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.