<p begin="00:00:07.495" end="00:00:09.368" style="s2">- [Voiceover] A linear array transducer</p>
<p begin="00:00:09.368" end="00:00:11.564" style="s2">with a musculoskeletal exam type</p>
<p begin="00:00:11.564" end="00:00:13.107" style="s2">is used to perform an ultrasound</p>
<p begin="00:00:13.107" end="00:00:16.103" style="s2">examination of the quadriceps tendon.</p>
<p begin="00:00:16.103" end="00:00:18.355" style="s2">The patient is in a supine position</p>
<p begin="00:00:18.355" end="00:00:20.929" style="s2">with the knee flexed 90 degrees.</p>
<p begin="00:00:20.929" end="00:00:24.345" style="s2">The transducer is placed<br />longitudinally just proximal</p>
<p begin="00:00:24.345" end="00:00:26.962" style="s2">to the patella with the<br />orientation marker directed</p>
<p begin="00:00:26.962" end="00:00:28.933" style="s2">to the patient's head.</p>
<p begin="00:00:28.933" end="00:00:32.297" style="s2">The compact fibrillar pattern<br />of the quadriceps tendon</p>
<p begin="00:00:32.297" end="00:00:35.012" style="s2">is seen superficial to the<br />bright hyperechoic signal</p>
<p begin="00:00:35.012" end="00:00:37.124" style="s2">of the distal femur.</p>
<p begin="00:00:37.124" end="00:00:39.177" style="s2">The bright hyperechoic patella is seen</p>
<p begin="00:00:39.177" end="00:00:41.050" style="s2">on the right of the image.</p>
<p begin="00:00:41.050" end="00:00:44.090" style="s2">The suprapatellar fat pad<br />can be seen as a triangular,</p>
<p begin="00:00:44.090" end="00:00:47.089" style="s2">bright hyperechoic<br />structure just superficial</p>
<p begin="00:00:47.089" end="00:00:49.755" style="s2">to the suprapatellar bursa.</p>
<p begin="00:00:49.755" end="00:00:52.983" style="s2">The transducer should be swept<br />from medial to lateral to</p>
<p begin="00:00:52.983" end="00:00:56.314" style="s2">evaluate the entire quadriceps tendon.</p>
<p begin="00:00:56.314" end="00:00:58.883" style="s2">The transducer should<br />then be rotated 90 degrees</p>
<p begin="00:00:58.883" end="00:01:02.627" style="s2">counterclockwise for a short<br />axis view of the tendon.</p>
<p begin="00:01:02.627" end="00:01:05.157" style="s2">The medial and lateral condyles are seen</p>
<p begin="00:01:05.157" end="00:01:07.914" style="s2">as bright hyperechoic lines.</p>
<p begin="00:01:07.914" end="00:01:10.818" style="s2">The cartilage of the knee is<br />seen superficial to the bone</p>
<p begin="00:01:10.818" end="00:01:13.581" style="s2">as a black anechoic line.</p>
<p begin="00:01:13.581" end="00:01:17.041" style="s2">The pancake shaped speckled<br />suprapatellar tendon is seen in</p>
<p begin="00:01:17.041" end="00:01:21.394" style="s2">cross-section anterior to<br />the suprapatellar bursa.</p>
<p begin="00:01:21.394" end="00:01:23.652" style="s2">The transducer should be<br />swept from the patella</p>
<p begin="00:01:23.652" end="00:01:26.636" style="s2">to the musculotendinous<br />insertion of the tendon</p>
<p begin="00:01:26.636" end="00:01:28.969" style="s2">to complete the examination.</p>

<p begin="00:00:04.770" end="00:00:06.813" style="s2">- [Voiceover] The following<br />video is a description of the</p>
<p begin="00:00:06.813" end="00:00:10.262" style="s2">fuse quadriceps tendonosis<br />primarily to the rectus</p>
<p begin="00:00:10.262" end="00:00:11.838" style="s2">femurus portion.</p>
<p begin="00:00:11.838" end="00:00:13.081" style="s2">Here's the bony anatomy,</p>
<p begin="00:00:13.081" end="00:00:15.982" style="s2">associated with the suprapatellar region</p>
<p begin="00:00:15.982" end="00:00:17.695" style="s2">of the anterior knee.</p>
<p begin="00:00:17.695" end="00:00:21.917" style="s2">Superimposed CAT scan will<br />be modeling the quadricep</p>
<p begin="00:00:21.917" end="00:00:25.264" style="s2">tendon insertion to the<br />base of the patella,</p>
<p begin="00:00:25.264" end="00:00:28.097" style="s2">followed by the quadricep fat pad,</p>
<p begin="00:00:29.115" end="00:00:31.907" style="s2">which is seen here highlighted in yellow.</p>
<p begin="00:00:31.907" end="00:00:36.132" style="s2">Also here highlighted in<br />yellow is the prefemoral</p>
<p begin="00:00:36.132" end="00:00:40.299" style="s2">fat pad which surrounds the<br />anterior aspect of the femur.</p>
<p begin="00:00:41.765" end="00:00:43.404" style="s2">And highlighted here in blue is the</p>
<p begin="00:00:43.404" end="00:00:46.210" style="s2">Anterior Articular Hyaline Cartilage,</p>
<p begin="00:00:46.210" end="00:00:50.421" style="s2">and in light blue would be<br />the normal synovial recess,</p>
<p begin="00:00:50.421" end="00:00:52.334" style="s2">the Suprapatellar Bursa.</p>
<p begin="00:00:52.334" end="00:00:56.576" style="s2">Here is the corresponding<br />Normal Quadricep Tendon Image</p>
<p begin="00:00:56.576" end="00:01:00.016" style="s2">as the tendon fibers<br />insert to the highlighted</p>
<p begin="00:01:00.016" end="00:01:03.016" style="s2">Patellar base, the proximal surface.</p>
<p begin="00:01:04.580" end="00:01:08.953" style="s2">Highlighted here is the<br />anterior margin of the femur.</p>
<p begin="00:01:08.953" end="00:01:12.176" style="s2">Highlighted here in blue<br />is the fibrillar pattern</p>
<p begin="00:01:12.176" end="00:01:15.759" style="s2">of the normally situated<br />quadriceps tendon.</p>
<p begin="00:01:16.719" end="00:01:21.219" style="s2">Highlighted here in yellow<br />is the Quadricep Fat Pad,</p>
<p begin="00:01:21.219" end="00:01:25.696" style="s2">also highlighted here in yellow<br />is the Prefemoral Fat Pad,</p>
<p begin="00:01:25.696" end="00:01:28.789" style="s2">and next we have highlighted<br />here in light blue as the</p>
<p begin="00:01:28.789" end="00:01:32.314" style="s2">normally appearing synovial recess</p>
<p begin="00:01:32.314" end="00:01:34.804" style="s2">of the superpatellar bursa.</p>
<p begin="00:01:34.804" end="00:01:38.121" style="s2">To further demonstrate the<br />extensor mechanism of the</p>
<p begin="00:01:38.121" end="00:01:41.782" style="s2">quadricep tendon having the<br />patient tighten their quad</p>
<p begin="00:01:41.782" end="00:01:46.458" style="s2">will also force fluid into<br />the superpatellar recess.</p>
<p begin="00:01:46.458" end="00:01:48.992" style="s2">If no joint effusion is identified,</p>
<p begin="00:01:48.992" end="00:01:52.694" style="s2">this is one way to bring<br />out normal physiologic fluid</p>
<p begin="00:01:52.694" end="00:01:54.777" style="s2">between the two fat pads.</p>
<p begin="00:01:56.837" end="00:02:00.682" style="s2">This image shows a diffuse<br />formation of the more</p>
<p begin="00:02:00.682" end="00:02:04.268" style="s2">superficial layer of the quadricep tendon.</p>
<p begin="00:02:04.268" end="00:02:06.043" style="s2">Highlighted in white is a normal</p>
<p begin="00:02:06.043" end="00:02:09.012" style="s2">appearing base of the patella.</p>
<p begin="00:02:09.012" end="00:02:12.415" style="s2">Highlighted here is the<br />normal appearing interior</p>
<p begin="00:02:12.415" end="00:02:16.382" style="s2">surface of the femur followed<br />by a thickened quadricep</p>
<p begin="00:02:16.382" end="00:02:19.532" style="s2">tendon insertion proximal to its insertion</p>
<p begin="00:02:19.532" end="00:02:20.782" style="s2">of the patella.</p>
<p begin="00:02:22.255" end="00:02:25.073" style="s2">Highlighted here in yellow<br />is the normal appearing</p>
<p begin="00:02:25.073" end="00:02:29.472" style="s2">quadriceps fat pad followed<br />by the normal appearing</p>
<p begin="00:02:29.472" end="00:02:31.055" style="s2">prefemoral fat pad.</p>
<p begin="00:02:32.286" end="00:02:36.698" style="s2">Here we have in light blue<br />a more normal appearing</p>
<p begin="00:02:36.698" end="00:02:39.823" style="s2">physiologic amount of synovial fluid,</p>
<p begin="00:02:39.823" end="00:02:42.494" style="s2">and then red represents<br />the superficial layer</p>
<p begin="00:02:42.494" end="00:02:45.618" style="s2">of the quadricep tendon<br />which is now diffuse,</p>
<p begin="00:02:45.618" end="00:02:49.096" style="s2">indicating diffuse<br />tendonosis of the rectus</p>
<p begin="00:02:49.096" end="00:02:50.429" style="s2">femurus portion.</p>

<p begin="00:00:09.429" end="00:00:11.263" style="s2">- We're going to review the knee exam,</p>
<p begin="00:00:11.263" end="00:00:13.106" style="s2">but before we get started, there are a few</p>
<p begin="00:00:13.106" end="00:00:16.420" style="s2">important principles to be aware of.</p>
<p begin="00:00:16.420" end="00:00:18.967" style="s2">Some of the ultrasound settings need to be</p>
<p begin="00:00:18.967" end="00:00:21.396" style="s2">taken care of before we do the exam.</p>
<p begin="00:00:21.396" end="00:00:24.996" style="s2">Firstly, we look to see<br />that we have the machine</p>
<p begin="00:00:24.996" end="00:00:28.064" style="s2">set up for musculoskeletal.</p>
<p begin="00:00:28.064" end="00:00:30.413" style="s2">We do this by pressing the exam button</p>
<p begin="00:00:30.413" end="00:00:32.838" style="s2">on the machine, which will identify</p>
<p begin="00:00:32.838" end="00:00:35.806" style="s2">that we are in musculoskeletal mode.</p>
<p begin="00:00:35.806" end="00:00:39.566" style="s2">We will click select, and<br />we are ready to begin.</p>
<p begin="00:00:39.566" end="00:00:42.024" style="s2">I recommend using a linear transducer,</p>
<p begin="00:00:42.024" end="00:00:44.595" style="s2">which is between eight and 13 hertz.</p>
<p begin="00:00:44.595" end="00:00:46.425" style="s2">When using this transducer, it's important</p>
<p begin="00:00:46.425" end="00:00:47.965" style="s2">to stay with a consistent method,</p>
<p begin="00:00:47.965" end="00:00:49.331" style="s2">so that you're always confident</p>
<p begin="00:00:49.331" end="00:00:52.370" style="s2">of where you are when<br />you're scanning the patient.</p>
<p begin="00:00:52.370" end="00:00:55.384" style="s2">I recommend keeping the<br />notch of the transducer</p>
<p begin="00:00:55.384" end="00:00:59.336" style="s2">always in the superior aspect,<br />always pointing upwards</p>
<p begin="00:00:59.336" end="00:01:02.484" style="s2">toward the patients head,<br />as well as immediately</p>
<p begin="00:01:02.484" end="00:01:04.710" style="s2">toward the patient's body.</p>
<p begin="00:01:04.710" end="00:01:06.440" style="s2">You can correlate this with the machine,</p>
<p begin="00:01:06.440" end="00:01:09.597" style="s2">because there's a dot in<br />the upper left hand corner</p>
<p begin="00:01:09.597" end="00:01:11.343" style="s2">of the screen, which will orientate you</p>
<p begin="00:01:11.343" end="00:01:15.343" style="s2">as far as your scanning<br />or injection techniques.</p>
<p begin="00:01:37.566" end="00:01:40.015" style="s2">We're going to begin<br />scanning the right knee.</p>
<p begin="00:01:40.015" end="00:01:42.546" style="s2">I like to begin the scan by starting</p>
<p begin="00:01:42.546" end="00:01:45.722" style="s2">at the quadriceps tendon,<br />with the transducer</p>
<p begin="00:01:45.722" end="00:01:49.860" style="s2">with the notch facing<br />towards the patient, upwards,</p>
<p begin="00:01:49.860" end="00:01:52.338" style="s2">In a longitudinal plane.</p>
<p begin="00:01:52.338" end="00:01:54.671" style="s2">As my landmarks, I'm going to use</p>
<p begin="00:01:54.671" end="00:01:57.414" style="s2">so the bottom of the<br />transducer is touching the top</p>
<p begin="00:01:57.414" end="00:01:59.476" style="s2">of the patella tendon.</p>
<p begin="00:01:59.476" end="00:02:02.797" style="s2">I can clearly see the fibers<br />of the quadriceps tendon</p>
<p begin="00:02:02.797" end="00:02:06.797" style="s2">attaching on the patella<br />here at the distal end.</p>
<p begin="00:02:10.854" end="00:02:13.448" style="s2">It's important to maintain<br />contact on both ends</p>
<p begin="00:02:13.448" end="00:02:17.757" style="s2">of the transducer, to<br />get an accurate image.</p>
<p begin="00:02:17.757" end="00:02:20.725" style="s2">I'm going to scan up<br />and down the quadriceps</p>
<p begin="00:02:20.725" end="00:02:23.166" style="s2">to detect any abnormality.</p>
<p begin="00:02:23.166" end="00:02:26.755" style="s2">Clinically, if I suspected<br />a tear more approximately,</p>
<p begin="00:02:26.755" end="00:02:29.677" style="s2">I would examine further,<br />but for most purposes,</p>
<p begin="00:02:29.677" end="00:02:31.260" style="s2">this is sufficient.</p>
<p begin="00:02:39.323" end="00:02:40.645" style="s2">Next, we are going to take a look</p>
<p begin="00:02:40.645" end="00:02:42.922" style="s2">at the patient's cartilage, with the knee</p>
<p begin="00:02:42.922" end="00:02:45.368" style="s2">in the flex position.</p>
<p begin="00:02:45.368" end="00:02:48.440" style="s2">By holding the transducer<br />with the notch facing</p>
<p begin="00:02:48.440" end="00:02:50.963" style="s2">towards the patient,<br />in the medial position</p>
<p begin="00:02:50.963" end="00:02:54.385" style="s2">and placing the probe in cross section,</p>
<p begin="00:02:54.385" end="00:02:57.135" style="s2">just above the patient's patella.</p>
<p begin="00:02:59.037" end="00:03:01.789" style="s2">Here, I see a clear image of the patient's</p>
<p begin="00:03:01.789" end="00:03:04.517" style="s2">medial and lateral epicondyles,</p>
<p begin="00:03:04.517" end="00:03:07.758" style="s2">with cartilage shown in<br />the area of blackness.</p>
<p begin="00:03:07.758" end="00:03:10.524" style="s2">In demonstration of<br />arthritis or chondropenia,</p>
<p begin="00:03:10.524" end="00:03:13.675" style="s2">we can measure from the<br />center of the cartilage,</p>
<p begin="00:03:13.675" end="00:03:17.154" style="s2">as well as at the edge of each<br />epicondyle and compare them</p>
<p begin="00:03:17.154" end="00:03:20.829" style="s2">to standards to determine<br />the grade of osteoarthritis.</p>
<p begin="00:03:20.829" end="00:03:23.087" style="s2">By freezing the image, I can now measure</p>
<p begin="00:03:23.087" end="00:03:24.684" style="s2">the cartilage thickness.</p>
<p begin="00:03:24.684" end="00:03:27.999" style="s2">I press the caliper button<br />and I locate the center</p>
<p begin="00:03:27.999" end="00:03:31.895" style="s2">of the cartilage and I<br />can measure the distance</p>
<p begin="00:03:31.895" end="00:03:33.812" style="s2">of cartilage thickness.</p>
<p begin="00:03:37.059" end="00:03:39.941" style="s2">I can measure the cartilage<br />thickness at the point</p>
<p begin="00:03:39.941" end="00:03:44.108" style="s2">of each lateral condyle and<br />compare these to normal values.</p>

<p begin="00:00:09.494" end="00:00:13.392" style="s2">- Next we're going to review<br />injection of the knee.</p>
<p begin="00:00:13.392" end="00:00:15.580" style="s2">Before we get started,<br />keep in mind that this is</p>
<p begin="00:00:15.580" end="00:00:19.340" style="s2">just a demonstration, and<br />normally these are performed</p>
<p begin="00:00:19.340" end="00:00:23.355" style="s2">under sterile environments,<br />with Betadine, and prepping</p>
<p begin="00:00:23.355" end="00:00:26.802" style="s2">the area properly, this<br />is just an idea to show</p>
<p begin="00:00:26.802" end="00:00:30.027" style="s2">the physician exactly the<br />approach that we use in doing</p>
<p begin="00:00:30.027" end="00:00:34.505" style="s2">injections with the proper<br />needle placement and approach.</p>
<p begin="00:00:34.505" end="00:00:37.462" style="s2">The most common target that<br />physicians typically inject</p>
<p begin="00:00:37.462" end="00:00:41.272" style="s2">the knee joint, is the<br />Suprapatellar Recess, or Bursa.</p>
<p begin="00:00:41.272" end="00:00:44.087" style="s2">We begin by placing the<br />transducer in a longitudinal</p>
<p begin="00:00:44.087" end="00:00:47.631" style="s2">plane, with the end of<br />the transducer just above</p>
<p begin="00:00:47.631" end="00:00:49.473" style="s2">the patient's Patella.</p>
<p begin="00:00:49.473" end="00:00:52.791" style="s2">Next, in setup for the<br />injection, I'm going to rotate</p>
<p begin="00:00:52.791" end="00:00:56.958" style="s2">my transducer to cross-section,<br />and here we can visualize</p>
<p begin="00:00:59.526" end="00:01:02.712" style="s2">the physiologic fluid of<br />the Suprapatellar Recess,</p>
<p begin="00:01:02.712" end="00:01:06.699" style="s2">which is the band of<br />darkness above the Cortex.</p>
<p begin="00:01:06.699" end="00:01:10.039" style="s2">This will be the target<br />site of our knee injection.</p>
<p begin="00:01:10.039" end="00:01:12.960" style="s2">The proper landmarks associated<br />with a knee injection</p>
<p begin="00:01:12.960" end="00:01:16.617" style="s2">are palpating the Iliotibial<br />Band, which is a structure</p>
<p begin="00:01:16.617" end="00:01:19.439" style="s2">that runs down the Lateral<br />Thigh, and in between</p>
<p begin="00:01:19.439" end="00:01:22.164" style="s2">the Iliotibial band and<br />the Vastus Lateralis</p>
<p begin="00:01:22.164" end="00:01:23.803" style="s2">is the soft spot.</p>
<p begin="00:01:23.803" end="00:01:25.470" style="s2">Palpated right here.</p>
<p begin="00:01:26.716" end="00:01:31.148" style="s2">A needle as it's inserted<br />in this soft spot,</p>
<p begin="00:01:31.148" end="00:01:35.372" style="s2">between the Iliotibial Band<br />and the Vastus Lateralis,</p>
<p begin="00:01:35.372" end="00:01:40.017" style="s2">in a direction directly beneath<br />the center of the transducer</p>
<p begin="00:01:40.017" end="00:01:42.934" style="s2">to ensure an accurate localization.</p>
<p begin="00:01:48.114" end="00:01:51.772" style="s2">The needle will be guided<br />into the Suprapatellar Bursa,</p>
<p begin="00:01:51.772" end="00:01:55.102" style="s2">and Lidocaine is typically<br />injected to ensure proper</p>
<p begin="00:01:55.102" end="00:01:58.519" style="s2">location, and we'll see the Bursa expand.</p>
<p begin="00:02:08.897" end="00:02:12.506" style="s2">In addition to injections<br />of Cortisone or Lidocaine,</p>
<p begin="00:02:12.506" end="00:02:16.127" style="s2">or other medications, we<br />often aspirate the knee</p>
<p begin="00:02:16.127" end="00:02:18.056" style="s2">if there is a significant effusion</p>
<p begin="00:02:18.056" end="00:02:20.753" style="s2">of the Suprapatellar Recess.</p>
<p begin="00:02:20.753" end="00:02:24.832" style="s2">By doing this, we use the<br />same approach as the described</p>
<p begin="00:02:24.832" end="00:02:28.296" style="s2">injection technique,<br />however, initially we'll use</p>
<p begin="00:02:28.296" end="00:02:30.431" style="s2">an 18-gauge needle.</p>
<p begin="00:02:30.431" end="00:02:34.598" style="s2">Insert the Suprapatellar<br />Recess, and drain the fluid out.</p>

<p begin="00:00:09.454" end="00:00:12.351" style="s2">- We're going to begin<br />scanning the right knee.</p>
<p begin="00:00:12.351" end="00:00:14.822" style="s2">I like to begin the scan by starting</p>
<p begin="00:00:14.822" end="00:00:18.130" style="s2">at the quadricep tendon<br />with the transducer</p>
<p begin="00:00:18.130" end="00:00:21.669" style="s2">with the notch facing<br />towards the patient upwards</p>
<p begin="00:00:21.669" end="00:00:24.322" style="s2">in a longitudinal plane.</p>
<p begin="00:00:24.322" end="00:00:26.839" style="s2">As my landmarks I'm going to use</p>
<p begin="00:00:26.839" end="00:00:29.166" style="s2">so the bottom of the<br />transducer is touching</p>
<p begin="00:00:29.166" end="00:00:31.391" style="s2">the top of the patella tendon.</p>
<p begin="00:00:31.391" end="00:00:34.795" style="s2">I can clearly see the fibers<br />of the quadricep tendon</p>
<p begin="00:00:34.795" end="00:00:36.795" style="s2">attaching on the patella</p>
<p begin="00:00:38.228" end="00:00:40.145" style="s2">here at the distal end.</p>
<p begin="00:00:42.769" end="00:00:44.681" style="s2">It's important to maintain contact</p>
<p begin="00:00:44.681" end="00:00:49.430" style="s2">on both ends of the transducer<br />to get an accurate image.</p>
<p begin="00:00:49.430" end="00:00:52.539" style="s2">I'm going to scan up<br />and down the quadricep</p>
<p begin="00:00:52.539" end="00:00:55.028" style="s2">to detect any abnormality.</p>
<p begin="00:00:55.028" end="00:00:58.039" style="s2">Clinically if I suspected<br />a tear more proximally,</p>
<p begin="00:00:58.039" end="00:01:01.629" style="s2">I would examine further<br />but, for most purposes</p>
<p begin="00:01:01.629" end="00:01:03.212" style="s2">this is sufficient.</p>
<p begin="00:01:11.243" end="00:01:13.733" style="s2">Next we're going to take a<br />look at the patient's cartilage</p>
<p begin="00:01:13.733" end="00:01:17.371" style="s2">with the knee in the flex position.</p>
<p begin="00:01:17.371" end="00:01:19.560" style="s2">By holding the transducer</p>
<p begin="00:01:19.560" end="00:01:21.435" style="s2">with the notch facing towards the patient</p>
<p begin="00:01:21.435" end="00:01:24.989" style="s2">in the medial position,<br />I am placing the probe</p>
<p begin="00:01:24.989" end="00:01:29.156" style="s2">in cross section just above<br />the patient's patella.</p>
<p begin="00:01:31.048" end="00:01:33.436" style="s2">Here I see a clear image of the patients</p>
<p begin="00:01:33.436" end="00:01:36.569" style="s2">medial and lateral epicondyles</p>
<p begin="00:01:36.569" end="00:01:39.573" style="s2">with cartilage shown in<br />the area of blackness.</p>
<p begin="00:01:39.573" end="00:01:42.430" style="s2">In demonstration of<br />arthritis or chondropenia</p>
<p begin="00:01:42.430" end="00:01:45.996" style="s2">we can measure from the<br />center of the cartilage</p>
<p begin="00:01:45.996" end="00:01:48.570" style="s2">as well as at the edge of each epicondyle</p>
<p begin="00:01:48.570" end="00:01:50.985" style="s2">and compare them to standards to determine</p>
<p begin="00:01:50.985" end="00:01:52.743" style="s2">the grade of osteoarthritis.</p>
<p begin="00:01:52.743" end="00:01:53.953" style="s2">By freezing the image,</p>
<p begin="00:01:53.953" end="00:01:56.676" style="s2">I can now measure the cartilage thickness.</p>
<p begin="00:01:56.676" end="00:01:58.687" style="s2">I press the caliper button</p>
<p begin="00:01:58.687" end="00:02:02.104" style="s2">and I locate the center of the cartilage.</p>
<p begin="00:02:03.003" end="00:02:07.170" style="s2">And I can measure the distance<br />of cartilage thickness.</p>
<p begin="00:02:08.850" end="00:02:11.477" style="s2">I can measure the cartilage thickness</p>
<p begin="00:02:11.477" end="00:02:13.736" style="s2">at the point of each lateral condyle</p>
<p begin="00:02:13.736" end="00:02:16.736" style="s2">and compare these to normal values.</p>