Patellar Tendon
Abnormalities of the patellar tendon are an important cause of anterior knee pain. The patellar tendon represents the final component of the quadriceps extensor mechanism and is the component lying between the patella which is a seamed bone and the tibial tubercle. Because the structure runs between two bones it is sometimes referred to as the patellar ligament. The histology of the patellar tendon is however that of a true tendon rather than a ligament. Abnormalities of the patellar tendon occur most commonly at its two ends. In childhood it is the distal end where abnormalities are most commonly seen whereas in adolescence the proximal end can be more problematic.Osgood Schlatter’s disease is an osteochondrosis of the patellar tendon insertion. The aetiology of the disease is uncertain but there is an association with sporty athletic children. It is argued that there is a traction enthesopathy which results in new bone formation at the tibial tubercle as well as tendinopathy of the distal patellar tendon. In most cases imaging is not required as the clinical diagnosis of distal patellar tendon pain in association with palpable overgrowth of the tibial tubercle makes the clinical diagnosis is easy. Plain radiographs are most often requested however in cases when there is clinical doubt, an ultrasound examination provides a better depiction of the bony and soft tissue abnormalities without a radiation cost. On ultrasound thickening of the patellar tendon with loss of its normal internal structure associated with increased Doppler signal and new bone formation at the tibial tubercle are the commonest findings.
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Osteochrondritis
The adjacent deep infra patellar bursa should also be examined as an association between deep infra patellar bursitis and ongoing symptoms has been described. Similar findings are present on MR examinations. An equivalent condition is also described at the proximal end of the patellar tendon termed Sindig-Larsen syndrome. This entity is less common than Osgood Schlatter’s disease. The most common abnormality detected in the proximal patellar tendon is focal patellar tendinopathy or jumpers knee. This abnormality affects the central third of the patellar tendon particularly its posterior margin. As its name would imply it is frequently associated with running and jumping sports. The aetiology is uncertain. Some authors describe impingement of the lower pole of the patellar against the dorsal aspect of the patellar tendon as the principal cause. In some cases enthesopathy and bony overgrowth of the lower pole of the patellar is seen.
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Bursitis
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Dysplasia
Patellar Tendon
Quadriceps
Maltracking
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