Ultrasound Evaluation of Patellar Tendinopathy in Athletes: A Case-Based Demonstration By Dr. Saurav Gogoi🎓 Asian Pain Academy Alumni

Introduction

Anterior knee pain is one of the most common sports-related complaints, particularly in athletes involved in jumping, sprinting, or racquet sports. Patellar tendinopathy (jumper’s knee) is a frequent diagnosis, resulting from repetitive overload of the extensor mechanism. Traditional assessment relies on history and clinical tests, but musculoskeletal ultrasound (MSK-US) provides a real-time, dynamic, and highly accurate evaluation of tendon morphology and pathology.

This blog presents a case from our alumni network, demonstrating how ultrasound can guide accurate diagnosis and management of patellar tendinopathy in athletes.

Case Presentation

A 27-year-old male badminton player presented with anterior knee pain for 7 months, aggravated during training and jumping activities. The pain was persistent despite activity modification and physiotherapy.

On clinical examination, tenderness was localised to the inferior pole of the patella. The knee joint range of motion was preserved, but squatting and lunges reproduced pain.

Ultrasound Findings - patellar tendinopathy ultrasound

Musculoskeletal ultrasound was performed using a high-frequency linear probe.

• The right patellar tendon appeared enlarged and hypoechoic compared to the contralateral side.

• Tenderness was elicited on probe pressure at the proximal attachment of the tendon.

• Loss of fibrillar echotexture and focal thickening were noted, consistent with chronic tendinopathy.

• Doppler interrogation revealed increased neovascularisation, correlating with pain.

👉 These findings confirmed patellar tendinopathy (jumper’s knee).

Educational Value of Ultrasound in Pain Medicine

1. Dynamic and Real-Time

Ultrasound allows direct visualisation of the patellar tendon during flexion and extension, helping correlate mechanical loading with pain reproduction.

2. Comparative Evaluation

In this case, comparison with the asymptomatic contralateral tendon highlighted asymmetry in thickness and echotexture, strengthening diagnostic accuracy.

3. Guiding Management

Ultrasound not only aids diagnosis but also helps in planning and guiding interventions such as PRP injections, high-volume injections, or needling techniques, ensuring precise targeting of pathological regions.

4. Athlete-Friendly

Being radiation-free, portable, and relatively low-cost, MSK-US is ideal for pain medicine practice, particularly for on-field evaluation.

Clinical Pearls from the Case

• History and clinical localisation remain the first step, but ultrasound adds objectivity and precision.

• Chronic tendinopathy is degenerative, not purely inflammatory; hence management should focus on eccentric loading, physiotherapy, and regenerative therapies rather than repeated corticosteroids.

• Ultrasound can monitor tendon healing over time, guiding safe return to sport.

Contribution

📌 Ultrasound Demonstration by: Dr. Saurav Gogoi🎓 Asian Pain Academy Alumni

This case highlights the importance of academic training and hands-on ultrasound practice, which empowers physicians to integrate MSK imaging into clinical decision-making for athletes.

Conclusion

Patellar tendinopathy is a significant cause of chronic anterior knee pain in athletes. Musculoskeletal ultrasound provides rapid, accurate, and reproducible assessment of tendon pathology and can directly guide interventions. This case demonstrates how ultrasound is reshaping sports medicine and pain practice, particularly when applied by trained clinicians.

References

1. Cook JL, et al. Patellar tendinopathy: clinical diagnosis, load management, and advice for challenging cases. Br J Sports Med. 2016;50(24):1424–1431.

2. Dragoo JL, et al. Platelet-rich plasma as a treatment for patellar tendinopathy: a randomized controlled trial. Am J Sports Med. 2014;42(3):610–618.

3. Dutta D. Musculoskeletal Ultrasound in Pain Practice. Asian Pain Academy, 2024.