Patellar tendinitis: MR imaging features, with suggested pathogenesis and proposed classification.

McLoughlin, R F; Raber, Earl; Ad, Vellet; Wiley, J. Preston; Bray, Robert C.

doi:10.1148/radiology.197.3.7480766

Cited by 72 publications

(43 citation statements)

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“…Shalaby et al [15] have reported that, abnormal MRI findings might be present in asymptomatic knees of older active patients and in only Blazina stage III patients of patellar tendinitis but we have documented abnormal MRI findings in our young patient group and who were asymptomatic. McLoughlin et al [12] have classified ''jumper's knee'' with MRI findings according to the involvement of the tendon in craniocaudal plane, presence of perichondral-bone avulsion and intratendinous signal alterations. We did not use this classification system because the lesions in our case series were not characteristic for ''jumper's knee''.…”

Section: Discussionmentioning

confidence: 99%

The fate of patellar tendon and infrapatellar fat pad after arthroscopy via central portal

Bayar

Turhan

Özer³

et al. 2008

Knee Surg Sports Traumatol Arthr

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Central patellar (CP) portal is an accessory portal in arthroscopic knee surgery, which generally is considered to be safe. In this cross sectional study, we aimed to delineate the clinical and radiological outcome of patellar tendon (PT) and Hoffa's fat pad after the use of this approach. From our hospital records, patients who underwent arthroscopy via CP portal were identified and were invited for the study. There were16 men and 4 women with a mean age of 32 years. Mean follow-up time was 28 months. Meniscectomy had been performed for irreparable bucket-handle type medial meniscal tears in all patients. At the latest follow-up, no patients had anterior knee pain and physical examination was normal. Mean PT thickness of operated knees measured with Ultrasonography was 5.63+/-1.56, while it was 3.76+/-0.46 mm in contralateral knees and the difference was significant. Contour irregularity of PT and focal hypoechoic areas were found in 17 patients, two of which also had hyperechogenic calcification focuses. Abnormal signal intensity of PT was also found in 17 patients with Magnetic Resonance Imaging (MRI). Eleven of these had decreased signal intensity within the tendon which was interpreted as fibrosis. In six patients, increased signal intensity, radiologically similar to chronic tendinitis, was detected. Four patients had decreased signal intensity in the Hoffa's fat pad. Local fibrous tissues in patellar tendon might cause weakness in the tendon. This study showed that although CP portal did not cause any clinical problems in a low demand group of patients, it leads to a significant radiological sequela in the tendon, biomechanical significance of which needs to be clarified.

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Section: Discussionmentioning

confidence: 99%

The fate of patellar tendon and infrapatellar fat pad after arthroscopy via central portal

Bayar

Turhan

Özer³

et al. 2008

Knee Surg Sports Traumatol Arthr

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“…Further, the addition of the Gd-contrast agent made it possible to reveal lesions not detected on other sequences. The literature on the application of Gd CME on tendons is limited (Movin et al, 1998a, Movin et al, 1998b, McLoughlin et al, 1995. used Gd CME in patients with chronic mid-portion Achillodynia and concluded that the intratendinous signal alterations were more obvious after Gd contrast agent was used (Movin et al, 1998a) and that Gd CME depicted a larger size of the intratendinous abnormality than US (Movin et al, 1998b).…”

Section: Static and Dynamic Contrast Agent Enhancement (Studies 1-ii)mentioning

confidence: 99%

Magnetic resonance imaging in chronic achilles tendinopathy

Shalabi

2004

Acta Radiol

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The main objective of this thesis was to evaluate and monitor the morphological response following treatment interventions in patients with chronic Achilles tendinopathy by using different MRI-techniques. For this purpose, we investigated different types of sequences, including gadolinium contrast medium enhanced T1-WI images (CME T1-WI) and developed a precise method to measure tendon volume and mean intratendinous signal of the Achilles tendon. Study I aimed at evaluating 15 patients with chronic painful Achilles tendinosis, before -and two years after -surgical treatment. There was marked regression of the intratendinous signal postoperatively. The most sensitive sequence for depicting an intratendinous lesion in this study was CME T1-WI images. They showed a regression of the intratendinous signal abnormality from 13/15 patients preoperatively to 4/15 postoperatively. The clinical outcome was excellent in 8, good in 5, fair in 1 and poor in 1 patient. In study II, the early contrast agent enhancement in the dynamically enhanced MRI signal (DEMRI) was correlated to the histopathological findings in 15 patients with chronic Achilles tendinopathy. Early contrast enhancement (within the first 72 seconds) was seen in DEMRI in the symptomatic Achilles tendons with a significant difference compared to the asymptomatic contralateral tendons. Increased severity of tendon changes, including fiber structure abnormality, increased vascularity, rounding of nuclei and increased amount of glycosaminoglycans, correlated to CME. In study III, we developed a computerized 3-D seed growing MRI-technique to measure tendon volume and mean intratendinous signal. This technique showed an excellent inter-and intra-observer reliability. The technique was also used to prospectively follow up the tendon adaptation and healing described in studies IV-VI. In study IV, using serial MRI during a period of one year we evaluated the biological effect of tendon repair following iatrogenic tendon injury by five transversal ultrasound-guided core-biopsies employing a needle technique in chronic Achilles tendinopathy. Alterations found during healing, such as tendon volume and intratendinous reactive changes could be monitored by MR imaging, and subsided as noted in the seven and twelve months follow-up. In study V, we evaluated the effect of treatment with three months daily-performed heavy loaded calf muscle strength training program in 25 patients who had been suffering from chronic painful Achilles tendinopathy. The tendon volume decreased with 14%, and the mean intratendinous signal with 23%. The clinical outcome was improved. In study VI, we revealed tendon adaptation immediately following calf muscle strength training. An MRI examination within 30 minutes of the performed exercises resulted in increased total tendon volume (12%) and mean intratendinous signal (31%).In conclusion, MRI-techniques can be used as an adjunct to clinical evaluation by monitoring morphological effects following different treatment interventions, thereby ...

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“…It is at rest that the blood fl ow has previously been measured. 9 The bone-tendon junction has traditionally been considered relatively avascular, 29 but Scapinelli 30 suggests that although the distal attachment of the patellar tendon does have an area of avascularity, the proximal attachment is surrounded by the inferior half of the patella and the infrapatellar fat pad, which are highly vascularized structures. 9 Innervation is supplied by a branch of the saphenous nerve.…”

Section: Anatomy and Pathology Of The Patellar Tendonmentioning

confidence: 99%

“…Several authors, however, report no signifi cant relationship between height or patellar-tendon length and patellar tendinopathy. 7,28,29,[37][38][39] Many authors have also tried to link muscle properties to patellar tendinopathy. Muscle fl exibility, muscle strength, and muscle imbalances have all been suggested as potential factors in patellar tendinopathy.…”

Section: Intrinsic Factorsmentioning

confidence: 99%

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Etiology of Patellar Tendinopathy in Athletes

Hale¹

2005

Journal of Sport Rehabilitation

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Objective: To review the etiology of patellar tendinopathy as it relates to clinical management of chronic patellar-tendon disease in athletes. Data Sources: Information was gathered from a MEDLINE search of literature in English using the key words patellar tendinitis, patellar tendonitis, patellar tendinosis, patellar tendinopathy, and jumper's knee. Study Selection: All relevant peer-reviewed literature in English was reviewed. Data Synthesis: The etiology of patellar tendinopathy is multifactorial, incorporating both intrinsic and extrinsic factors. Age, muscle fl exibility, training program, and knee-joint dynamics have all been associated with patellar tendinopathy. The roles of gender, body morphology, and patellar mobility in patellar tendinopathy are unclear. Conclusions: The pathoetiology of patellar tendinopathy is a complex process that results from both an infl ammatory response and degenerative changes. There is a tremendous need for research to improve our understanding of the pathoetiology of patellar tendinopathy and its clinical management.

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Patellar tendinitis: MR imaging features, with suggested pathogenesis and proposed classification.

Abstract: Patellar tendinitis demonstrates a consistent spectrum of changes at MR imaging that can aid understanding of the origin and treatment of damage.

Cited by 72 publications

References 0 publications

The fate of patellar tendon and infrapatellar fat pad after arthroscopy via central portal

The fate of patellar tendon and infrapatellar fat pad after arthroscopy via central portal

Magnetic resonance imaging in chronic achilles tendinopathy

Etiology of Patellar Tendinopathy in Athletes

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