Distal Quadriceps Tendinosis

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Distal Quadriceps Tendinosis

Authors, Editors, Case Information Author: Bryson Merrill, MD Affiliation: Womack Army Medical Center, Fort Bragg, NC Co Author(s): Alex Houser, DO, CAQSM, FAAFP Senior Editor: Nicholas Moore, MD Clinical Vignette: A 30-year-old female presented with a 3-month history of insidious onset of right superior knee pain. Pain was worse with jumping, running, and going up and down stairs. She endorsed the occasional sensation of her quadriceps "giving out", particularly when going downstairs. Type of Probe Used: 15-4 MHz Linear Transducer Unlabeled long axis view of the distal quadriceps tendon Unlabeled long axis view of the distal quadriceps tendon. Labeled long axis view of the distal quadriceps tendon Labeled long axis view of the distal quadriceps tendon (Q). Note the area of tendinosis (arrowheads) with irregular echotexture, thickening, and disorganization of the linear tendon fibers. patella (P); femur (F); quadriceps fat pad (QF); prefemoral fat pad (PF); suprapatellar joint recess (arrow). Unlabeled long axis view comparing bilateral distal quadriceps tendons Unlabeled long axis view comparing bilateral distal quadriceps tendons. Image A is the asymptomatic side measuring approximately 0.75 cm thick, while Image B is the symptomatic side measuirng approximately 1.25 cm thick. Unlabeled short axis view of the distal quadriceps tendon Unlabeled short axis view of the distal quadriceps tendon. Labeled short axis view of the distal quadriceps tendon Labeled short axis view of the distal quadriceps tendon with evidence of irregular echotexture and thickening consistent with tendinosis (arrowheads). Interpretation Image Interpretation: The distal quadriceps tendon exhibits fusiform thickening of approximately 1.25 cm proximal to the superior patellar pole compared to approximately 0.75 cm on the asymptomatic side. There is a heterogeneous hypoechoic signal with loss of compact fibrillar structure within the area of maximal tenderness consistent with quadriceps tendinosis. Teaching Pearl: Quadriceps tendinosis is less common than patellar tendinopathy but should be considered in athletes with insidious anterior knee pain worsened by squatting, resisted knee extension, jumping, or heavy lifting. Ultrasound findings often include tendon thickening, hypoechogenicity, loss of the normal fibrillar pattern, and possible Doppler signal at the symptomatic portion of the distal quadriceps tendon. Treatment is typically load modification with progressive strengthening, often using eccentric or heavy-slow resistance principles. Ultrasound can also help identify partial tearing if present, but management should still be guided by symptoms and load tolerance. References: 1. King D, Yakubek G, Chughtai M, et al. Quadriceps tendinopathy: a review-part 1: epidemiology and diagnosis. Ann Transl Med. 2019;7(4):71. doi:10.21037/atm.2019.01.58 2. Pfirrmann CWA, Jost B, Pirkl C, Aitzetmüller G, Lajtai G. Quadriceps tendinosis and patellar tendinosis in professional beach volleyball players: sonographic findings in correlation with clinical symptoms. Eur Radiol. 2008;18(8):1703-1709. doi:10.1007/s00330-008-0926-9 3. Catapano M, Babu AN, Tenforde AS, Borg-Stein J, McInnis KC. Knee extensor mechanism tendinopathy: evaluation, treatment, and prevention. Curr Sports Med Rep. 2022;21(6):205-212. doi:10.1249/JSR.0000000000000967
NOTE: For more information, please contact the AMSSM, 4000 W. 114th Street, Suite 100, Leawood, KS 66211 (913) 327-1415.

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Authors, Editors, Case Information

Unlabeled long axis view of the distal quadriceps tendon

Labeled long axis view of the distal quadriceps tendon

Unlabeled long axis view comparing bilateral distal quadriceps tendons

Unlabeled short axis view of the distal quadriceps tendon

Labeled short axis view of the distal quadriceps tendon

Interpretation

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