Proximal Patellar Tendinosis And Partial Tearing

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Proximal Patellar Tendinosis And Partial Tearing

Authors, Editors, Case Information Author: Laura Mattson, DO Affiliation: Spectrum Health Department of Orthopedic Surgery Co Author(s): Raul Rosario-Concepcion, MD Senior Editor: Raul Rosario-Concepcion, MD Clinical Vignette: 15yo male basketball player presenting for bilateral anterior knee pain for 2 years, insidious in onset, worsening over time and provoked by running and jumping. Exam shows tenderness to palpation over the inferior pole of the patellae and proximal patellar tendons bilaterally, with intact extensor mechanisms (no lag). Type of Probe Used: 3-14 MHz linear array transducer LAX PPT Long axis view of the proximal patellar tendon at its insertion on the inferior pole of the patella. LAX PPT labeled Long axis view of the proximal patellar tendon demonstrating thickening and heterogenous echotexture. The proximal patellar tendon measures between 0.8-1cm in thickness versus the more distal, normal appearing tendon which measures 0.4cm. An area of partial thickness tearing is encircled. Adjacent cortical irregularities are appreciated in the inferior patellar pole. SAX PPT Short axis view of the proximal patellar tendon, just distal to its insertion on the inferior pole of the patella. SAX PPT labeled Short axis view of the proximal patellar tendon, demonstrating partial thickness tearing of the central, undersurface fibers. LAX PPT Doppler Long axis view of the proximal patellar tendon demonstrating increased neovascularity on color doppler in the central undersurface tendon fibers. #6 - Video View Video The proximal patellar tendon is scanned in long axis from medial to lateral. The patellar tendon appears thickened and of heterogenous echotexture proximally, with partial thickness tearing of the central undersurface fibers. There are associated cortical irregularities of the inferior patellar pole. #7 - Video View Video The patellar tendon is scanned in short axis from distal to proximal from the level just above the tibial tuberosity to the level just below the inferior pole of the patella. At the proximal-most portion, there is evidence of tendon thickening as well as partial thickness tearing of the central undersurface tendon fibers. Interpretation 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.
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 PPT

LAX PPT labeled

SAX PPT

SAX PPT labeled

LAX PPT Doppler

#6 - Video

#7 - Video

Interpretation

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