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This is an interesting case

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of this is a 36-year-old gentleman.

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He did have a history of patellar tendonitis.

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Presented to me actually, uh, initially for, uh, ultrasound,

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um, to evaluate his patellar tendon.

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And what's interesting about it, um, a um,

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basketball player, a different basketball player,

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actually struck his patella directly from the medial side

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and basically, um, uh,

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ba struck it into an upward direction.

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In the er, this patient did have some swelling medially,

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a joint effusion, and no quadriceps

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or patella tenderness, tenderness.

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Although, uh, we now know that the er physical exam

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isn't entirely reliable.

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And he showed up for an exam, MRI examination

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and his ultrasound five days later.

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So the reason why he got an ultrasound and MRI is

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because, uh, he was one of those, uh, patients

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who knew a guy who also knew another guy

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and knew a bunch of doctors.

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So basically got, um, everything ordered all at once.

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And while I was scanning him, I said, well,

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it looks like your patella tendon is ruptured.

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And you can see on these longitudinal images,

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this is the patella at the left hand side of the image.

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And inferiorly, uh, would be the tibial tuberosity.

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But you can see that there's disruption

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of the proximal portion of the patellar tendon.

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There's actually herniation of portions

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of hoffa's fat pad into the defect

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where the patellar tendon was torn.

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But as I was scanning him, he says, he tells me that,

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oh yeah, by the way,

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I'm also getting a MRI next door at your

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imaging facility an hour from now.

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I was like, well then why are we ordering all these studies?

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And it's because, um, he happened to know a guy.

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He knew another guy. But in any case, as we scroll from, uh,

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medial to lateral, you can see also there's some

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heterogeneous filling defect in this, um, uh,

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patellar tendon rupture.

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And this we'll see on subsequent MRI,

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uh, represents blood products.

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But you can see in addition to the patella tendon rupture,

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there's a, basically a complete cleavage

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through hoffa's fat pad.

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These are just the, um,

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transverse images from top to bottom.

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You can identify the trochlea groove of the,

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um, distal femur.

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And as we, uh, move from, uh, superior inferior,

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you can see the heterogeneity of the, um, tendon.

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And here is that defect where there's a herniation of fat,

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uh, through that patella tendon.

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Here are the corresponding images and no surprise here.

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Uh, obviously ultrasound is a very good modality

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for diagnosing either quadriceps tendon

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or patellar tendon tears.

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This did give us a little bit more information,

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but I'll just recap what we saw here.

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Very similar to the ultrasound findings

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where we see a cleavage through the infra patellar fat pad.

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This is the contracted blood products.

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This dar signal intensity structure.

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This, this set actually under sort

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of already undergone hemosiderin deposition by this point.

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Uh, but you can see that there's a small tag

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of residual tendon tissue at the patellar tendon

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and then a more longer tendon stump at

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the tibial tuberosity.

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And a background of tendon thickening, partially due

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to edema and hemorrhage within the tendon from the acute

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injury, as well as the patient's underlying tendinosis.

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What's interesting about this case is that it also extended

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to involve the retina macular structures.

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So as you move to the lateral retina macular, you can see

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that there's some blood products here as well.

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There's a, actually a defect in the, uh,

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lateral patella ret aum, sort of the junction

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with the iliotibial band.

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So this had lateral extension as well as medial extension.

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You can see here that portions

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of the medial patella femoral ligament

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look somewhat attenuated.

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And, um, you can also notice

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that there's an alignment issue as well.

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This patient has patella Ulta, which, um,

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I didn't pull up the initial knee radiographs,

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but this is when he, um, showed up to the er.

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Uh, I think Dr.

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Ria gave a measurement of about seven centimeters, um,

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to indicate the, uh, presence of a patella tenon rupture.

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And this is, um, 10 centimeters.

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So that would meet our criteria

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for a patella tendon rupture.

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So that is, um, our case of a nice patella tendon rupture

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with, uh, with ultrasound correlation.

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Now, actually one thing,

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and I don't know if these images are shared with you,

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but he did have a follow-up MRI.

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Um, he was ha having trouble with, um, range of motion,

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especially with knee flexion.

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He wasn't able to get past 90 degrees.

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His actual, his clinically patellar tendon reconstruction

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that he had was doing pretty well.

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We can see this postoperative appearance.

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Let me pull up these images

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of this thickened, uh, ligament.

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And this is, uh, roughly about three months postoperative.

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Um, so, um, I usually give about six months of repaired,

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uh, ligaments or tendons for the signal changes to sort

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of normalize and quiet down.

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But as we've learned today, that sometimes, uh,

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postoperative changes can persist, uh, for quite some time.

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Uh, so I wouldn't wanna over-interpret this as failure

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of the, of the, uh, ligament uh, repair.

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And again, the patient was doing well clinically in

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terms of his rare pair.

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The problem he was having was, uh, with range of motion, um,

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and he didn't have anything

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that looked like a cyclops lesion.

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But you can see in areas of this knee

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that there is infiltration of the infra fat pad, um, close

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to the menisci and also in the super patella region,

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there's some low signal intensity fibrosis

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that represent part of this arthro fibrosis.

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If you compare and contrast to his preoperative MRI,

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you don't see these areas of fibrosis, um,

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that you see on this, um, postoperative MRI.

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So unfortunately for him, he had

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to undergo a manipulation under an, uh, anesthesia,

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and that got him to about 135 degrees of flexion.

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Remember, he could only get to about 90 degrees of flexion

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and unfortunately he started to lose range of motion, um,

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and was backed down to 95 degrees about one month

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after his manipulation under anesthesia.

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And the most recent follow-up, he's still rehabbing.

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Um, so this case not only shows, um, the, an example

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of a patellar tendon rupture,

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but also the postoperative sequelae

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of patients who've had previous surgery

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and loss of range of motion.