Patellar Tendon Degeneration part II

about patellar tendon degeneration

In a previous post I showed you my daily routine in studying patellar tendon degeneration and how crucial is to combine all the imaging modalities for a better treatment strategies.

It’s not easy to study post-surgical outcomes of a tendon with the Mri evaluation; lots of artifacts and calcfications doesn’t allow a clear visualization of tendon’s fibres.


Sagittal T1w (left) and GeStir (right) of patellar tendon degeneration 10 years after surgery reconstruction; red arrows indicate the site of pain.

This is the case of a patient that ten years after surgical reconstruction of the patellar tendon, starts to feel pain. Is it possible to “see” the pain? Gross tendon degeneration is evident but, only with ultrasound examination I can better depict the hypervascularity of the tendon in the site of referred pain and the relationship between patellar tendon and Hoffa’s fat pad, its well known “biomechanical attenuator”.

But I also asked to myself: what’s behind this tendon degeneration? Dynamic Mri study gave me the answer: a scarce patellar mobility during active flexion-extension movements was evident.

Less patellar mobility means more stress for the tendon. Isn’t it?

Meniscal Cyst

Today I want to show you the case of a patient that comes to me for an ultrasound examination of a palpable mass adjacent to the postero-medial compartment of the knee joint, with an history of a major knee inury five years before; the sonographic findings reveal a well defined cystic lesion and associated meniscal tear.

Always ask for an Mri investigation to better evaluate the real extent of the meniscal tear; don’t trust only ultrasound!

The Mri exam perfectly depicts the cyst and the meniscal complex tear with gross mucoid degeneration.


Coronal (left) and Axial (right) T2 weighted Mri scans (0.3 tesla).


Ge Stir (left) and T1 weighted sagittal Mri scans (0.3 tesla) of the same patient.