Paper Review:Progressive Tendon-loading Exercises Vs Eccentric Exercise Therapy in Patellar Tendinopathy
A) Joint effusion with increased signal of hoffa fat pad
B) Thickened tendon with hypoechoic areas
C) Large hypoechoic area with discontinuity of fibers
D) Hypoechoic mass within the tendon
Image 1. Illustration of concentric, eccentric and isometric exercise (courtesy of wodconnect)
Image 2. Visual depiction of progressive tendon-loading exercise and eccentric exercise protocol (Breda et al)
Answer B. Diagnostic ultrasound of patellar tendinopathy should show a thickened but intact tendon. There may be areas of hypoechoic tissue and increased signal on collar doppler. Joint effusion and hyperechogenicity of hoffa fat pad should not be seen in patellar tendinopathy. Discontinuity of fibers and a large hypoechoic area is something you would expect with patellar tendon rupture. A hypoechoic mass can be seen with enthesophytes, gout or even potentially apophysitis of the inferior pole, none of which fit the clinical vignette.
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