about dynamic ultrasound and mri evaluation of partial patellar tendon tear
Today I show you the case of a partial tear at proximal insertion of the patellar tendon in a professional football player. The patient refears pain during flexion-extension at inferior patellar pole; hystory of repetitive trauma as usual in football players.
Sagittal Xbone T1w (left) and T1w TSE (right) Mri scan (o.3 Tesla)
The Mri exam shows a partial tear of the patellar tendon proximal insertion. In these kind of injury I always need a dynamic ultrasound exam, both in clino and orthostatic position.
The partial tear is better depicted with the dynamic ultrasound evaluation; the dynamic Mri is also useful to appreciate the tendon relationship with the patella.
About the dynamic ultrasound study of the medial collateral ligament bursa.
Three layers can be defined on the medial compartment of the knee: layer I – crural fascia; Layer II – superficial portion of the medial collateral ligament; Layer III – joint capsule and the deep portion of the medial collateral ligament.
Along the course of layer II, the medial collateral ligament bursa may become apparent when filled with fluid; as happened in this patient after an intense session of horse riding.
Coronal Fast Stir (left) and T2 weighted Mri sequences (0.3 tesla).
All of bursae are typically founded in areas where friction takes place, such as between bony surfaces and ligaments or tendons.
The dynamic ultrasound examination better defines the fluid collection within the bursa;
If necessary, the elastosonography evalutaion allows to monitorate the evolution of fluid collection; in this patient is still evident the typical fluid appearance with three-layer colour pattern.
About weight-bearing ultrasound study of patellar tendon.
Take a look at this clinical case in which the patient with a clear evidence of patella alta and lateral patellar compression syndrome, has a tendinopathy of the patellar tendon at its proximal insertion, with chronic anterior knee pain and instability.
Sagittal T1w and Stir Mri sequences (0.3 tesla).
In orthostatism is most evident the increase of flow in vessels that are dilated because of inflammatory response.
This is the reason why I always perform the ultrasound examination both in clino and in orthostatism. Have you ever tried?