Experience with Ultrasound of the Knee Joint at Mulago Hospital, Uganda

Background : The knee is prone to various pathology. Mulago Hospital records of 2001/2002 show that an average of 432 patients with knee joint disorders are seen in orthopaedic and rheumatology outpatient clinics out of a total of 5400 patients annually. For a long time the only mode of radiological investigation for these patients has been x-rays of the knee joints and this meant that limited information was got about the soft tissue component of the knee.Advances in technology with high frequency transducers, power Doppler ultrasound and extended field of view function have facilitated the progressive development of musculoskeletal sonography (MS). In developing countries like Uganda, where advanced imaging modalities like MRI are unaffordable and not readily available, ultrasound U/S serves as an efficient substitute in trained hands. This study was aimed at describing the sonographic pattern of knee joint pathology at Mulago Hospital in patients with knee joint symptoms.
Methods :A cross sectional descriptive study of the sonographic pattern of knee joint pathology wasperformed at Mulago Hospital from July 2004 –February 2005. A total of 107 consecutive patients referred to the Radiology department with knee joint pathology were studied. The patients’ socio-demographic data, clinical history and physical examination were recorded. Sonography of the knees was done using U/S machines [ATL-HDI 1500, Sonoace [Medison] SA8800 & SA9900] with high frequency linear transducers (7-12 MHz) The sonographic appearance of joint fluid, synovitis , loose bodies, bursae and cysts, tendon, mensci and ligament pathology were recorded. The data was entered in the computer using Epi-data soft ware and analysed using the SPSS version 10.
Results : A total of 107 patients had their knee joints evaluated with U/S. The age range was from 2 months to 80 years. The mean age was 38.0 and median 36 years. The commonest presenting symptoms were painful swelling of the knee 55(51.4%), pain 39 (36.4%), swelling and inability to move were 6 (5.6%). Sonographic features revealed osteoarthrosis was the most frequent 22(59.5%), loose bodies were 7 (18.9%) and fractures 2(5.4%).
Conclusion : U/S can ably evaluate the pathology of menisci, ligaments, tendons and muscles. The majority of the knee joint pathology disorders were as a result of the degenerative disease. In view of the fact that MRI is not readily available and is expensive, U/S goes a long way in contributing to the diagnoses of knee joint pathology in a low resourced countries like Uganda.