Patrick Graham

Chronic Patellar Tendon Rupture: A Case Report With Associated Imaging

Rupture of the patellar tendon is a disabling diagnosis most commonly associated with a forceful eccentric loading of the extensor mechanism during strenuous activity ( Boublik et al., 2011 ; Matava, 1996 ). A neglected, chronic rupture of the patellar tendon is quite rare. The actual incidence and prevalence of this are unknown ( Tsitskaris, Subramanian, & Crone, 2013 ). A delay in presentation, as is discussed here, is a poor prognostic indicator ( Frois-Temponi, de Carvalho, da SilvaBernardes, & Presses-Teixeira, 2016 ; Matava, 1996 ; Ramseier, Werner, & Heinzelmann, 2006 ). Predisposing factors include repetitive microtrauma of the tendon, medical conditions known to weaken tendons and ligaments (i.e., rheumatological, autoimmune, scleroderma), adverse drug effects (i.e., use of fl ouroquinolones), or long-term use of corticosteroids either systemic or locally ( Enad, 1999 ; Matava, 1996 ).

Symptomatic Patellar Plica in a Runner.

Patella plicae are normal anatomic structures of the knee, typically asymptomatic and of little clinical signifi cance ( Giffi th & LaPrade, 2008 ; Sznajderman, Smorgick, Lindner, Beer, & Agar, 2009 ). Plicae are remnants of mesenchymal tissue that is incompletely resorbed, leaving “pleats” of tissue behind in the knee ( Camanho, 2010 ; Dupont, 1997 ). It is estimated that up to 50% of the population has some form of persistent plicae of the knee ( Camanho, 2010 ; Hayashi et al., 2013 ). Irritation of the patella plica, usually from strenuous activities involving repetitive fl exion and extension of the knee, results in a dull, aching pain of the anterior knee ( Giffi th & LaPrade, 2008 ). This is a common cause of anterior knee pain, although frequently misdiagnosed ( Al-Hadithy, Gikas, Mahapatra, & Dowd, 2011 ). Mediopatellar plica irritation is the most common cause of knee pain related to this disorder ( Farkas, Gaspar, & Jonas, 1997 ). Patients typically describe a dull, aching pain of the anterior knee, medial to the patella and superior to the joint line ( Sznajderman et al., 2009 ). The majority of cases are successfully treated with nonoperative interventions ( Griffi th & LaPrade, 2008 ). Here is presented a case of patella plica syndrome, with associated imaging, that unfortunately was unresponsive to conservative management.