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Differential Diagnosis

  • Avulsion fracture
  • Patellar fracture
  • Patellar tendon rupture
  • Patellar tendonitis


This patient was diagnosed with a rupture of the patellar tendon. The x-ray shows the high position of the patella (patella alta) and thickened, indistinct patellar tendon soft tissues and infrapatellar fat stranding.

Learnings/What to Look for

  • Patellar tendon rupture occurs almost exclusively with trauma at either the patellar or tibial insertion of the patellar tendon and is often associated with a small avulsion fracture
  • Risk factors include chronic microtrauma (tendinopathy—”jumper’s knee”); prior therapeutic intervention such as direct injection of steroids or previous repair of the anterior cruciate ligament; and many chronic systemic illnesses

Pearls for Urgent Care Management

  • Nonoperative treatment for partial tears with intact extensor mechanism is immobilization in full extension for 6 weeks with weightbearing and rehabilitation
  • Complete patellar tendon rupture will require an operative approach

Acknowledgment: Image and case presented by Experity Teleradiology (

A 41-Year-Old with Knee Pain After Playing Basketball
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