intermetaphyseal distance is the same as in children of the previous age group (1:7). At the upper surface of the proximal metaphysis of the fibula, the ossification point of its head is visible. The epiphysis of the tibia retains the shape of a cone with a rounded apex; the tubercles of the intercondylar eminence are not pronounced.

X-ray in lateral projection (see Fig. 48, b). The image of the knee joint differs from that described in the previous section by the presence of multiple, partially fused, partially isolated centers of ossification of the kneecap and the presence of an ossification point of the head of the fibula.

^ Indicators of the anatomical structure of the knee joint, available for analysis, in principle the same as on radiographs of children of the previous age group. The norm for the relationship between the spatial positions of the thigh and lower leg is the valgus deviation of the latter, which is increased compared to the norm in adults. The angle formed at the intersection of the longitudinal axes of the femur and tibia is open to the lateral side, its average value is 165 - 170°.

An indicator of the correspondence of bone age to the child’s passport age is the presence of ossification centers of the central part of the patella and the head of the fibula.

^ The undulation of the contour of the medial surface of the femoral epiphysis can simulate manifestations of a destructive process. A distinctive feature of the age norm of the named contour is precisely its wavy, and not jagged (“corroded”) character, as well as the preservation of the end plate.

Projective layering on the central parts of the epiphysis of the femur of multiple centers of ossification of the patella can create the impression of pathological changes in the structure of the epiphysis. The main points of differential diagnosis are, firstly, the absence of a similar area of ​​sclerosis in the structure of the epiphysis on a lateral radiograph, and secondly, the absence of reactive osteoporosis or osteosclerosis.

^ AGE 6-7 YEARS

The main manifestations of enchondral bone formation at this age are the emergence of additional centers of ossification of the marginal (lateral and posterior) surfaces of the epiphysis of the femur, complete ossification of the central and dorsal (bearing articular surface) parts of the patella. Additional ossification centers of the femoral epiphysis provide ossification of the lateral and posterior parts of the epiphysis. During the same age period, the ratio of the rates of ossification of the medial and lateral condyles of the femur changes again. It consists in a more rapid increase in the vertical size of the bone part, now not of the lateral, but of the medial condyle, as a result of which the height of both condyles first becomes the same, and then the height of the medial condyle begins to predominate. Complete ossification of the central part of the patella as a result of an increase in size and fusion of individual ossification centers ends at approximately 7 years. By the end of this age period, the cartilaginous structure is preserved by: a small part of the marginal sections of the distal epiphysis of the femur, subarticular sections of the tibial epiphysis, the apex, lateral edges and anterior surface of the patella, the tuberosity of the tibia, about 1/3 of the volume of the head of the fibula and metaepiphyseal growth zones.

^ X-ray anatomical picture. X-ray in posterior projection. The transverse size of the metaphysis of the femur practically corresponds to the anatomical one. Its lateral surfaces are slightly concave, the epicondyles are not pronounced. The edges of the metaphysis are bent upward, the medial edge is rounded, the lateral edge is pointed (Fig. 49, b). The metaepiphyseal growth zone of the femur may have an uneven height during this age period due to its slightly larger size in the lateral sections. Its medial half is displayed, as a rule, in the form of a single strip of enlightenment, limited by clear end plates, the lateral half - in the form of two such strips due to the separate display of the anterior and posterior sections of the growth zone. The area of ​​preparatory calcification is wide. The image of the epiphysis of the femur can have several options depending on the ratio of the heights of the medial and lateral condyles and the size, number and location of additional centers of ossification of the marginal parts of the epiphysis revealed on the radiograph. In children 6 years old, the predominant height of the lateral epicondyle often remains (see Fig. 49, a). The intercondylar recess is poorly expressed. Usually only additional ossification centers are identified, forming the lateral sections of the condyles. The ossification points located at the lateral contour of the medial condyle are much larger than those located at the lateral contour of the lateral condyle. Both of them have an oval or approximately oval shape and are surrounded by end plates.

Another version of the x-ray image of the epiphysis of the femur, characteristic of a slightly later stage of its formation, is presented in Fig. 49, b. The height of both condyles of the femur is almost the same, their contours are even, and additional centers of ossification of the lateral sections of the condyles are not visible. At the same time, in the structure of the lateral part of the medial condyle, several clearly defined areas of increased optical density of small sizes can be traced. representing an image of additional centers of ossification of the posterior surface of the condyle. In the lower part of the medial condyle, a relatively large area of ​​increased optical density with a clearly defined end plate, which has a similar anatomical substrate (an additional center of ossification of the posterior part of this condyle), is also visible. In addition to this, the radiograph shows the ossification nuclei of the patella layered on the central parts of the epiphysis of the femur. Rice. 49, c and d illustrates another variant of the age norm of an x-ray image of the epiphysis of the femur, which is more typical for children 6 1/2 - 7 years old. There is a clear predominance of the height of the medial condyle, the intercondylar recess is clearly expressed. The contours of the lateral surfaces of both condyles are uneven due to the presence of multiple additional ossification centers. The structure of the lateral sections of the condyles appears uneven; separate bone fragments of various sizes are visible, but approximately the same round or oval shape, surrounded by clear contours. The anatomical basis for this structural heterogeneity is the projectional superposition of additional centers of ossification of the posterior surfaces of the condyles. Against the background of the central part of the epiphysis, partially isolated, partially fused points of ossification of the patella can be traced. This variant of the x-ray anatomical picture is quite rare.

Rice. 49. Options for depicting additional centers of ossification of the femoral condyles on a radiograph in the posterior projection (explanation in the text).

More often, in children 7 years old, an image of the distal epiphysis of the femur is observed, shown in Fig. 49, d and corresponding to the final phase of ossification, namely, the complete fusion of additional ossification centers with the main mass of the condyles. On the radiograph, the height of the medial condyle of the femur is slightly greater than the height of the lateral one, which corresponds to the shape of the cartilaginous model of the epiphysis. The contour of the lateral surfaces of the condyles is moderately wavy; there is no abundance of additional centers of ossification of the lateral sections of the condyles. There is still some heterogeneity in the structure of the lateral sections of the condyles, but it is rather weakly expressed. The boundaries of individual areas of increased optical density (display of additional centers of ossification of their posterior surfaces that have not completely merged with the condyles) are almost indistinguishable; only part of their contours is revealed. Against the background of the central part of the epiphysis of the femur, a uniform, clear shadow of the completely ossified central part of the patella is visible.

In addition to the variations in the X-ray image of the epiphysis of the femur in children of the analyzed age period, there is also variability in the shape and size of the proximal epiphysis of the tibia (semi-oval, as in Fig. 49, a, without signs of the image of the tubercles of the intercondylar eminence, trapezoidal shape, as in Fig. 48 , b, or a form approaching the anatomical one with low, but still clearly differentiated tubercles of the intercondylar eminence, as in Fig. 49, view). The conventional X-ray joint space of the knee joint in most cases has an irregular shape with a predominance of height, depending on the ratio of the heights of the medial or lateral condyle or its lateral or medial marginal sections. The height of the central part of the x-ray articular retains the same ratio to the height of the intermetaphyseal distance (1: 7). The medial and lateral surfaces of the tibial metaphysis have approximately the same concavity, although its medial edge retains a slightly larger transverse dimension and some sharpness. The ossification nucleus of the head of the fibula is round in shape, its transverse size is approximately 1/2 the width of the metaphysis of this bone.

X-ray in lateral projection. The dimensions and shape of the metaphysis of the femur correspond to the anatomical ones. The metaepiphyseal growth zone of the femur is displayed as a single strip of enlightenment with more or less wavy contours. The epiphysis of the femur is displayed on the radiograph in the form of two semi-ovals, the larger of which, with less clear contours, corresponds to the medial condyle, the smaller to the lateral (Fig. 50, e). The Ludloff spot described above clearly stands out against the background of the upper part of the epiphysis. The nature of the contours of the femoral condyles and the structure of their dorsal sections can have a number of variations associated with the number and localization of additional centers of ossification of their marginal sections. In Fig. 50, a and b, a variant of preferential display of additional centers of ossification of the posterior surface of the condyles is presented. The contours of the condyles are slightly wavy, the structure of the anterior sections is homogeneous. In the structure of the posterior parts of the epiphysis of the femur and at its contour, multiple large additional points of ossification are identified, having an oval shape and each surrounded by end plates. Despite the presence of a large number of ossification nuclei, the contour of the posterior surface of the condyles can be traced quite clearly. The given version of the x-ray image of the epiphysis of the femur is one of the relatively rare ones; more often, additional centers of ossification of its posterior surface are significantly smaller in size and fewer in number, as, for example, in Fig. 50, d. The contours of the condyles are also slightly wavy, the structure of both their anterior and posterior sections is homogeneous. At the posterior and anterior surfaces of the condyles, single small additional centers of ossification of a rounded shape are identified.

A relatively rare case of displaying on a radiograph taken in a lateral projection additional centers of ossification not of the posterior, but of the lateral sections of the condyle is presented in Fig. 50, c and d. The contours of both condyles of the femur are clear, in places slightly wavy. The structure of the marginal sections of the condyles is homogeneous. There are no additional centers of ossification near the contours of the condyles. At the same time, the heterogeneity of the bone structure of the epiphysis area adjacent to the posterior contour of the intercondylar recess is visible, associated with the presence of several round areas of increased optical density with relatively clear contours. Such areas of increased optical density are characteristic of the projection layering of additional ossification nuclei of the marginal sections of the condyles. Since they are projected at a considerable distance from the posterior surface of the condyles and, therefore, cannot be regarded as posterior additional centers of ossification, and additional ossification nuclei of the posterior surface of the intercondylar recess have not been described, the anatomical substrate of the described heterogeneity of the structure of the epiphysis of the femur can only be the centers of ossification of its lateral departments

The proximal epiphysis of the tibia has an approximately oval shape with a slight convexity in the area where the intercondylar eminence is located. Vertically oriented lines of force are clearly visible in its structure. The X-ray image of the patella is determined by the completeness of the fusion of multiple points of ossification of its central part into a single bone formation. In Fig. Figure 50 presents variants of the shape, contours and structure of the patella observed during the age period being analyzed. In Fig. 50, and the patella is a single whole, but its size is small, its contours are unevenly wavy. In Fig. 50, the dimensions of the patella are close to the anatomical ones (there is no complete correspondence due to the still unossified apex not being displayed on the radiograph). The structure of most of the patella is homogeneous, except for the upper section, where two ossification nuclei that have not yet merged with each other and with the main mass of the patella are visible. In Fig. 50, d, the patella is a single bone formation of fairly large size. A feature of its image is the pronounced waviness of the contour of the dorsal surface and the presence in the structure of arcuate stripes of sclerosis diverging from the dorsal surface. The anatomical substrate of these stripes is the waviness of the lateral surfaces of the patella, characteristic of the growth zones in the period preceding the appearance of ossification centers, in this case the lateral edges of the patella.

^ X-ray indicators of the anatomical structure of the knee joint, available for analysis. X-ray in posterior projection. When assessing the relationship between the spatial positions of the femur and tibia, standard values ​​of the angle formed at the intersection of the longitudinal axes of the femur and tibia are used, the same as in adults. When analyzing the image, it is possible to evaluate the following indicators: shape, size, contours and structure of the ossified parts of the metaphysis of the femur and epimetaphyses of the shin bones; the shape of the epiphysis of the femur and the structure of its central part and the contour of the articular surface (analysis of the structure and contours of the lateral parts of the epiphysis is reliable only in the absence of multiple lateral centers of ossification); anatomical relationships in the knee joint in the frontal and horizontal planes, the state of the metaepiphyseal growth zones. The height of the X-ray joint space of the knee joint can also be roughly estimated based on the ratio of the height of its central part to the value of the intermetaphyseal distance (normally 1:7). During this age period, it is impossible to assess the true shape, size and contours of the epimetaphyses of the bones that form the knee joint, the shape of the X-ray joint space and the state of the intercondylar eminence.

On a radiograph in a lateral projection, the following can be assessed: the shape, size, contours and structure of the ossified parts of the epimetaphyses of the femur and leg bones, the ossified part of the patella (with the caveat that the contour of the posterior surface of the epiphysis of the femur can be assessed only in the absence of multiple additional centers of ossification ); state of physiological enlightenment of the knee joint. During this age period, it is impossible to assess the anatomical relationships in the knee joint in the sagittal plane, the true shape, size and contours of the epimetaphyses of the bones forming the knee joint and the patella, and the condition of the tibial tuberosity.

An indicator of the correspondence of the local bone age to the passport age of the child is the presence of additional centers of ossification of the distal epiphysis of the femur.

Rice. 50. Options for depicting additional centers of ossification of the femoral condyles on a lateral radiograph (explanation in the text).

^ Differential diagnosis of x-ray anatomical norm and symptoms of pathological conditions. Certain difficulties in analyzing images may be associated with additional ossification nuclei of the marginal parts of the distal epiphysis of the femur. Single relatively large ossification nuclei have a number of common features in the X-ray image with the picture of osteochondritis dissecans (Koenig's disease). Differential diagnosis is based on the following differences. With partial or complete layering of additional posteroinferior or inferolateral ossification nuclei on the marginal sections of the bony part of the femoral condyles, it is possible to trace a continuous, smoothly rounded contour of the condyles; the structure of the condyles in the intervals between images of the ossification nuclei is not changed. The ossification nuclei themselves are surrounded on all sides by clear and even end plates. For comparison, in Fig. 51, a and b show an imprint and a skiagram from an x-ray of the knee joint of a child with local aseptic necrosis of the lateral condyle of the femur. At the lateral edge of the lower surface of this condyle, a bone fragment of irregular shape and with uneven contours is visible. The end plate is present only on the lower surface of this fragment. The contour of the lateral condyle at the level of the fragment is concave. The vertical and horizontal dimensions of this concavity correspond to the dimensions of the bone fragment. The contour of the niche is sclerotic.

Multiple additional ossification centers can simulate the picture of dystrophic changes in the bone tissue of the epiphysis, and also raise suspicions of the presence of tarsomegaly affecting not only the ankle, but also the knee joint. The main points for the differential diagnosis of multiple additional ossification nuclei with the X-ray picture of tarsomegaly are as follows. Normally, ossification nuclei of the distal epiphysis of the femur are detected only at the lateral and posterior contours of the condyles or against the background of the structure of their marginal sections. The localization of osteochondral formations at the lower contour of the condyles, and even more significantly distal to it, is one of the signs of tarsomegaly (see Fig. 51, c and d). Further, the ossification nuclei of the normally forming epiphysis of the femur, projected at its lateral contours, are located in a single chain (one on each of the sections of the condylar contour).

Rice. 51. X-ray picture of aseptic necrosis of the femoral condyle (a, b) and tarsomegaly (c, d).

The presence of several osteochondral formations located horizontally nearby indicates tarsomegaly. Additional ossification nuclei of the epiphysis “fit” into the contour of its cartilaginous model, with tarsomegaly, as seen in Fig. 51, c and d, this pattern is violated (if you draw a general outline around all the bone formations that appear on the radiograph, then the resulting figure will not correspond to the anatomical shape of the distal epiphysis of the femur).

Features of the x-ray image of the patella at the stage of incomplete fusion of the individual nuclei of its ossification (similar to that shown in Fig. 50, c) can simulate a fracture. The difference between the age-related x-ray anatomical norm and a fracture lies in the presence of clearly defined end plates in the unfused ossification nuclei, as well as in the uniform width of the clearing strip separating these nuclei from the main mass of the patella.

^ AGE 9-12 YEARS

Corresponds to the age of ossification of the tibial tuberosity and the marginal parts of the patella. Ossification of the tuberosity occurs partly due to the spread of the ossification process from the anterior parts of the metaphysis of the tibia, partly due to independent ossification centers that appear at the age of 9 years. The patella has 4 additional ossification centers - two lateral, anterior and apical, which appear at the age of 9 years. The merging of the silt with the main part of the patella occurs by 10-12 years. Complete ossification of the epiphyses of the femur, tibia and fibula is completed somewhat earlier (at about 8 years), and by the age of 13, only the metaepiphyseal growth zones and a small part of the tibial tuberosity retain the cartilaginous structure.

^ X-ray anatomical picture. X-ray in posterior projection (Fig. 52, a). The dimensions and shape of the metaphysis and epiphysis of the femur correspond to the anatomical ones. The shape and dimensions of the epiphysis of the tibia also correspond to the anatomical ones, but with the caveat that the tubercles of the intercondylar eminence are relatively low and have rounded apices. In the structure of the epimetaphyses of the bones that form the knee joint, all the characteristic systems of force lines are revealed. The X-ray joint space of the knee joint has the same shape as in adults, but its height is slightly greater. Against the background of the epimetaphysis of the femur, a homogeneous shadow of the patella, which has its inherent anatomical shape, is revealed. At the lateral contours and at the distal end, structural radiographs may reveal ossification nuclei of the corresponding marginal parts of the patella.

X-ray in lateral projection. The dimensions and shape of the epimetaphyses of the femur and tibia and the head of the fibula correspond to the anatomical ones. In children 8-9 years old, the anterior surface of the metaphysis of the tibia is moderately concave, its contour may be finely wavy (see Fig. 52, b). On radiographs of children 9-10 1/2 years old, at the anterior surface of the metaphysis of the tibia, one or several small points of ossification of the tuberosity of an elongated oval shape are revealed, surrounded by thin, but still traceable end plates (see Fig. 52, c).

Rice. 52. X-rays of the knee joint in 2 projections. Age period 9-12 years (explanation in the text).

At this age, additional ossification nuclei of the anterior surface of the patella and its apex, located at the corresponding contours, may be visible. The structure of the anterior sections of the patella may be heterogeneous due to an oblong-shaped area of ​​increased optical density with unevenly wavy contours. Along the edges of this area there is a narrow strip of enlightenment. The anatomical substrate for the described heterogeneity of the bone structure of the patella is the projection overlap of the ossification nuclei of its lateral sections (Fig. 53, a and b).

The entire range of radiological indicators of the anatomical structure of the knee joint is available for X-ray anatomical analysis. An indicator of the correspondence of the local bone age to the passport age of the child is the presence of ossification centers of the tibial tuberosity and additional ossification nuclei of the marginal sections of the patella.

Rice. 53. Additional ossification nuclei of the patella (a, b); calcification of the patellar bursa (c).

^ Differential diagnosis of x-ray anatomical norm and symptoms of pathological conditions. The ossification core of the apex of the patella may be mistaken for a bone fragment. An indicator of the age norm of an x-ray image of the patella is the presence of clear end plates at the ossification nucleus and the uniform height of the clearing strip separating it from the main part of the patella.

The undulation of the contour of the anterior surface of the metaphysis of the tibia can simulate the manifestation of a destructive process. The presence of a continuous end plate, as well as the uniformity of the sizes of individual waves and the depressions between them, make it possible to distinguish the age-related norm of the contour from destruction.

The presence of several ossification points of the tibial tuberosity, unequal in size, can cause difficulties in terms of differential diagnosis with Osgood-Schlatter disease. The main differential diagnostic feature is the state of physiological clearing of the knee joint (rhomboid space). Normally, it has two narrow wedge-shaped protrusions - upper and lower. Pathological processes in the area of ​​the anterior surface of the proximal epimetaphysis of the tibia are always accompanied by shading of the lower protrusion of the rhomboid space. To illustrate this point, a radiograph of the knee joint of a child with calcifying bursitis of the deep bursa of the knee joint is shown (see Fig. 53, c). At the anterior surface of the epiphysis of the tibia, three structureless intense shadows of approximately oval shape with clear, even contours are visible. Their location corresponds to the location of the deep bursa of the knee joint. The lower projection of the diamond-shaped space is shaded. What distinguishes the ossification nuclei of a normally forming tuberosity from the areas of its fragmentation in Osgood-Schlatter disease is the presence of end plates in them.

^ AGE 12-14 YEARS

At this age, complete ossification of the tibial tuberosity occurs. Individual points of ossification, gradually merging with each other, form almost the entire cartilaginous model of the tuberosity, with the exception of a small area in the lower section. Cartilage tissue also remains for some time between the dorsal surface of the bony part of the tuberosity and the anterior surface of the metaphysis of the tibia.

^ X-ray anatomical picture. X-ray in lateral projection. The image of the patella, metaepiphyses of the femur and tibia and the head of the fibula corresponds to their image in adults (with the exception of the presence of clearing stripes of the metaepiphyseal growth zones and the display of the process of ossification of the tibial tuberosity). The ossified part of the tibial tuberosity has the shape of a relatively wide strip with a widened and rounded lower end. At the beginning of this age period, it is divided into several parts by transverse stripes of enlightenment (Fig. 54, a), later it represents a single whole (see Fig. 54, b). The lower end of the ossified part of the tuberosity is separated from the lower edge of the depression on the anterior surface of the body of the tibia by a relatively wide gap. A narrower gap separates the “proboscis” of the tuberosity from the anterior surface of the tibial metaphysis. The outline of the latter may be slightly wavy.

X-ray in posterior projection (see Fig. 54, c). The image of the knee joint is generally similar to that of adults. The exception is two details of the x-ray anatomical picture. The first of these is the above-mentioned presence of an image of the metaepiphyseal growth zones. The second detail is a relatively common wide transverse strip of low optical density against the background of the metaphysis of the tibia with a fairly clear upper contour and an unclear lower one. This structural feature is caused by the projection layering of the unossified part of the tuberosity (the gap between the lower end of the bony part of the tuberosity and the lower edge of the depression on the anterior surface of the metaphysis of the tibia - see Fig. 54, a and b).

The set of indicators of the anatomical structure of the knee joint available for analysis is identical to that in adults. An indicator of the correspondence of the local bone age to the passport age of the child is complete or almost complete ossification of the tibial tuberosity.

^ Differential diagnosis of x-ray anatomical norm and symptoms of pathological conditions. Transverse bands of lucency separating the ossified part of the tibial tuberosity may simulate a fracture or fragmentation of the tuberosity as a manifestation of Osgood-Schlatter disease. The differentiation of the age-related x-ray anatomical norm from both of these pathological conditions is based on the absence of shading of the lower protrusion of the rhomboid space, the presence of closing plates limiting the mentioned transverse stripes of enlightenment, and a smooth, rather than stepped, contour of the anterior surface of the ossified part of the tuberosity. For comparison, we present an x-ray of the knee joint of a child suffering from Osgood-Schlatter disease (see Fig. 54, d). The structure of the bony part of the tuberosity, as can be seen in the figure, is heterogeneous, its anterior contour is uneven, and the continuity of the end plate is broken. At the anterior surface of the tuberosity, an irregularly shaped bone fragment with uneven contours is visible. The overall contour of the anterior surface of the tuberosity (taking into account the described bone fragment) is stepped. The diamond-shaped space is shaded.

A transverse band of reduced optical density in the structure of the metaphysis of the tibia on a posterior X-ray may simulate pathological changes in the bone structure. To exclude an erroneous conclusion, the possibility of such a projection layering of the unossified part of the tibial tuberosity should be taken into account.

Rice. 54. X-rays of the knee joint in 2 projections. Age period 12-14 years (a, b, c); X-ray picture of Osgood-Schlatter disease (d).

^ AGE 15-17 YEARS

The age period of the final stage of postnatal formation of the bone components of the knee joint, namely, synostosis of the metaepiphyseal growth zones and the growth zone of the tibial tuberosity.

The normal x-ray anatomy of the knee joint differs from its x-ray anatomy in adults only in that in the initial stages of the synostosis process, sharply narrowed stripes of clearing of the growth zones can be traced, and after their complete closure, narrow horizontal stripes of sclerosis can be traced at the site of their former location.

All indicators of the anatomical structure of the knee joint described in the introductory part are available for x-ray anatomical analysis.

^ ANKLE AND FOOT

The ankle joint, as is known, is formed by the articular surfaces of the distal epiphyses of the tibia bones and the trochlea of ​​the talus. The distal epiphysis of the tibia has an approximately square shape with rounded edges; on its medial side there is a protrusion directed downwards - the medial malleolus. On the lateral side of the distal metaepiphysis of this bone there is a notch with a rough surface, to which the fibula is adjacent. Articular hyaline cartilage covers the distal concave surface of the epiphysis and the inner surface of the medial malleolus. The distal epiphysis of the fibula is called the lateral malleolus. On its inner side there is an articular surface that does not extend to the top of the ankle. The talus has a body, a neck and a head. The upper surface of the body of the talus in the frontal plane has the shape of a block with a weakly expressed depression in the center and two, also vaguely pronounced, shafts - medial and lateral. In the sagittal plane, the upper surface of the body of the talus is convex with a slightly flatter and shorter anterior slope and a steeper and longer posterior slope. The upper surface of the trochlea and the upper part of the lateral surfaces are covered with articular hyaline cartilage. The superior and medial articular surfaces articulate with the epiphysis and medial malleolus of the tibia, the lateral articular surface with the lateral malleolus. Thus, the joint space of the ankle joint in the frontal plane is U-shaped, and arcuate in the sagittal plane.

The skeleton of the foot is divided into three sections - the tarsus, metatarsus and phalanges. The tarsus, in turn, is divided into anterior and posterior sections. The posterior tarsus consists of two bones - the talus and calcaneus, located one above the other. The talus, in addition to the parts already noted (body, neck and head), also has two processes - lateral and posterior. In the latter, two tubercles are distinguished - medial and lateral. On the head of the talus there is a scaphoid articular surface, on the lower surface of the body there are calcaneal articular surfaces, separated by a groove of the tarsal sinus. The calcaneus has a body and a calcaneal tubercle. On the medial side of the body there is a rectangular bony protrusion - the support of the talus. On the upper surface of the body there are the anterior, middle and posterior talar articular surfaces and the groove of the sinus tarsus, on the anterior side of the body there is a cuboid articular surface. The anterior tarsus consists of 5 bones. The scaphoid bone has a relatively small thickness, its surface facing the head of the talus is concave, facing the sphenoid bones is convex. On the inferomedial surface of the scaphoid there is a fairly large tuberosity. The articular surfaces do not extend to the tuberosity of the scaphoid. The cuboid bone is shaped like its name. Articular hyaline cartilage covers three of its surfaces - the dorsal, with which it articulates with the calcaneus, the ventral, with which the IV and V metatarsals articulate, and the medial, with which the cluboid bone articulates with the lateral sphenoid bone. Ventral to the scaphoid bone there are three wedge-shaped bones - medial, intermediate and lateral, articulating on one side with the scaphoid bone, on the other - with the I, II and III mold bones.

X-rays of the ankle joint are performed in two standard (posterior and lateral) projections, and of the foot - in three projections: plantar, lateral and oblique. On radiographs of a fully formed ankle joint, the following radiological indicators of its anatomical structure are analyzed: shape, size, contours and structure of the distal epiphysis of the tibia, lateral malleolus and trochlea of ​​the talus; state of the x-ray joint space and anatomical relationships in the joint. The criterion for the correct anatomical relationships in the frontal plane is the uniform height of the x-ray joint space (its horizontal part) and the location at the same level of the lateral edge of the epiphysis of the tibia and the lateral edge of the trochlea of ​​the talus. In the sagittal plane, indicators of the correctness of the relationships are considered to be the uniform height of the X-ray joint space and the location at the same level of the centers of the articulating articular surfaces of the epiphysis of the tibia and the trochlea of ​​the talus. On radiographs of the foot after completion of its formation, the following indicators are used to assess the spatial position of the calcaneus and talus bones in the frontal and sagittal planes. In the sagittal plane, the position of the talus is characterized by the magnitude of the talo-tibia angle, formed when the longitudinal axes of these bones intersect. The standard values ​​for this angle are 90°. The spatial position of the heel bone (also in the sagittal plane) is characterized by the size of the calcaneal-plantar angle, formed at the intersection of two lines, one of which is drawn tangentially to the lower surface of the heel bone, the second connects the lower surface of the calcaneal tubercle and the lower surface of the head of the first metatarsal bone. The standard values ​​for this angle are 15-20°. In the frontal plane, an indicator of the normal spatial positions of these bones is the intersection of their longitudinal axes at an angle of 12-15° (calcaneal-talar angle). The size of the longitudinal arch of the foot is characterized by the size of the angle formed at the intersection of lines tangent to the lower surfaces of the heel and first metatarsal bones on a radiograph taken in a lateral projection. The normal indicator is considered to be the value of this angle in the range from 125° to 135°. In addition, when analyzing photographs of the foot, the shape, size, contours and structure of the bones of the foot skeleton, as well as the anatomical relationships in the tarsal, metatarsophalangeal and interphalangeal joints can be assessed. The criterion for the correctness of these relationships is the uniform height of the X-ray joint spaces, and for joints with unequal length of articular surfaces (talonavicular, metatarsophalangeal and interphalangeal joints) - the location of their centers at the same level, for flat joints - the location of the edges of the articular surfaces at the same level.

A presentation of age-related x-ray anatomy is given simultaneously for the ankle and foot.

^ AGE UP TO 9 MONTHS

The degree of ossification of the metaepiphyses of the bones of the leg and the skeleton of the foot differs little from what they had at the end of intrauterine development. The cartilaginous structure during this age period is preserved by: the epiphyses of the tibia bones and partly their metaphyses, a significant part of the calcaneus, talus and cuboid bones and the entire scaphoid, all the wedge-shaped bones of the tarsus and the epiphyses of the metatarsal bones and phalanges of the fingers.

^ X-ray anatomical picture. Ankle joint. X-ray in posterior projection. The lateral surfaces of the metaphysis of the tibia are moderately concave, the distal surface has a slightly pronounced saddle shape. The medial edge of the metaphysis is bent upward and slightly pointed. The lateral contour of the metaphysis of the fibula is rectilinear, the medial contour is concave. The edges of the metaphysis are rounded. The epiphyses of the lower leg bones are not visible on x-ray. The upper surface of the trochlea of ​​the talus is straight, the shafts of the trochlea and the groove between them are not pronounced. The metaphysis of the tibia and the trochlea of ​​the talus are separated by a wide gap, as are the lateral surfaces of the metaphyses of the tibia.

X-ray in lateral projection. All surfaces of the metaphysis of the tibia (including the distal) are moderately concave. The epiphyses of the tibia bones are not identified. The upper surface of the trochlea of ​​the talus is arched, the posterior edge of the trochlea is rounded, and the posterior process of the talus is not pronounced. Against the background of the lower part of the body of the talus, the lateral process is visible, the upper surface of the anterior part of the talus is rectilinear, its differentiation into a neck and head is not expressed.

Foot. X-ray in the plantar projection (Fig. 55). The rounded anterior ends of the calcaneus and talus and the cuboid bone, which has an irregularly oval shape, are visible. The remaining tarsal bones are not visible on the x-ray. The metatarsal bones and phalanges of the fingers are represented only by metadiaphyses.

X-ray in lateral projection. The shape of the ossified part of the calcaneus generally corresponds to the anatomical one. The rectangular shadow of the support of the talus is visible against the background of her upper body. The calcaneal tubercle is short, with a slightly convex dorsal contour. The cuboid bone is small in size, with convex dorsal and plantar surfaces and rounded corners. The remaining tarsal bones are not visible on x-ray. The structure of all bones is uniformly fine-celled, without signs of lines of force.

R is. 55. X-ray of a child’s foot at the age of 1 year.

^

When analyzing images, it is possible to evaluate the following indicators: the shape, contours and structure of the ossified parts of the distal metaphyses of the tibia, talus, calcaneus and cuboid bones, metadiaphyses of the metatarsal bones and phalanges of the fingers; anatomical relationships in the ankle joint in the frontal and sagittal planes. The criterion for the correctness of these relationships in the frontal plane due to the lack of an image of the epiphysis of the tibia and the uneven height of the X-ray joint space is the parallelism of the lines drawn tangentially to the distal surface of the metaphysis of the tibia and to the upper surface of the block of the talus, as well as the location at the same level of the lateral edges of the named surfaces. In the sagittal plane, an indicator of the norm of anatomical relationships in the ankle joint is the location of the centers of the metaphysis of the tibia and the trochlea of ​​the talus on one vertical straight line.

When assessing the spatial position of the talus and calcaneus in the frontal and sagittal planes, standard values ​​of the tibiotalar and calcaneal-talar angles, the same as in adults, are used. The magnitude of the calcaneal-plantar angle, due to incomplete ossification of the calcaneal tubercle and non-ossification of the head of the first metatarsal bone, differs from the norm in adults and is equal to 10-15°. The criterion for the correctness of the anatomical relationships in the subtalar joint in the sagittal plane is the projection overlap of the head of the talus on the body of the calcaneus by no more than 1/4 of its vertical size.

For the reasons mentioned above, the standard value of the angle of the longitudinal arch of the foot is greater than in adults and equals 130-137°. During this age period, it is impossible to assess the true shape, size and contours of the calcaneus, cuboid and talus, the condition of the remaining tarsal bones, the epiphyses of short tubular bones, the anatomical relationships in the joints of the anterior tarsus and the condition of the metaepiphyseal growth zones.

^ AGE FROM 1 YEAR TO 3 YEARS

This period corresponds to the age at which ossification of the epiphyses of the short tubular bones of the foot and the bones of the anterior tarsus begins. The timing of the appearance of the centers of ossification of the named anatomical formations is not as precise as the beginning of ossification of the carpal bones, and can only be named approximately. The first to appear, at the age of approximately 1 year, is the ossification nucleus of the distal epiphysis of the tibia. Then, at intervals of about a year, the center of ossification of the lateral sphenoid bone appears, and after a short period of time, approximately at the age of 2 1/2 years, the medial and intermediate sphenoid bones, the epiphyses of the metatarsal bones and phalanges, and the lateral malleolus begin to ossify. The order of appearance of the centers of ossification of the medial and intermediate sphenoid bones does not have a specific pattern. In most cases, the medial sphenoid bone begins to ossify first, but the simultaneous appearance of ossification centers of these bones and an earlier onset of ossification of the intermediate bone are possible. The lateral and intermediate sphenoid bones each have only one ossification nucleus; ossification of the medial sphenoid bone can occur from one, two or more centers. Ossification of the scaphoid begins at the age of 3-3 1/2 years and occurs most often from a single ossification center, although the presence of multiple centers is possible. The cartilaginous structure is preserved by the age of 3: about 1/3 of the volume of the epiphysis of the tibia, including the medial malleolus; about 1/2 the volume of the lateral malleolus; marginal parts of the talus, calcaneus (including the apophysis of the calcaneal tubercle) and cuboid bones; most of the bones of the anterior tarsus and the epiphyses of short tubular bones.

^ X-ray anatomical picture. Ankle joint on the radiograph in the posterior projection (Fig. 56, a). The image of the metaphyses of the leg bones is similar to that described in the previous section. The epiphysis of the tibia is shaped like a wedge with the base facing the medial side.

Its position relative to the metaphysis is eccentric due to the greater ossification of the medial section of the cartilaginous model. The lateral malleolus is rounded, located closer to the lateral edge of the metaphysis. The upper surface of the talus trochlea is flat with rounded edges. The X-ray joint space of the ankle joint is wide, wedge-shaped with the base of the wedge facing laterally. In the structure of the metaepiphyses of the tibia bones and the talus trochlea, systems of longitudinal lines of force are clearly visible.

Rice. 56. Radiographs of the ankle and foot. Age period 1-3 years (explanation in the text).

On a radiograph in a lateral projection (see Fig. 56, b), the epiphysis of the tibia has a rectangular shape with convex anterior and posterior contours. The lateral malleolus, as on the posterior radiograph, is round in shape. The X-ray joint space of the ankle joint is wide with a smaller height in the middle part and the greatest height at the anterior and posterior edges. The image of the talus and calcaneus is the same as in children of the previous age period, with the exception of a distinct functional design of the architectonics of the bone structure.

Foot. On a radiograph in the plantar projection, the image of the foot depends on the state of ossification of the bones of the anterior tarsus and the epiphyses of the short tubular bones. In children aged about 2 years, in addition to the bodies of short tubular bones, the cuboid and anterior sections of the calcaneus and talus, ossification nuclei of the lateral sphenoid bone, the distal epiphysis of the first metatarsal and proximal phalanges of the fingers are also detected (see Fig. 56, c). At a slightly older age (about 2 1/2 years), radiographs usually show ossification nuclei of all three sphenoid bones. The shape of the lateral sphenoid bone and cuboid by this time becomes similar to the anatomical one, the intermediate and medial sphenoid bones are round (see Fig. 56, d). In children 3-3 1/2 years old, the x-ray anatomical picture is characterized by significant polymorphism. Its possible options are presented in Fig. 57. On the first radiograph of a 3-year-old child (see Fig. 57, a) the size and shape of the cuboid and lateral sphenoid bones are close to anatomical. The ossification nuclei of the medial and intermediate sphenoid bones and the ossification point of the scaphoid are visible. Ossification of the medial sphenoid bone occurs from two nuclei of uneven size. This state of ossification of the bones of the anterior tarsus is the most natural for this age. On the second radiograph of a child of the same age (see Fig. 57, b) the images of the cuboid and lateral sphenoid bones are approximately the same as in Fig. 57, a. The medial sphenoid bone, which is formed from a single ossification nucleus, also has significant dimensions.

Rice. 57. Variants of ossification of the bones of the anterior tarsus in the age period of 1-3 years

(explanation in text).

At the same time, this child has not yet developed a center of ossification of the intermediate sphenoid bone and the epiphyses of the metatarsal bones, except I. On the last radiograph (see Fig. 57, c) of a child also 3 years old, the ossification nuclei of all bones of the anterior tarsus, heads II- IV metatarsal and distal epiphysis of the II and I metatarsals. A peculiarity of the x-ray anatomical picture is the disproportionately small size of the intermediate sphenoid bone in comparison with the size of the ossified part of the scaphoid bone.

Rice. 58. Multiple ossification points of the navicular and medial wedge-shaped bones of the foot (a); diagram of indicators of anatomical relationships in the joints of the anterior tarsus of an adult (b) and a child 3 1/2 years old (c).

On a lateral projection radiograph in 3-year-old children, all tarsal bones can be traced. Rice. 58, a illustrates the x-ray anatomical picture with a variant of ossification of the medial sphenoid and scaphoid bones from several centers of ossification. The scaphoid bone is represented by one large ossification nucleus and three small ones located at the dorsal surface of the cartilaginous model of the bone. At the base of the first metatarsal, four separate, partially overlapping ossification nuclei of the medial cuneiform bone are visible, surrounded by distinct endplates.

^ Radiological indicators of the anatomical structure of the ankle and foot, available for analysis. Ankle joint. The following indicators can be assessed: shape, size, contours and structure of the talus trochlea; anatomical relationships in the joint in the frontal and sagittal planes (the criteria for correct relationships in the joint are the same as for children of the previous age group). We would like to draw attention to the fact that the shape of the X-ray joint space cannot be used as an indicator of the anatomical relationships in the ankle joint in the frontal plane, since due to the age-related uniqueness of the shape of the ossified part of the epiphysis of the tibia, it is normally wedge-shaped.

The condition of the metaepiphyseal growth zones of the lower leg bones must also be assessed.

Foot. X-ray indicators of its anatomical structure, available for analysis, are different for different states of ossification of the bones of the anterior tarsus. Before the ossification point of the navicular bone appears, it is possible to assess the spatial position of the calcaneus and talus bones and the size of the longitudinal arch of the foot. The standard values ​​of the angles characterizing these indicators are identical to those given when describing the normal x-ray anatomy of children of the previous age group. In addition, it is possible to assess the shape, contours and structure of the ossified parts of the calcaneus, talus, cuboid and lateral sphenoid bones, the contours and structure of the ossification nuclei of the remaining sphenoid bones and the epiphyses of the short tubular bones of the foot; anatomical relationships in the subtalar, metatarsophalangeal and interphalangeal joints. The criteria for their correctness in the subtalar joint are the same as for children under the age of 1 year; in the last two groups of joints, the correctness of the anatomical relationships is indicated by the location of the centers of the ossified parts of the articulating epiphyses at the same level.

After the appearance of the ossification point of the scaphoid bone, in addition to the above, it also becomes possible to assess the anatomical relationships in the talonavicular joint in the frontal and sagittal planes and in the Lisfranc joint in the frontal plane. The criterion for their correctness in the first joint is the location on radiographs in both projections of the center of ossification (or ossification nucleus) of the scaphoid bone at the level of the center of the scaphoid surface of the head of the talus. The criterion for the correctness of the anatomical relationships in the scaphoid-sphenoid joint is the location on the radiograph in the plantar projection of the center of ossification of the scaphoid bone (or the center of its ossified part) at the level of the gap between the bony parts of the medial and intermediate sphenoid bones (see Fig. 58, c).

During this age period, it is impossible to assess the true size and contours of the distal epiphyses of the tibia bones and the short tubular bones of the foot, as well as the bones of the anterior tarsus.

An indicator of the correspondence of the local bone age to the passport age of the child in children 2 years old is the presence of an ossification nucleus of the lateral sphenoid bone, in children 3-3 1/2 years old - the presence of an ossification center of the scaphoid bone.

^ Differential diagnosis of x-ray anatomical norm and symptoms of pathological conditions. The ossification of the medial sphenoid and scaphoid bones from several centers of ossification deserves special attention, especially in the case when the radiograph shows one large ossification core, near the contour of which there are, as it were, several small fragments (see Fig. 58, a). With appropriate history, these imaging features may be mistaken for a bone fracture. An indicator of the x-ray anatomical norm for the image of these bones is the presence of end plates surrounding not only the large ossification core, but also small “fragments”.

^ AGE 5-6 YEARS

During this age period, almost complete ossification of the bones of the anterior tarsus occurs, the degree of ossification of the epiphyses of the tibia bones and the short tubular bones of the foot, as well as the calcaneus and talus, increases significantly. As follows from this characteristic, qualitatively new manifestations of enchondral bone formation are not observed during these periods, and the ossification of cartilaginous models of the epiphyses does not end. The basis for identifying this age period was the appearance of some features of the X-ray image of the foot on radiographs taken in the plantar and, to a lesser extent, lateral projections.

^ X-ray anatomical picture. On a radiograph of the foot in the plantar projection, the dimensions of the head and neck of the talus, the anterior part of the body of the calcaneus, cuboid, lateral and intermediate cuneiform bones, as well as their shape, generally correspond to the anatomical ones. The epiphyses of the metatarsal bones and phalanges of the fingers are almost completely ossified. In the structure of these bones, almost all of the systems of force lines characteristic of them can be traced. The possibility of different options for the normal x-ray image of the medial sphenoid and scaphoid bones, presented in Fig., deserves special attention. 59 and 60. In Fig. 59, and the most typical version of the x-ray anatomical norm is presented. Both the scaphoid and medial sphenoid bones have the appearance of a corresponding bone formation. Their shape is close to anatomical, the contours are smooth, the structure is homogeneous with the rudiments of its characteristic lines of force. In Fig. 59, b the medial sphenoid and scaphoid bones also look like single bone formations. At the same time, their contours are coarsely wavy in places (especially the talus surface of the scaphoid), the shape is irregular - the scaphoid, for example, has a wedge-shaped shape with a smaller height of its medial section. As already mentioned, ossification of these bones often occurs from several centers of ossification. It should be added that ossification of the scaphoid, even in the presence of a single center of ossification, may proceed unevenly. The different phases of fusion of individual ossification centers, as well as the difference in the rate of ossification of the medial and lateral parts of the scaphoid, determine both this and subsequent variants of the x-ray anatomical picture.

Rice. 59. Variants of the shape of the ossified part of the navicular and medial cuneiform bones of the foot on a radiograph in the plantar projection (explanation in the text).

Rice. 59, c and d are similar to each other in the image of the medial sphenoid bone. In both cases, it consists of two parts of unequal size, each surrounded by end plates and separated by a narrow uniform strip of lucency (the stage of incomplete fusion of two ossification nuclei of this bone).

Rice. 60. Variant of ossification of the navicular bone of the foot (a, b). X-ray picture of osteochondropathy of the navicular bone in the fragmentation stage (c).

The depiction of the scaphoid bone in these drawings is different. In Fig. 59, in the scaphoid bone has the appearance of a single bone formation, its contours are smooth, its structure is homogeneous, but its shape is irregular, not corresponding to the anatomical one, due to the significantly smaller longitudinal size of the medial part. In Fig. 59, d, the scaphoid bone also has the appearance of a single bone formation, also has a homogeneous structure and even contours and a shape that does not correspond to the anatomical one, but this discrepancy is of a different kind. It is determined by the presence of an angular protrusion on the anterior surface of the bone due to the faster rate of ossification of the middle part of the bone and the straightness of the contours. In Fig. 60, a and b, the scaphoid bone consists of three oval-shaped ossification nuclei that have not yet merged with each other with clearly defined end plates. The location of the middle ossification nucleus can serve as an explanation for the formation of what appears in Fig. 59, a bony protrusion on the anterior surface of the scaphoid. The image of the medial sphenoid bone in this case has no features.

The set of radiological indicators of the anatomical structure of the ankle joint and foot available for analysis is the same as in children of the previous age group.

^ Differential diagnosis of x-ray anatomical norm and manifestations of pathological conditions. Almost all of the above options for the age norm of x-ray images of the medial sphenoid and scaphoid bones can cause certain difficulties when analyzing the images. A strip of clearing separating the two unfused ossification nuclei of the medial sphenoid bone may suggest (with an appropriate history) the presence of a fracture. A distinctive feature of the x-ray anatomical norm is the continuity of the end plates delimiting each part of the bone and the uniform width of the clearing strip between them.

The peculiarity of the shape of the scaphoid bone, and even more so its display in the form of several independent bone parts (non-fused large ossification nuclei), can be mistakenly taken for signs of osteochondropathy. Differential diagnosis of incomplete fusion of the ossification nuclei of a normally forming scaphoid with the radiological picture of osteochondropathy in the fragmentation stage is based on the following radiological differences. As already noted, the ossification nuclei of the scaphoid bone (see Fig. 60, a and b) are of a regular oval or round shape, each of them is surrounded by a clearly defined, smooth closing plate and has a uniform fine-mesh structure. In contrast, osteochondropathy in the fragmentation stage (see Fig. 60, c) is characterized by the irregular shape of individual fragments, the absence of end plates in them with uneven contours and uneven bone structure with a predominance of areas of increased optical density.

^ AGE FROM 9 TO 14 YEARS

Age period of the fourth stage of postnatal formation of this part of the osteoarticular system, consisting V ossification of the apophyses of the tubular bones and tarsal bones. The apophyses that ossify at these ages due to independent ossification centers include: the medial malleolus (its apex), the medial tubercle of the posterior process of the talus, the apophysis of the calcaneal tubercle, the tuberosities of the scaphoid and V metatarsal bones. The onset of ossification of the named anatomical formations does not have a strictly defined age; their ossification centers can appear in the age range from 8 to 11 years. The first, at the age of 8 - 8 1/2 years, are 2-3 points of ossification of the apex of the medial malleolus. Somewhat later - at about 9 years - one ossification nucleus of the medial tubercle of the posterior process of the talus and one or two ossification nuclei of the apophysis of the calcaneal tubercle are revealed. The very last, at 10-11 years of age, are the tuberosities of the scaphoid and fifth metatarsal bones to begin to ossify. The apex of the lateral malleolus does not have an independent center of ossification. By the age of 14, the cartilaginous structure is preserved only by the metaepiphyseal growth zones of the bones of the leg and short tubular bones of the foot and the growth zones of the apophyses.

^ X-ray anatomical picture. Ankle joint. X-ray in posterior projection (Fig. 61, a). The dimensions and shape of the metaphyses of the leg bones correspond to the anatomical ones. The epiphysis of the tibia, with the exception of the medial malleolus, in shape, nature of the contours and architectonics of the bone structure corresponds to its image in adults. The medial malleolus in children 8-10 years old is relatively short; at its lower rectilinear contour, several small centers of ossification are visible first, and then a fairly large ossification nucleus of its apex. The dimensions, shape and architecture of the bone structure of the lateral malleolus correspond to the anatomical ones. The apex of the lateral malleolus, which is an extra-articular formation, does not have a separate center of ossification. In this regard, the presence of a separate bone fragment in this place, even if surrounded by an end plate, is an indisputable sign of a fracture (see Fig. 61, b). The presence of endplates around the bone fragment and on the distal surface of the lateral malleolus in the presented radiograph is explained by the fact that this is an old nonunion fracture. The lateral sections of the metaepiphyseal growth zones of the tibia and fibula in children 8-10 years old may have a wedge shape with the bases of the wedges facing outward. The degree of expansion of the marginal sections of the metaepiphyseal growth zones is the same; its edges, due to the discrepancy between the images of the anterior and posterior sections, can be two- or even multi-contour.

Rice. 61. Ossification nucleus of the medial malleolus (a); fracture of the lateral malleolus (b); X-ray of the ankle joint of a 13-year-old child (c).

The proximal surface of the talus has the shape of a weakly defined block. The X-ray joint space of the ankle joint has the same shape as in adults, its height is uniform throughout. By the end of the age period, i.e. in children 13-14 years old, the image of the ankle joint differs from its image in adults only in the presence of metaepiphyseal growth zones of the bones of the leg (see Fig. 61, c), which acquire a uniform height along their entire length .

X-ray in lateral projection. The shape and size of the distal metaphyses of the leg bones correspond to the anatomical ones. The anterior and posterior surfaces of the epiphysis of the tibia in children 9-9"/2 years old are convex, in older children they are straight, with slightly rounded distal edges. The articular surface of the epiphysis is concave, corresponding to the convexity of the talus block. The medial malleolus in children of this age is shortened, against the background of the talus block, the ossification points of the apex of the medial malleolus may be visible. At older ages, the image of the medial and lateral malleoli is the same as in adults. The anterior and posterior parts of the metaepiphyseal growth zone of the tibia are wedge-shaped expanded (with the bases of the wedges facing outward), the degree of expansion the marginal sections of the zone are the same.The right and left edges of the anterior section of the growth zone can be displayed separately.

The image of the talus and calcaneus in children aged before and after 9 years has a number of differences. In children under the age of 9-10 1/2 years (Fig. 62, a), the block of the talus has the shape of a hemisphere with the same length of its anterior and posterior slopes. The posterior edge of the trochlea is rounded, the posterior process of the talus is not pronounced. The lateral process of the talus has a rounded apex. The upper surface of the anterior section of the talus is straight, the transition of the neck to the head is not differentiated. The shape of the body of the calcaneus, in principle, corresponds to the anatomical one. The calcaneal tubercle is short, the contour of its posterior surface is coarsely wavy, the end plate is sclerotic.

In children over the age of 9-9 1/2 years, the shape of the talus corresponds to the anatomical one. A completely ossified lateral tubercle of the posterior process of the talus is revealed, projected on a radiograph taken with the correct placement and direction of the central beam of X-rays, below the contour of the posterior calcaneal surface and overlapping the body of the calcaneus. Somewhat higher and dorsal to it, the ossification nucleus of the medial tubercle can be traced. The lower edge of the ossification nucleus is located at the same level with the contour of the posterior calcaneal surface of the talus. Between the ossification core and the posterior surface of the block, a narrow, uniform strip of clearing is visible, limited by the closing plates (see Fig. 62, b). Under other centration conditions, the image of the lateral tubercle of the posterior process may be projectively deviated in the proximal direction (see Fig. 62, c). The guideline for differentiating the lateral and medial tubercles is the contour of the posterior calcaneal surface of the talus - the posterior lateral tubercle is located on its continuation. Under these conditions, the ossification nucleus of the medial posterior tubercle may project below the image of the lateral posterior tubercle. We focus the readers' attention on this variant of displaying the ossification nucleus of the medial tubercle because it is important for the differential diagnosis of the x-ray anatomical norm and apophysiolysis of this tubercle. If we are guided by the usual location of the posterior tubercles (medial above the lateral) and do not take into account the possibility of displaying them differently, then when analyzing the radiograph presented in Fig. 62, c, one may get the impression of the presence of apophysiolysis (based on the displacement of the ossification nucleus in the distal direction).

Fig. 62. Variants of the x-ray image of the ossification nucleus of the medial tubercle of the posterior process of the talus (explanation in the text).

A relatively rare version of the x-ray image of the ossification nucleus of the medial tubercle of the posterior process of the talus is shown in Fig. 62, g. The ossification nucleus is mostly projected against the background of the talus block in the form of a bone fragment of an irregularly oval shape, surrounded by a narrow uniform strip of low optical density. The shape of the calcaneus is generally the same as in children under 9-9 1/2 years of age. At the posterior surface of the calcaneal tubercle, one relatively massive ossification nucleus of its apophysis is initially traced, which, as a rule, has a central position (Fig. 63, a).

Rice. 63. Variants of X-ray imaging of ossification of the apophysis of the calcaneal tuber (a, b); ossification nucleus of the tuberosity of the fifth metatarsal bone (c).

Later, two or three more ossification nuclei of various shapes and thicknesses appear (see Fig. 62, b). Regardless of the number and size of the ossification nuclei of the apophysis of the calcaneal tuber, they all have clear, even contours and are located at the same distance from the dorsal surface of the calcaneal tuber. In children 13-14 years old, the apophysis of the calcaneal tuber is revealed on an x-ray along its entire length. With strongly pronounced waviness of the apophyseal growth zone, several contours of the posterior surface of the calcaneal tuber may be revealed, partially intersecting the image of the apophysis and creating a false impression of fragmentation of the latter (see Fig. 63, b).

Foot. Radiograph in plantar projection. The image of its constituent bones is identical to that of adults, with the exception of two features: the presence of metaepiphyseal growth zones of short tubular bones and the presence of an ossification nucleus of the tuberosity of the fifth metatarsal bone (see Fig. 63, c).

^ Radiological indicators of the anatomical structure of the ankle and foot, available for analysis. In children over 11 years of age, it is, in principle, possible to assess all the indicators listed in the introductory part of this section. In children 8-10 1/2 years old, the true shape, size and contours of the medial and lateral malleolus, posterior process of the talus, calcaneal tuber of the calcaneus and proximal end of the fifth metatarsal cannot be assessed.

^ Differential diagnosis of x-ray anatomical norm and symptoms of pathological conditions. Difficulties in image analysis may arise due to the uneven height of the distal metaepiphyseal growth zones of the leg bones. As is known, the wedge shape of the growth zone as a whole or of any part of it is one of the components of the radiological symptom complex of epiphysiolysis. The distinction between the age norm and the pathology of the shape of the named growth zones is based on the following radiological differences. Normally, the medial and lateral, as well as the anterior and posterior, marginal sections of both growth zones are expanded to the same extent and are limited by clear end plates. The adjacent edges of the metaphysis and epiphysis in children of this age group are located at the same level. In cases of traumatic osteoepiphysiolysis (Fig. 64, a and b - x-ray picture of osteoepiphysiolysis of the distal epiphysis of the tibia, Fig. 64, c - x-ray picture of traumatic epiphysis of the distal epiphysis of the fibula), a pronounced uneven expansion of one of the marginal sections of the metaepiphyseal growth zone (anterior and medial in Fig. 64, a and b, lateral - in Fig. 64, c). The contours of the growth zone at the level of this excessive expansion are uneven, jagged, and there are no end plates. The location of the adjacent edges of the metaphysis and epiphysis at different levels is also noted.

X-ray imaging of the process of ossification of the calcaneal tuber can present certain difficulties in deciding the presence or absence of osteochondropathy of the apophysis of the calcaneal tuber (Schinz's disease). Normally, as noted above, the ossification nuclei of the apophysis of the calcaneal tuber have a homogeneous structure, smooth contours and are located at the same distance from the posterior surface of the calcaneal tuber. Violation of these patterns (all, any two, or only at least one) is a sign of the pathological state of the apophysis (see Fig. 62, b, the apophysis of the calcaneal tuber consists of three parts of different thickness and length, the upper part is apophyseal, visible on the radiograph the growth zone is wedge-shaped expanded). The ossification nucleus of the medial tubercle of the posterior process of the talus and the tuberosity of the fifth metatarsal can also cause difficulties in image interpretation. The indication for differential diagnosis is, firstly, to exclude a fracture of the fully formed named anatomical formations, and secondly, to resolve the issue of the presence or absence of traumatic apophysiolysis.

Rice. 64. X-ray picture of osteoepiphysiolysis of the distal epiphysis of the tibia (a, b) and the distal epiphysis of the fibula (c).

The difference in the radiological picture of normally forming apophyses and avulsion fractures and osteoapophysiolysis was presented in Chapter. 1. In this section we provide an illustration of these differences using specific examples. In Fig. 65, and a radiograph is presented in the lateral projection of the child’s foot with traumatic apophysiolysis of the medial posterior tubercle of the talus. It is clearly visible that the apophyseal growth zone of this tubercle has a wedge-shaped shape, its edges are uneven, the ossification nucleus is shifted upward - its lower edge is located significantly higher than the posterior edge of the calcaneal surface of the talus.

Rice. 65. X-ray picture of anophyseolysis of the medial tubercle of the posterior process of the talus (a) and the tuberosity of the fifth metatarsal (b).

Rice. 63, c and 65, b illustrate the differences in the X-ray picture of the normally forming tuberosity of the fifth metatarsal bone and its traumatic apophysiolysis. In Fig. 63, the apophyseal growth zone has a uniform width; although its contours are tortuous, they have clear end plates. In Fig. 65, b the apophyseal growth zone has a wedge-shaped shape, the integrity of the end plate of the base of the ossification nucleus of the tuberosity is broken, the ossification nucleus itself is displaced in the dorsal direction (the dorsal edge of its base is located dorsal to the edge of the growth zone of the same name on the surface of the metatarsal bone).

^ AGE 15-17 YEARS

The age period of the final stage of postnatal formation of the ankle joint and foot, namely, synostosis of the metaepiphyseal and apophyseal growth zones. The X-ray image of the ankle joint and foot differs from the image in adults only in the presence initially of narrowed growth zones, and then in the presence of stripes of sclerosis at the site of their former location. It is possible to analyze the entire complex of indicators of the anatomical structure of a given section of the osteoarticular system.

CONCLUSION

When describing the features of the normal x-ray anatomy of the osteoarticular system of children of different ages, place was also given to the differential diagnosis of normal x-ray anatomical details with manifestations of pathological conditions. It was presented, however, strictly in relation to the specific features of x-ray images of various joints and parts of the spine and to a certain period of their formation. Due to the great importance for the correct diagnosis of diseases and injuries of bones and joints of a reliable distinction between normal and pathological, we considered it appropriate to complete the book with a brief summary of a number of general provisions of the relevant differential diagnosis. In accordance with the task of presenting general provisions, this section examines only those features of the X-ray image of a normally developing osteoarticular system that are typical for all or almost all of its parts and, in addition, have a certain similarity with the manifestations of pathological processes or the consequences of traumatic influences . The analyzed features of the x-ray anatomical norm are discussed in the order of the sequence of their appearance on x-rays.

^ Absence of images of the epiphyses of tubular bones on the radiograph. In the previous sections of the book, it was noted that in children of the first year of life, the epiphyses of the tubular bones are still formed by cartilaginous tissue that does not have natural x-ray contrast, and therefore the absence of their image on the x-ray is the age-related x-ray-anatomical norm. The regularity of this feature of the x-ray anatomical picture for the named age period does not constitute a reason for an unconditional refusal to resolve the issue of the presence or absence of dysplastic or destructive processes in a child in a particular joint.

Establishing the presence of a destructive process, the cause of which is most often hematogenous osteomyelitis of metaepiphyseal localization typical for this age, is to some extent facilitated by a fairly pronounced characteristic clinical picture. The same applies to a certain extent to destructive tumor processes. Diagnosis of dysplastic changes, such as aplasia, and even more so hypoplasia of the epiphyses, due to the relative paucity of clinical manifestations, which often consist of only a slight shortening of the limb and sometimes a limitation of the motor function of the joint, is very difficult.

The most complete and reliable information about the state of cartilaginous models of the epiphyses is provided by artificial contrast contrast of the joint cavity, however, some indirect and sometimes direct signs of the presence of a pathological process can also be obtained based on the analysis of conventional radiographs, especially since artificial contrast contrast in children under the age of one year is associated with great difficulties.

As is known, a constant component of the radiological symptom complex of acute and subacute osteomyelitis is pronounced, visually detectable osteoporosis. Differences in the optical density of the image of paired bones of the limbs are normally not observed. Further, although the inflammatory process is localized mainly in the metaepiphysis, the x-ray usually reveals linear, fringed or multilayer periostitis. There are no normal age-related features of bone contours that even remotely resemble periostitis.

With hypoplasia, and even more so with aplasia of the epiphysis, the latter has reduced dimensions compared to the age-specific individual norm, including the vertical one. A decrease in this latter size can be detected using comparative x-ray measurements of the distance between the surfaces of the ossified part of the bones facing each other, forming the right and left elbow, hip, knee and ankle joints. Normally, this distance in paired joints always has the same value (due to the synchronicity of the increase in the size of their epiphyses). Based on this, a decrease in the said distance in one of the joints can be considered as a sign of growth retardation of one or both of the epiphyses that form it or, in other words, as a sign of the presence of hypoplasia or aplasia (depending on the degree of decrease in the distance). Of course, this diagnosis can only be made if the x-ray does not show the above-mentioned signs of the inflammatory process, which often leads to greater or lesser destruction of the epiphyses and, accordingly, to a decrease in their height. It should also be taken into account that a decrease in the distance between the proximal surface of the metaphysis of the femur and the bony part of the roof of the acetabulum in one of the hip joints is a sign of not only hypoplasia or aplasia of the femoral head, but also congenital hip dislocation. Differential diagnosis of these two pathological conditions is based on the presence or absence of other permanent signs of congenital dislocation of the hip, in particular, the bevel of the roof of the acetabulum (if the visual assessment of the position of the roof is in doubt, then the issue can be resolved based on measuring the angle of its inclination relative to the line connecting V-shaped cartilages. Normally, its value does not exceed 25-27°).

It is possible to diagnose a decrease in the height and head of the humerus, although in this case the technique described above cannot be used. A sign of this decrease is a displacement in the cranial direction of the medial angle of the metaphysis of the humerus from its normal position at the level of the lower edge of the glenoid fossa of the scapula. There is no need for differential diagnosis with dislocation in this joint, since due to the presence of bone and soft tissue limiters (the processes of the scapula, the ligament stretched between them and the acromial end of the clavicle) upward displacement of the head of the humerus is impossible without their destruction.

Thus, only the underdevelopment of the distal epiphyses of the forearm bones and the short tubular bones of the hand and foot remains inaccessible for diagnosis.

^ Age-related features of the shape of the epiphyses of long tubular bones. The peculiarity of the shape of the ossified part of various epiphyses visible on the radiograph, characteristic of different stages of their formation, was described in detail in the main sections of the book, so we only briefly recall its essence. A general pattern of X-ray images of the epiphyses of long tubular bones before the process of their ossification is completed is the anatomical discrepancy not only of their size, but also of their shape. This is due to unequal rates of ossification of different parts of the same epiphysis and represents a normal feature of the x-ray anatomy of the osteoarticular system of children aged 1 to 8 years, i.e., during the period from the beginning to complete ossification of cartilaginous models. The physiological condition of the discrepancy between the radiological form and the anatomical one does not exclude another, pathological, genesis. In other words, it does not exclude the possibility that it may represent a manifestation of pathological conditions - congenital or acquired, local or systemic disruption of the processes of ossification, deformation or destruction of cartilaginous models of the epiphyses. This circumstance may confront the doctor with the need for differential diagnosis of normal and pathological conditions. A decisive role in solving this issue also belongs to artificial contrasting of the joint cavity, which makes it possible to reliably assess the shape, size and contours of the cartilaginous model of the epiphyses. However, for the use of this method of x-ray examination there are not always sufficient clinical indications or necessary conditions, so we want to draw attention to those supporting points of x-ray diagnostics that can be obtained by analyzing ordinary x-rays.

The undeniable significance for correct differential diagnosis of a good knowledge of the normal x-ray anatomy of the osteoarticular system at various stages of enchondral bone formation hardly needs to be proven. Nevertheless, due to the rather significant variability in the age-related periods of normal changes in the shape of the X-ray image of the epiphyses, this knowledge alone is sometimes not enough, and there is a need to use additional techniques for the differential diagnosis of normality and pathology. The simplest technique is to compare the shape (and size) of the epiphyses that form the paired joints of the limbs. Normally, with the exception of very rare cases, it is the same, so identifying differences can serve as a fairly reliable indication of the presence of pathology (in a joint with smaller epiphyses or one epiphysis and a discrepancy between their shape and the average age norm). The diagnostic value of this technique is generally limited. Firstly, it is not applicable for identifying systemic disorders of osteogenesis due to the lack of standards for comparison, and secondly, its use only allows us to state the presence of a deviation from the norm without solving the clinically important question of what exactly this deviation is caused by - a violation of only the processes of ossification or true deformation , i.e., deformation of the entire cartilaginous model of the epiphysis. Much more informative in this regard, although somewhat more complex, is comparative radiometry of intermetaphyseal distances in paired joints, i.e., the distances between the surfaces of the metaphyses of the articulating bones facing each other (in the hip joint - between the proximal metaepiphyseal growth zone of the femur and the roof of the acetabulum). It is advisable to measure them to identify asymmetrical deformations in two places, namely at both edges of the metaphyses. The same value of the intermetaphyseal distance in a joint with an altered shape of the epiphysis, as in its paired healthy one, is a reliable sign of the absence of true deformation, in other words, a violation of only the processes of ossification. When the entire cartilaginous model is deformed, the altered shape of the epiphysis is necessarily combined with a decrease in this distance (one or both, depending on the type of deformation).

Comparative X-ray measurements of three values ​​in the knee joint - the height of the bony part of each of the epiphyses forming it and the intermetaphyseal distance - can also help in diagnosing mild forms of systemic disorders of ossification of the epiphyses, such as pseudoachondroplasia, point dysplasia of the epiphyses, etc. However, diagnosis using This technique is only possible in children aged 1 to 3 years, but this is precisely the period when the diagnosis of these diseases is most difficult. We are talking about mildly expressed forms for the reason that the diagnosis of severe ones, manifested by such radiological signs as the absence of images of the epiphyses in children 2-3 years old or the presence of uneven “pointed” ossification, does not require the use of any special techniques. It has been established that the normal height of each epiphyses of the knee joint in children under 3 years of age is equal to 1/3 of the intermetaphyseal distance (see Chapter 3, X-ray anatomy of the knee joint). A smaller height of one or both epiphyses indicates a delay in ossification, that is, a disruption of the normal course of this process. Identification of signs of such a disorder in both knee joints, even if they have different severity, is a fairly strong argument in favor of systemic damage, since with local ossification disorders such symmetry is practically not observed.

^ Features of the shape of x-ray joint spaces of the joints of the limbs. When applied to X-ray images of joints in children under the age of 8 years, i.e., before the age of completion of ossification of cartilaginous models of the epiphyses, the term “X-ray joint space” is largely arbitrary. Its anatomical substrate, in contrast to adults, in addition to the joint space itself and the integumentary hyaline cartilage, also consists of parts of the articulating epiphyses that are not ossified and therefore invisible on x-rays. Due to the above-mentioned unequal rate of ossification of different parts of the same epiphysis, X-ray joint spaces have not only a greater height than on radiographs of adults, but also an irregular, most often wedge-shaped, shape. This circumstance significantly complicates the decision on the preservation or disruption of normal anatomical relationships in the joint, since a commonly used sign of the correctness of the relationships is the uniform height of the X-ray joint space, and the appearance of wedge-shape is considered a sign of subluxation. The age-related periods of complete ossification of the cartilaginous models of the epiphyses, after which the X-ray joint spaces acquire the shape characteristic of them in adults, are subject to individual fluctuations, which does not allow us to determine with absolute accuracy the period when the above criteria for assessing the anatomical relationships in the joints become reliable. In connection with these circumstances, the only reliable means of eliminating diagnostic errors is to use, to assess the anatomical relationships in the joints of the extremities in children under 10 years of age, not generally accepted criteria, but those developed in relation to the features of x-ray images of the joints of the extremities during the period of incomplete ossification of the epiphyses of tubular bones. A description of the criteria for normal and pathological anatomical relationships specific to different joints of the extremities was given in Chapters 2 and 3.

^ Age-related peculiarities of bone contours. One of the types of this originality, which, from our point of view, deserves the greatest attention, is the relatively small waviness of the contours of individual sections of bones, revealed on radiographs of children aged 8-12 years. It is explained by an increase in the tuberosity of the surfaces of the growth zones before the onset of ossification of the apophyses. After the appearance of ossification nuclei, the severity of the waviness of the contour gradually decreases and then disappears completely. Due to the atypical nature of bone contours in adults and the short duration of its existence, this waviness may cause an erroneous diagnosis of the presence of a destructive process. This originality of contours is most clearly manifested at the end of the acromial process of the scapula, the inferolateral surface of the iliac crest, the symphyseal surface of the pubis and on the cranial surface of the vertebral bodies. The difference between this age-related feature of contours and manifestations of destruction is the following. Normally, all “waves” have the same height and length of the bases and smoothly rounded tops. The spaces between them also have the same width. For destructive processes, such orderliness of the contours of the bones is not typical; they are “eaten away”, with protrusions and depressions of irregular shape and sharp peaks.

The remaining features of the image of the osteoarticular system are of a more specific nature, and their differential diagnosis with symptoms of diseases and injuries was given in the main chapters of the book.

^ REFERENCES

Dyachenko V. L. X-ray osteology: norm and variants of the skeletal system in x-ray images. M., 1954.

Kosinskaya N. S. Development of the foot and ankle skeleton: X-ray anatomical studies // Vestn. rentgenol. and radiol. - 1958. - No. 1. - P. 27-36.

Lagunova I. G. X-ray anatomy of the skeleton. - M.: Medicine, 1981.

Maykova-Strogonova V. S., Rokhlin D. G. Bones and joints in x-ray images. - T. 1, 2. - M.: Medgiz, 1957.

Fedorov I. I. Processes of ossification of the pelvis in an x-ray image: Author's abstract. dis. Ph.D. honey. Sci. - 1955.

Fortushnov D. I. Some data on the development of the structure of the spongy substance of human vertebrae // Proceedings of the department. norms, anatomy of the Saratov State. honey. in-ta. - Vol. 1. - Saratov, 1955. - P. 88-93.

Yukhnova O. M., Durov M. F., Yadryshnikova L.#., Getman L.K. Age-related features of the spine and spinal cord in children and adolescents // Orthopedist. and traumatol. - 1982. - No. 8. - P. 72-75.

Dawson£., Smith L. Atlanto-axion subluxation in children due to vertebral anomalies//J. bone a joint surg. - 1979. - Vol. 61 A. - P. 4-10.

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Preface

Chapter 1. Anatomical and x-ray characteristics of the stages of postnatal enchondral bone formation

Anatomical and X-ray anatomical general characteristics of the stages of postnatal formation of the osteoarticular system

^ Chapter 2. X-ray anatomy of the spinal column

Cervical spine

Thoracic and lumbar spine

Sacral spine

^ Chapter 3. Normal x-ray anatomy of the shoulder girdle and upper limb

Shoulder girdle and shoulder joint

Elbow joint

Wrist and hand

^ Chapter 4. Normal x-ray anatomy of the pelvic girdle and lower limb

Pelvic girdle and hip joint

Knee-joint

Ankle and foot

Conclusion

List of basic literature

Vera Ilyinichna Sadofeva

^ NORMAL X-RAY ANATOMY OF THE OSTEO-ARTICULAR SYSTEM OF CHILDREN

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Leningrad branch. 191104, Leningrad, st. Nekrasova, 10.

Printing house named after Kotlyakov Publishing House "Finance and Statistics"

USSR State Committee for Press.

195273, Leningrad, st. Rustaveli, 13.

The bones of the human skeleton provide reliable support for the entire body and protection for vital internal organs. It is the bones and muscles that enable the human body to move. Muscles have the ability to contract, which, in fact, sets the human body in motion. Thus, the human musculoskeletal system includes:

• skeletal bones;
• joints that connect individual bones of the skeleton to each other (the largest are the hip and knee joints);
• muscles.

Human bones are constantly growing and changing. A newborn baby has about 350 bones. As the baby grows, some bones fuse together, so in an adult, their number is 206. The human skeleton is finally formed by the age of thirty, and in women this process ends earlier than in men.

Anatomy and physiology of joints of the human skeleton

As mentioned above, the articulations of the bones of the skeleton are called joints. Some of them are immobile (skull bones), others are almost immobile (cartilaginous joints of the spine), but most are mobile and provide various motor functions (flexion, extension, abduction, etc.). Movable joints are called synovial joints. This name is due to the anatomical structure of the joint, which is a unique complex that includes the following composition:

• joint capsule;
• articular surfaces;
• articular cavity;
• articular discs;
• menisci;
• articular lips.

The joint capsule is a complex combination of collagen and elastin fibers and connective tissue. Together, these fabrics form a kind of filter, which has a huge number of different functions. The joint capsule is penetrated by a complex network of blood vessels and nerve endings that provide nutrition to the joint, its blood supply and signaling function, that is, they send information about its position to the brain.

Articular surfaces are the smooth surfaces of bones that make connections. The ends of the bones are covered with a thin layer of cartilage tissue and a special lubricant that reduces mechanical friction between the bones.

Movement in a joint directly depends on its shape. There is a certain classification, according to which it is customary to distinguish the following types of joints:

• cylindrical (connecting the first two cervical vertebrae);
• flat (connects the tarsal bones of the foot and the carpal bones of the human hand);
• saddle (thumb);
• ellipsoid (connects the radius to the wrist);
• spherical (shoulder and hip joint);
• hinged (knee joint, elbow joint and finger joints).

The joint cavity is a closed and completely sealed slit-like space that does not communicate with the environment. It is the joint cavity that contains the synovial membrane and synovial fluid. What it is? The synovial membrane is the inner layer of the joint capsule, which lines the entire cavity of the joint, excluding its cartilaginous areas. The main function of the synovial membrane is protective; it is this structure that prevents friction and promotes shock absorption. Ensuring the protective function of the synovial membrane is possible due to the fact that it is able to secrete a special lubricant, which is called synovial fluid.

Synovial fluid is a special substance that has a complex molecular structure and chemical composition. Without going into details, we note that synovial fluid is blood plasma and a protein-polysaccharide component that provides the viscosity and elasticity of this substance. The main function of the synovium is to reduce friction when loading the joints and ensure optimal sliding of the articular cartilage. Among other things, synovial fluid provides nutrition to the joint and prevents wear and tear.

Articular discs are biconcave plates that are located between the articular surfaces of some joints and divide it into two cavities. They perform a shock-absorbing function and ensure the elimination of inconsistencies between articular surfaces. The same function is performed by menisci - a kind of cartilage pads. The shape of the menisci depends on the shape of the ends of the bones. Another auxiliary formation of the joint is the articular labrum. This formation is ring-shaped fibrous cartilage. This formation occurs only in the hip and shoulder joints.

The knee joint contains another important structural unit - muscles. Under the influence of nerve impulses, the muscles of the knee joint contract, which ensures a person’s motor function, that is, allows him to walk. The knee joint has flexor and extensor muscles. Flexion occurs thanks to the muscles located on the back of the thigh and the knee joint. Extension is possible thanks to the quadriceps muscle and the patella, which is an additional fulcrum.

Human joints can be simple (2 bones) or complex (more than 2 bones). The largest joints in the human skeleton are the hip and knee joints. The latter has a rather complex anatomical structure, and therefore deserves special attention.

Features of the anatomical structure of the knee

In order to understand the cause of various pathological conditions of the knee, it is worth understanding its anatomical and functional features. The knee joint is the most complex joint in its structure. This is a prime example of a complex block joint. The knee joint is formed at the junction of the distal femur and the tibia. Part of the joint is the patella (or kneecap), which performs a protective function and prevents mechanical damage.

There is some discrepancy between the articular surfaces of the femur and tibia, so the menisci, which are triangular cartilage plates that compensate for the discrepancy between the tibia and femur, come to the aid of the knee joint. The knee joints have two menisci: the outer (lateral) and the inner (medial). They help to evenly distribute pressure when the joint is loaded. The outer edge of both menisci almost completely follows the shape of the tibial condyles. The menisci are attached to the joint capsule in a special way, with the inner meniscus attached more tightly and therefore being less flexible and mobile than the outer meniscus. The medial meniscus tends to move backward when the knee flexes. The outer meniscus is more mobile, which explains the fact that a tear of the lateral meniscus is much less common than a similar injury to the medial meniscus.

The structure and shape of the joint is distinguished by the presence of several synovial bursae (bursae), which are located along the tendons and muscles.

The main bursae are located in front of the patella. The largest and most significant synovial bursae are suprapatellar and infrapatellar. Other bursae are smaller, but no less significant. Synovial bursae produce synovial fluid, which reduces friction in the joint and prevents wear and tear.

Here are the basic theoretical knowledge that every patient should have.

Functional load on the joint

The lower extremities of humans are the undisputed leaders in the number of injuries and pathological changes, and there is an explanation for this. The hip and knee joints are the largest for a reason. It is these joints that bear the greatest load when walking and moving, and it is the knee that bears the entire weight of the human body.

The knee joint is hinged and has complex biomechanics, that is, it provides a fairly large number of diverse movements (including the knee joint can produce circular rotational movements, which is not typical for most joints of the human skeleton).

The main functions of the knee joint are flexion, extension and providing support. Bones, ligaments and cartilage work as one coherent mechanism and provide optimal mobility and shock absorption to the joint.

Orthopedics as a branch of clinical medicine

Orthopedics studies the etiology and pathogenesis of various disorders and dysfunctions of the musculoskeletal system. Such disorders can be the result of congenital pathology or intrauterine developmental defects, injuries and various diseases. In addition, orthopedics studies methods for diagnosing and treating various pathological conditions of the musculoskeletal system.

There are several sections of orthopedics:

1. Outpatient orthopedics. The most significant section, since most patients of orthopedic doctors are treated in an outpatient clinic or day hospital.
2. Children's and adolescent orthopedics. The musculoskeletal system of children and adolescents has certain physiological and anatomical features. The goal of pediatric and adolescent orthopedics is the prevention and timely elimination of congenital pathologies. Among the methods it is customary to distinguish conservative therapy and surgical interventions.
3. Surgery. This area of ​​orthopedics deals with the surgical correction of various pathologies.
4. Endoprosthetics or replacement of damaged joints and their parts with implants.
5. Sports orthopedics and traumatology.

Among the diagnostic methods in orthopedics, imaging methods such as radiography, magnetic resonance imaging, ultrasound examination of joints and underlying tissues, computed tomography, as well as podography, stabilometry, densitometry and optical tomography are used.

Laboratory and clinical tests are also widely used, which help to identify the presence of pathogenic microflora, changes in the chemical composition of synovial fluid and establish the correct differential diagnosis.

Cause of knee pain: the most common pathologies

Knee pain is a consequence of mechanical damage or injury that occurs due to severe overload. What are the symptoms and what should make the patient wary?

The main sign of pathological changes in the knee joint is pain and inflammation. The intensity of pain and its localization depends on the etiology of the pathological condition and the degree of damage to the knee joint. The pain may be constant or intermittent, or occur during certain activities. Another diagnostic sign of the lesion is a violation of movement in the knee joint (its limitation). When trying to bend or straighten the knee, when walking or leaning on the affected limb, the patient experiences discomfort and pain.

Effusion in the knee joint: etiology, pathogenesis and clinical picture

Among the most common diseases of the knee is a pathological accumulation of synovial fluid or effusion in the cavity of the knee joint. The main sign of fluid accumulation is swelling, increase in volume, limited joint mobility and pain when moving. Such changes are visible to the naked eye and the diagnosis is beyond doubt (see photo). If you notice such changes, you should immediately seek medical help. Timely differential diagnosis and accurate determination of the cause of synovial fluid accumulation is the key to successful treatment.

There can be many reasons for this condition, but most often knee effusion is formed as a result of injuries or various general diseases. The human body produces effusion as a response to aggressive external influences. Thus, the cause of pathological accumulation of fluid can be a fracture, rupture of tendons or menisci, severe dislocation or hemorrhage. The most dangerous are injuries in which pathogenic microflora enters directly into the joint cavity and purulent inflammation occurs. Synovial fluid is a favorable environment for the active reproduction of various bacteria. This condition is considered dangerous and requires immediate medical intervention. Also, effusion can be a consequence of various diseases, most often infectious (tuberculosis, chlamydia, syphilis, streptococcus, etc.).

To diagnose the disease and select adequate therapy, the cause of its occurrence should be determined. The most reliable diagnostic method is laboratory testing of synovial fluid, which changes its composition and consistency.

Bursitis, or inflammation of the bursae

Bursitis is an inflammation of the synovial bursae. Quite often, practicing doctors in sports orthopedics and traumatology encounter this pathology. Constant microtraumas and excessive loads are the cause of this pathology in people involved in sports (especially strength sports). Moreover, often, ignoring the recommendations of orthopedic doctors to take care of the damaged knee joint, athletes continue intense training, which only worsens the current situation.

Bursitis is often referred to as housewives' knee joint. From kneeling for a long time while washing floors, inflammation occurs in the synovial patellar bursa. Another fairly common form of this disease is pes anserine bursitis or popliteal bursitis. The pes anserine is where certain tendons connect on the inside of the knee joint. The bursa is located under the exit of these tendons and can become inflamed under certain stress or injury.

With bursitis, the knee joint is painful on palpation, swelling and redness, deterioration of general condition, local hyperthermia and a general increase in body temperature may occur. There may be slight stiffness or decreased range of motion in the knee joint.

Bursitis develops as a result of injuries and mechanical damage or infection of the bursa. Even a minor injury or shallow cut can cause the disease.

The medical prognosis depends on the degree of advanced disease, its ability to spread, and the patient’s immune status.

Meniscal injuries

About half of all knee injuries are meniscal injuries. The anatomical structure of the knee joint, as mentioned above, creates favorable conditions for various traumatic conditions, and trauma to the medial (internal) meniscus of the knee joint is 4-7 times more likely. This pathology is called meniscopathy and is a degenerative-destructive pathology.

The cause of meniscopathy of the knee joint is acute and chronic injuries, which are often an occupational disease of athletes. Acute injury is most often accompanied by a phenomenon such as a block of the knee joint or a block symptom. What it is? Immediately after the initial injury, the patient experiences severe pain in the joint and a sharp limitation of its mobility. It seems that the patient's lower leg is fixed in a flexed position, and there is a feeling of jamming.

Damage to the meniscus can cause effusion and swelling. In a later period, the pain becomes strictly localized directly along the line of the joint space. Differential diagnosis with bruise or sprain is necessary. If the diagnosis is made incorrectly, then with repeated injury the disease enters the chronic stage, which is characterized by severe pain, severe limitation of movement in the joint and various inflammatory-trophic disorders. In this case, conservative therapy may be ineffective, and the patient is indicated for surgical intervention.

Some pathologies of the knee joint are found only in pediatric practice in adolescent children (from 10 to 15 years). The most striking example is Osgood-Schlatter disease. The most consistent diagnostic sign of this pathology is the appearance of a peculiar lump, which is located on the knee joint, just below the kneecap. At first, the course of the disease is sluggish, but later the pain constantly intensifies, the patient’s movements become constrained, and the affected knee joint increases in volume.

The disease occurs as a result of aseptic destruction of the nucleus and tuberosity of the tibia. As a rule, the disease is asymmetrical and affects only one knee joint. The cause of this pathology is a violation due to various reasons of blood circulation in the knee joint. The disease has a long course (from several weeks to several months); the knee joint is fully restored only after the formation of the skeleton is completed (at about 30 years of age).

This is not a complete list of reasons that can cause pain in the knee joint. This review does not indicate methods of treatment for various diseases of the knee joint, since self-medication is the cause of quite serious complications. Affected knee joints love the cold! If you have any symptoms of knee damage, the only thing you can do is apply ice to the sore knee. This helps reduce pain and relieve swelling. You can apply ice every 3-4 hours for 10-15 minutes, and then you should seek medical help as soon as possible. An experienced specialist, having examined the patient’s knee joint, can make a preliminary diagnosis and prescribe adequate treatment.

A large risk group for diseases of the knee joints are athletes and women in menopause. If you are overweight, have a sedentary lifestyle, or have certain hormonal or metabolic disorders, you may not feel completely safe.

Proper nutrition, a healthy lifestyle and moderate exercise help prevent. You should not endure pain in the knee joint, but you also do not need to take painkillers without a doctor’s prescription.

The human skeleton has a complex structure. Each element performs a specific function, being responsible for normal life activity. Thus, the knee area, which includes bone tissue, ligaments, nerves, and joints, is responsible for the mobility of the limbs. Damage to at least one component can cause limited movement or complete immobility. Therefore, it is so important to know the anatomy of the knee joint and ligaments in order to be able to recognize the signs of an impending disease and begin treatment in time.

Knee elements

The main components of the knee:

1. large bones with muscles that form the entire structure of the knee area;
2. menisci, thanks to which the joint moves;
3. nerves and blood vessels are responsible for sensitivity and response to various stimuli;
4. Cartilage ligaments connect bones and muscles. These elements bear the main load on the knee area.

The anatomy of the knee joint is very complex, and makes it difficult to treat this area in case of various diseases. To make it easier to understand the anatomy of this important part of the skeleton, we suggest looking at the structure of the knee joint in pictures, and familiarizing yourself with each component element of the knee separately.

Bone area

Let's figure out what bones make up the knee:

The anatomy of the knee joint is such that its constituent bones are covered with cartilage. Cartilage tissue is designed to reduce the load on bone tissue during movement (bones do not rub against each other).

According to the anatomy of the knee joint, bursae filled with synovial fluid serve as a barrier against abrasion for the patella. The purpose of the bags is also to help the muscles while walking.

Muscle

The knee area is equipped with two groups of muscles responsible for flexion and extension of the limbs.

The extensors are located in front of the femur. These muscles are responsible for motor activity; when they work, the knee joint is able to straighten.

The flexors are located behind the thigh and in the knee area. When this type of muscle contracts, the limb can bend at the knee.

Menisci

Let us turn again to the anatomy of the knee joint in pictures, where you can see in detail the arrangement of the elements.

The menisci are located between the condyles and the plane of the tibia. Their purpose is to distribute the load from the femur to the tibia.

If any damage occurs to the menisci, or they have to be removed during surgery, irreversible changes in the cartilage tissue may develop.

In the central area, the menisci are much thinner than in the peripheral area. Due to this, a shallow depression is formed on the surface of the tibia, which evenly distributes the load.

Nerves of the knee area

The dorsum of the knee is equipped with popliteal nerve endings, which simultaneously provide sensation to the lower leg and foot.

Rising slightly above the knee joint, the popliteal nerve is divided into two types: tibial, peroneal. The first is located on the plane of the lower leg (back part), the second goes to its front area. In case of injuries to the knee area (this is the anatomy of the structure), both nerves are located at the risk zone (they can be damaged).

Blood vessels

The large vessels include the popliteal artery and popliteal vein. Both blood vessels are located on the dorsal plane of the knee.

The purpose of these vessels is to supply blood to the lower leg and foot. The artery carries the flow of nutrients peripherally, the popliteal vein - towards the heart.

The artery is also divided into the following blood-carrying vessels:

• the upper lateral, which is divided into even more precise vessels;
• superior medial (above the medial condyle);
• middle knee, feeding the joint capsule;
• lower, knee literal;
• lower, knee medial.

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• the great saphenous vein, which flows into the large femoral vein;
• small subcutaneous, starting from the back of the foot. Next, the vein rises and passes to the popliteal fossa, where it merges, forming the popliteal.

Ligaments and cartilage

Let's look at the anatomy of the knee joint ligaments - the connective tissue of the knee area. The function of ligaments is to connect and strengthen the bones that form the joint. Ligaments are divided into two types - extracapsular and intracapsular. Both types are divided into varieties that perform specific functions:

See what the anatomy of the knee joint looks like in the photo attached below.

The cartilage in the knee serves as shock absorbers during any movement. The joint constantly experiences friction while walking. But the cartilage tissue remains elastic and smooth, despite heavy loads. All articular bones that participate in movement and are in contact with each other end with cartilage. Synovial fluid is a nutrient medium for cartilage tissue and maintaining its shock-absorbing properties.

Liquid capsule

The purpose of the joint capsule is protection. From the inside, the area is filled with synovial fluid, allowing the joint to move without damaging the cartilage tissue.

Synovial fluid not only protects cartilage, but also serves as a nutrient medium for it. The liquid also serves as a barrier to various inflammatory processes, preventing them from penetrating into the joint cavity. You can see the full structure of the knee joint in the video attached below.

Diseases around the knees

Looking at the structure of the human knee joint and its diseases, we can divide them into two groups:

• arthritis, accompanied by various inflammatory processes;
• arthrosis, when deformation of joint tissue occurs.

Diseases of the knee area occur for the following reasons:

1. injuries of varying severity with damage to ligaments;
2. inflammatory processes in the meniscus or its removal;
3. fractures of the articular part of the knees;
4. hemorrhages in the knee area.

If you experience pain or swelling when you feel your knees, be sure to contact a specialist for advice, diagnosis and treatment. It is important to diagnose a disease of the knee joint as soon as possible, so as not to lead to surgery and a long recovery period.

An incipient disease of the articular part may have virtually no symptoms. Pain is not always felt, but only during exertion. Therefore, you should listen more carefully to the most minor changes and sensations in your body.

One of the obvious signs of knee joint disease is limited walking, a feeling of stiffness in the knee area. This happens when the joint cavity begins to accumulate a large amount of synovial fluid. Manifestations of the disease are as follows:

• the volume of the knee increases;
• swelling appears;
• difficult to bend and straighten the knee;
• with any, even minor, load on the limb, severe pain is felt.

Only a doctor can carry out diagnostic measures. Do not try to get rid of accumulated joint fluid yourself. The main thing is to prevent synovial fluid from entering the joint cavity.

The anatomy of knee ligaments is such that they can tear when injured. When the ligaments rupture, swelling appears at the popliteal part (fossa), instability and pain are felt in the limb.

In addition to visual signs, a rupture is signaled by a crunching sound or sharp pain. The first thing to do in such a situation is to stop moving (loss of stability occurs) and ask for help. You cannot move on your own, because if the ligaments are injured, even your own weight will put a heavy load on the limbs.

After various knee injuries, bursitis can develop - an inflammatory process of sacs filled with fluid. The liquid is designed to improve slip between tendons and ligaments. Bursitis manifests itself as constant pain, swelling, tumors, and swelling of the knee joint. In rare cases, bursitis leads to a fever.

Getting acquainted with the anatomy of the human knee joint, it is clear that the kneecap is one of the most vulnerable areas. It may shift - take a perpendicular position instead of its natural position. The triangular bone (base of the kneecap) slips out of its normal location. When an injury occurs, severe pain occurs, followed by swelling of the knee.

After recovery, you should be aware that the displacement of the kneecap can occur more than once. With each subsequent injury, the pain becomes stronger. It is important to follow medical prescriptions and preventive measures during the recovery period to avoid re-injury.

Knee joint diseases affect not only adults, but also children. Teenagers involved in professional sports often injure their knee joints during training associated with heavy loads. As a result, Schlatter's disease manifests itself - inflammation of the tibial tuberosity. Signs of the disease:

• pain under the kneecap;
• tumor formation in the area of ​​the tibia;
• persistent pain even in a quiet position.

The feeling of discomfort with Schlatter's disease, in some situations, goes away only as the teenager grows up.

In addition to diseases of the knee area resulting from injuries, there are chronic diseases:

• arthritis. It has many varieties, one of which is rheumatoid arthritis, accompanied by constant stiffness when moving;
• osteoporosis(wear and tear of cartilage tissue);
• gout(swelling of the knee area);
• chondromalacia kneecap, when the pain affects the front of the knee.

The listed diseases are caused by heavy weight, permanent or old injuries, heavy loads, age-related changes, professional sports, insufficient elasticity and flexibility of muscles.

Diagnostic measures

To diagnose disease in the knee area, various techniques are used. The anatomy of the knee joint is clearly visible on MRI. The method allows you to see accurate images of joint tissue.

The use of MRI makes it possible to monitor all physiological changes taking place in the joints and to see the deformation that has occurred in the tissues.

This is a painless procedure with no contraindications. Thanks to the technique, an accurate diagnosis is made; it is possible to diagnose the smallest changes and injuries of the knee joint at the very beginning of the disease.

Ultrasound is also often used to determine changes in the anatomy of the knee joint. The diagnostic procedure is prescribed in situations:

• the presence of neoplasms on the articular bones (to determine their nature);
• in inflammatory processes;
• ligament ruptures;
• if the menisci or kneecap are damaged.

During diagnosis, the knee area is scanned in different projections, which makes it possible to examine joint lesions. The procedure does not require preliminary preparation, is painless and takes little time (about 20 minutes). Based on the results of examining the knee joint using ultrasound, the doctor diagnoses the disease.

How to forget about joint pain forever?

Have you ever experienced unbearable joint pain or constant back pain? Judging by the fact that you are reading this article, you are already familiar with them personally. And, of course, you know firsthand what it is:

• constant aching and sharp pain;
• inability to move comfortably and easily;
• constant tension in the back muscles;
• unpleasant crunching and clicking in the joints;
• sharp shooting in the spine or causeless pain in the joints;
• inability to sit in one position for a long time.

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