A Thermographic Evaluation of Patellar​ Tendon Partial Tear

about the thermographic evaluation of patellar tendon degeneration

“Many pathological processes in humans manifest themselves as local changes in heat production and also as changes in blood flow pattern at affected organs or tissues”. Vainer BG. FPA-based infrared thermography as applied to the study of cutaneous perspiration and stimulated a vascular response in humans. Phys Med Biol. 2005 Dec 7;50(23): R63–94. 

Since I met the human thermography I always use this kind of evaluation for diagnosis and monitoring of musculoskeletal diseases, together with all the other imaging modalities.

Today I show you the case of a young athlete practicing long jump, with a chronic patellar tendon tendinopathy and partial tear at its proximal attachment.

I always start with clinical examination and thermographic study.

termography-knee

Thermographic study of the painful right knee

termography knee normal

The thermographic evaluation of the healthy left knee shows a difference of 1,5°C less than the right one

Mri Patellar tendon Tendinopathy

Sagittal T1w – Fusion – Stir Mri of the same patient (0.3 Tesla)

I perform the MRI examination to have also the clear depiction of the cortical patellar bone; as you probably know in many similar cases a bone marrow edema is associated at the inferior pole of the patella.

The study is completed with the dynamic ultrasound exam, both in supine and orthostatic position.

The elastosonography evaluation shows less adaptive changes during the dynamic study, as is usually seen in these pathologic conditions.

I believe in integrated imaging study for musculoskeletal pathologies; thermal cameras are user-friendly for anyone is involved in the diagnosis, monitoring, and treatment of these kinds of pathological conditions.

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Patellar Tendon Degeneration

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 late patellar tendon degeneration 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.

pom

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.