Image Interpretation: The left proximal patellar tendon was thickened and of heterogenous echotexture, consistent with tendinosis, with associated cortical irregularity of the inferior patellar pole. There was additional evidence of partial thickness tearing of the central undersurface fibers of the proximal patellar tendon with increased vascularity in this region on color doppler evaluation. The left distal patellar tendon appeared normal.
Teaching Pearl: Care must be taken to avoid exerting excessive downward pressure on the ultrasound probe when evaluating for increased vascularity with color or power doppler. Power doppler, as opposed to color, is more sensitive in the detection of blood flow particularly in slow/low flow states. In this situation, the patient was treated with high volume hydrodissection/scraping/neovessel ablation of the proximal patellar tendon coupled with physical therapy with good clinical outcome. In addition, one study of 65 elite university athletes suggested that greater than 0.7cm thickness of the patellar tendon is an accurate predictor of clinical patellar tendinopathy (US sensitivity 81% specificity 95%; MRI sensitivity 100% specificity 89%). In our case, the proximal patellar tendon measured between 0.8-1cm.
Reference: Nishida Y, Nishino T, Tanaka K, Onishi S, Kanamori A, Yamazaki M. An Objective Measure of Patellar Tendon Thickness Based on Ultrasonography and MRI in University Athletes. J Clin Med. 2021 Sep 10; 10(18)4092. doi: 10.3390/jcm10184092. PMID: 34575211; PMCID: PMC 8471213.