Deep Infrapatellar Bursopathy

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Deep Infrapatellar Bursopathy

Authors, Editors, Case Information Author: Michael Serra-Jovenich, DO, MMSc, CPT Affiliation: Inspira Health / Rowan-Virtua School of Osteopathic Medicine PM&R Residency Co Author(s): Tamzid Hassan, DO; Zachary Noll, OMS III; Altamash Raja, DO, RMSK, CSCS Editor: Derek Stokes, MD Clinical Vignette: A 77-year-old male presented to clinic with three months of insidious onset left infrapatellar knee pain without an obvious inciting event including any report of trauma. His pain was most notably provoked when descending stairs and located primarily at the distal patellar tendon region. He otherwise denied any swelling or instability of the knee. On examination, range of motion was full without audible crepitus. Tenderness to palpation was identified at the inferior patellar pole and distal patellar tendon region. Type of Probe Used: 15-4 MHz Linear Transducer Unlabeled Long Axis View of the Distal Patellar Tendon with Doppler Unlabeled Long Axis View of the Distal Patellar Tendon with Doppler Labeled Long Axis View of the Distal Patellar Tendon with Doppler Labeled Long Axis View of the Distal Patellar Tendon with Doppler. Cortical irregularities are present. No hyperemia is visualized in the image. These findings represent a deep infrapatellar bursa fluid collection indicating possible bursopathy. Unlabeled Short Axis View of the Distal Patellar Tendon with Doppler Unlabeled Short Axis View of the Distal Patellar Tendon with Doppler Labeled Short Axis View of the Distal Patellar Tendon with Doppler Labeled Short Axis View of the Distal Patellar Tendon with Doppler. No hyperemia is visualized in the image. These findings represent deep infrapatellar bursa fluid collection indicating possible bursopathy. Unlabeled Long Axis View of the Proximal Patellar Tendon Unlabeled Long Axis View of the Proximal Patellar Tendon Labeled Long Axis View of the Proximal Patellar Tendon Labeled Long Axis View of the Proximal Patellar Tendon. An area of highlighted hypoechogenicity was identified and may represent patellar tendinopathy versus a small partial thickness tear. Unlabeled Short Axis View of the Proximal Patellar Tendon Unlabeled Short Axis View of the Proximal Patellar Tendon Labeled Short Axis View of the Proximal Patellar Tendon Labeled Short Axis View of the Proximal Patellar Tendon. An area of hypoechogenicity is highlighted and may represent patellar tendinopathy versus a small partial tendon tear. #9 - Video View Video Short Axis Cine of the patellar tendon from proximal to distal. An area of hypoechogenicity representing tendinopathy versus small partial tear is briefly visualized proximally followed by an area of anechogenicity distally representing a fluid collection at deep infrapatellar bursa and possible bursopathy. #10 - Video View Video Long Axis Cine of the proximal patellar tendon from lateral to medial. An area of hypoechogenicity is visualized representing patellar tendinopathy with a possible small partial tear. #11 - Video View Video Long Axis Cine of the distal patellar tendon from medial to lateral. An anechoic fluid collection is visualized at deep infrapatellar bursa representing a possible deep infrapatellar bursopathy. #12 - Video View Video ERROR, No VIDEO HERE Interpretation Image Interpretation: A distended deep infrapatellar bursa suggestive of bursopathy was identified distally. No definitive hyperemia was visualized on the recorded images/videos. Additionally, a focal area of hypoechogenicity is noted at proximal patellar tendon attachment to the inferior patellar pole suggestive of a tendinopathy versus partial thickness tear. Teaching Pearl: There are two infrapatellar bursae: the superficial infrapatellar bursa between the skin and tibial tubercle, and the deep infrapatellar bursa between the distal patellar tendon and anterior proximal tibia. Deep infrapatellar bursopathy can be overlooked because it lies deep to the tendon and may coexist with distal patellar tendinopathy. Ultrasound should look for bursal distension or thickened bursal tissue deep to the distal patellar tendon, then scan the extensor mechanism to identify potential associated tendon pathology. Sonopalpation can help determine whether the bursa is the symptomatic structure. References: 1. Viegas FC, Aguiar RO, Gasparetto E, Marchiori E, Trudell DJ, Haghighi P, Resnick D. Deep and superficial infrapatellar bursae: cadaveric investigation of regional anatomy using magnetic resonance after ultrasound-guided bursography. Skeletal Radiol. 2007;36(1):41-46. doi:10.1007/s00256-006-0142-0 2. Draghi F, Corti R, Urciuoli L, Alessandrino F, Rotondo A. Knee bursitis: a sonographic evaluation. J Ultrasound. 2015;18(3):251-257. doi:10.1007/s40477-015-0168-z 3. Jena D, Barman A, Sahoo J, Patel R, Dalai A. A case of chronic deep infrapatellar bursitis complicated by patellar tendinopathy and its evaluation with musculoskeletal ultrasound. Cureus. 2022;14(2):e22057. doi:10.7759/cureus.22057
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Authors, Editors, Case Information

Unlabeled Long Axis View of the Distal Patellar Tendon with Doppler

Labeled Long Axis View of the Distal Patellar Tendon with Doppler

Unlabeled Short Axis View of the Distal Patellar Tendon with Doppler

Labeled Short Axis View of the Distal Patellar Tendon with Doppler

Unlabeled Long Axis View of the Proximal Patellar Tendon

Labeled Long Axis View of the Proximal Patellar Tendon

Unlabeled Short Axis View of the Proximal Patellar Tendon

Labeled Short Axis View of the Proximal Patellar Tendon

#9 - Video

#10 - Video

#11 - Video

#12 - Video

Interpretation

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