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.
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?
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?
Following a recent question made by Kris on my article “How Much is Enough”, I want to show you an example of my daily routine in studying the patellar tendon pathology: I always combine Mri and Ultrasound imaging! Take a look at this latepatellar tendondegeneration where the ultrasound scan better defines the presence of several calcifications, quite not visible on Mri acquisitions. Morover, with elastosonography study I can also appreciate the tendon stiffness. Distinguish early from late tendon disrepair/degeneration tendinopathy is crucial for planning the best treatment strategies.
Sagittal Ge Stir (left) – T1 weighted (right) Mri scans (0.3 Tesla) of a chronic proximal patellar tendon degeneration of a professional football player.
Sagittal Dynamic Ultrasound Scan of the same patient performed in orthostasis; the tendon degeneration is located only at the proximal insertion.