Proximal Patellar Tendinopathy

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Proximal 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: A 30-year-old male multi-sport athlete presented with a 6-month history of right anterior knee pain. There was a sudden onset of pain when loading to jump while playing volleyball. Pain was described sharp, had been persistent since onset, and worsened with explosive movements. Exam was 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 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 with a thickened (yellow line), hypoechogenic tendon. Intratendinous calcification (yellow arrowhead) seen in the proximal posterior patellar tendon. Mid substance partial tear (white arrowhead) also noted. Unlabeled Long Axis View of the Proximal Patellar Tendon with Color Doppler Unlabeled Long Axis View of the Proximal Patellar Tendon with Color Doppler. Hypervascularity seen originating deep to the patellar tendon and travelling superficially into the tendon. #4 - Video View Video Long axis cine of patellar tendon from medial to lateral, with central tendon thickening visualized. Interpretation Image Interpretation: The proximal patellar tendon appears thickening, hypoechogenic, with greater than 50% loss of fascicular structure or tendinosis, partial tear, and intratendinous calcification. There is extensive hypervascularization seen on doppler as well. Teaching Pearl: Patellar tendinopathy is a common lower-extremity tendon disorder, often presenting with insidious anterior knee pain but sometimes beginning after a high-load training session or explosive movement. Ultrasound should evaluate tendon thickness, hypoechogenicity, loss of fascicular structure, partial tearing, calcification, and Doppler hypervascularity. Evaluate multiple sonographic characteristics rather than relying on one feature. Use light transducer pressure when assessing Doppler signal so low-flow neovascularity is not compressed. References: 1. Hoksrud A, Ohberg L, Alfredson H, Bahr R. Color Doppler ultrasound findings in patellar tendinopathy (jumper's knee). Am J Sports Med. 2008;36(9):1813-1820. doi:10.1177/036354650831989 2. Sunding K, Fahlstrom M, Werner S, Forssblad M, Willberg L. Evaluation of Achilles and patellar tendinopathy with greyscale ultrasound and colour Doppler: using a four-grade scale. Knee Surg Sports Traumatol Arthrosc. 2016;24(6):1988-1996. doi:10.1007/s00167-014-3270-4 3. Ooi CC, Richards PJ, Maffulli N, et al. A soft patellar tendon on ultrasound elastography is associated with pain and functional deficit in volleyball players. J Sci Med Sport. 2016;19(5):373-378. doi:10.1016/j.jsams.2015.06.003
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Authors, Editors, Case Information

Unlabeled Long Axis View of the Proximal Patellar Tendon

Labeled Long Axis View of the Proximal Patellar Tendon

Unlabeled Long Axis View of the Proximal Patellar Tendon with Color Doppler

#4 - Video

Interpretation

UPCOMING EVENTS

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