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

Differential Diagnosis

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

Diagnosis

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 (www.experityhealth.com/teleradiology).