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Pediatric musculoskeletal ultrasound: age- and sex-related normal B-mode findings of the knee

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Abstract

Musculoskeletal ultrasound (MSUS) is an important tool for evaluating disease activity, therapeutic progress, and remission status of rheumatic diseases in children. Knowledge of age-related normal findings is essential when interpreting pathological findings such as those seen in juvenile idiopathic arthritis. To evaluate normal findings of the knee joint, we recorded age-related stages of musculoskeletal development in the knee of 435 healthy children between 1 and 18 years of age using high-resolution B-mode MSUS. We determined approximate age- and sex-related norms for the suprapatellar recess size, ossified patella size, and distal femoral intercondylar cartilage thickness. In almost all age-groups, over 64 % of children had visible fluid accumulation in the suprapatellar recess. Significant correlations were found between chronological age and the suprapatellar recess size and ossified patella length (p < 0.05). An age-dependent decrease in intercondylar cartilage thickness of the distal femoral epiphysis was found in children between 10 and 18 years of age. High-resolution B-mode MSUS is an excellent tool for assessing joint and skeletal development in children. Our reference data can be used to discriminate better between normal physiological findings and pathological abnormalities.

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Acknowledgments

The authors would like to thank all study volunteers and their parents.

Funding

This study was funded by Pfizer, Inc., which did not influence the design or conduct of the study or interpretation or reporting of the results (Competitive Grant WI 171287).

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Authors and Affiliations

  1. Department of Pediatrics, Asklepios Hospital Weissenfels, Naumburger-Strasse 76, 06667, Weissenfels, Germany

    Daniel Windschall & Christine Nirschl

  2. Department of Pediatric Rheumatology, Helios Klinikum Berlin-Buch, Schwanebecker Chaussee 50, 13125, Berlin, Germany

    Ralf Trauzeddel

  3. Practice for Pediatrics and Pediatric Rheumatology, Alte Bundesstrasse 37, 79194, Gundelfingen, Germany

    Maria Haller

  4. German Center for Pediatric Rheumatology, Gehfeldstrasse 24, 82467, Garmisch-Partenkirchen, Germany

    Manuela Krumrey-Langkammerer

  5. Practice for Pediatrics and Pediatric Rheumatology, Am Kleistpark 1, 15230, Frankfurt (Oder), Germany

    Antje Nimtz-Talaska

  6. Department of Pediatric Rheumatology, St. Marien Children’s Hospital, Grillparzerstrasse 9, 84036, Landshut, Germany

    Rainer Berendes

  7. Clinic for Pediatric Rheumatology, St. Josef Stift, Westtor 7, 48324, Sendenhorst, Germany

    Gerd Ganser & Katharina Palm-Beden

  8. Practice for Pediatrics and Pediatric Rheumatology, Cosimastrasse 133, 81925, Munich, Germany

    Philipp Schoof

  9. Charité University Medicine, 10117, Berlin, Germany

    Ralf Felix Trauzeddel

  10. Department for Pediatric Rheumatology, Clinic for Pediatrics and Neonatology, Justus Liebig-University Giessen, Feulgenstrasse 10-12, 35392, Giessen, Germany

    Hartwig Lehmann

Authors
  1. Daniel Windschall
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  2. Ralf Trauzeddel
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  3. Maria Haller
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  4. Manuela Krumrey-Langkammerer
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  5. Antje Nimtz-Talaska
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  6. Rainer Berendes
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  7. Gerd Ganser
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  8. Christine Nirschl
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  9. Philipp Schoof
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  10. Ralf Felix Trauzeddel
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  11. Katharina Palm-Beden
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  12. Hartwig Lehmann
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Consortia

on behalf of the Imaging Working Group of the German Society of Rheumatology in Childhood and Adolescense (GKJR)

Corresponding author

Correspondence to Daniel Windschall.

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Conflict of interest

Daniel Windschall has received a speaker honorarium from Abbvie and Pfizer, and reports grants from Roche and Pfizer. Ralf Trauzeddel has received a speaker honorarium from Pfizer. Maria Haller, Manuela Krumrey-Langkammerer, Antje Nimtz-Talaska, Rainer Berendes, Gerd Ganser, Christine Nirschl, Philipp Schoof, Ralf Felix Trauzeddel, and Katharina Palm-Beden declare that they have no conflicts of interest. Hartwig Lehmann has received a speaker honorarium from Abbvie, Pfizer, Novartis and Chugai, and reports advisory board membership of Chugai, Pfizer, and Baxalta.

Informed consent

Informed parental consent was obtained for all study participants. The study was approved by our institutional ethics committee.

Human and animals right

All study procedures performed in our participants were in accordance with the 1964 Declaration of Helsinki and its later amendments.

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Windschall, D., Trauzeddel, R., Haller, M. et al. Pediatric musculoskeletal ultrasound: age- and sex-related normal B-mode findings of the knee. Rheumatol Int 36, 1569–1577 (2016). https://doi.org/10.1007/s00296-016-3528-x

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  • DOI: https://doi.org/10.1007/s00296-016-3528-x

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