Patellar Tendinopathy

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Patellar Tendinopathy

Authors, Editors, Case Information Author: Ben Kopecky, DO, MS Affiliation: Mayo Clinic Physical Medicine & Rehabilitation, Rochester, MN Co Author(s): Co-Author: Karson Mostert, MD Senior Editor: Cara Prideaux, MD Senior Editor: William Denq, MD Clinical Vignette: 30 yo male multi-sport athlete with a 6-month history of anterior knee pain with sudden onset when loading to jump while playing volleyball. Pain is sharp, persistent since onset, and worsened with explosive movements. Exam is notable for intact extensor mechanism, although weak and painful with knee extension, and tenderness to palpation of proximal patellar tendon. Type of Probe Used: Linear LA4-18B LAX PT Long axis view of patellar tendon. Left is proximal. LAX PT Long axis view of patellar tendon. Hypoechogenicity of thickened tendon noted by yellow line. Intratendinous calcification (yellow arrowhead) seen in proximal posterior patellar tendon. Mid substance partial tear (white arrowhead). LAX PT Doppler Long axis view of patellar tendon with Doppler. Hypervascularity seen originating deep to the patellar tendon and travelling superficially into the tendon. #4 - Video View Video Long axis view of patellar tendon scanned dynamically. As the transducer moves medial to lateral, the central tendon thickening is visualized. Interpretation Image Interpretation: Long axis view of the patellar tendon. The patella is visualized on the left side of the picture with regular, linear fibers of the patellar tendon seen in the superficial and distal part of visualized tendon. There is tendon thickening, hypoechogenicity and greater than 50% loss of fascicular structure or tendinosis (yellow line), partial tear (white arrowhead), and intratendinous calcification (yellow arrowhead). There is extensive hypervascularization seen on doppler as well. Teaching Pearl: Patellar tendinopathy is one of the most common forms of tendon pathology in the lower extremity. Onset is typically insidious although it can present after a single explosive movement or difficult training session. There are 4 main characteristics that should be evaluated with ultrasound: 1. Tendinosis (% area: Mild = less than 25%, Moderate = 25-50%, Severe = greater than 50%) 2. Partial tears 3. Intratendinous calcification 4. Hypervascularization This is a case of severe tendinosis with evidence of all 4 elements of tendinopathy. Beyond activity modification and physical therapy, next steps could include therapeutic modalities such as shockwave therapy, ultrasound, or iontophoresis, PRP injection, tendon scraping, needle tenotomy/debridement, or reconstructive surgery.
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

LAX PT

LAX PT

LAX PT Doppler

#4 - Video

Interpretation

UPCOMING EVENTS

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