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?
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?