Disclosures: Shiv J. Patel: Nothing to disclose

Case Description: On presentation, this physically active patient described a chronic, intermittent, throbbing right sided knee pain with severity rated 2/10 on average. It was aggravated with squatting and lunging and relieved with rest and icing. On physical exam, he had decreased range of motion to knee extension. Ultrasound (US) revealed hypoechogenicity and evidence of partial intrasubstance tearing within the right patellar tendon. Conservative management with physical therapy was recommended. At 3-month follow-up, the patient reported significant resolution of right anterior and inferior knee pain but reported a new, sharp, intermittent, right suprapatellar pain. US revealed new onset suprapatellar effusion and hypoechoic intrasubstance tendinopathy and calcific enthesopathy of the right quadriceps tendon. Further evaluation with MRI revealed no additional findings. However, dynamic US revealed an anterior capsular tear with a suprapatellar effusion communicating into the vastus intermedius fibers of the quadriceps tendon when the knee was positioned in extension.

Setting: Outpatient Sports Medicine Clinic.

Patient: An active 31-year-old male with anterior and inferior right patellar pain.

Assessment/Results: Four months from initial presentation, the patient showed continued improvement in patellar tendinopathy pain. Plain film on x-ray suggested patella alta with a Blackburne-Peel Index greater than 1, possibly predisposing the patient to this anterior capsular tear. We recommended nonoperative management, but if the pain and symptoms fail to resolve, we will consider surgical repair of the capsule.

Discussion: This is a novel case report, to our knowledge, of patellar tendinopathy complicated by an anterior capsular tear communicating with vastus intermedius fibers, possibly due to the predisposing biomechanical risk factor of patella alta. Despite resolution of patellar tendinopathy, the patient had continued proximal quadriceps tendon pain that was only apparent through dynamic ultrasound compared to MRI.

Conclusion: Dynamic ultrasound should be considered as first line diagnostic imaging when evaluating persistent anterior quadriceps pain.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/dynamic-ultrasound-reveals-anterior-capsular-tear-with-vastus-intermedius-communication-following-treatment-for-patellar-tendinopathy-a-case-report/