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Is Impingement the Cause of Jumper’s Knee?

Dynamic and Static Magnetic Resonance Imaging of Patellar Tendinitis in an Open-Configuration System

Marius R. Schmid, MD^*,, Juerg Hodler, MD, Philipp Cathrein, MD, Stefan Duewell, MD^||, Hilaire A. C. Jacob, PhD^a and José Romero, MD

^* Department of Diagnostic Radiology, University of Zurich, Zurich
Department of Radiology, Orthopaedic University Hospital Balgrist, Zurich
Department of Orthopaedic Surgery, Orthopaedic University Hospital Balgrist, Zurich
^a Laboratory of Biomechanics, Orthopaedic University Hospital Balgrist, Zurich
^|| Radiology Department, Thurgauisches Kantonsspital, Frauenfeld, Switzerland

Address correspondence and reprint requests to Marius R. Schmid, MD, Radiology, Orthopaedic University Hospital Balgrist, Forchstrasse 340, CH-8008 Zurich, Switzerland

Background: Chronic overload is considered the main cause of patellar tendinitis, but it has been postulated that impingement of the inferior patellar pole against the patellar tendon during knee flexion could be responsible.

Hypothesis: The role of the patellar pole in patellar tendinitis can be determined by dynamic magnetic resonance imaging.

Study Design: Case-control study.

Methods: We compared 19 knees with patellar tendinitis and 32 asymptomatic knees of age-matched subjects using an open-configuration magnetic resonance imaging system. Dynamic sagittal images were obtained from full extension to 100° of flexion with and without activation of the quadriceps muscle. The following measurements were made from the images: tendon-patella angle, anteroposterior diameter of the tendon, signal difference-to-noise ratio, the shape of the inferior patellar pole, and the location of the patellar tendon insertion.

Results: The tendon-patella angle was not significantly different between groups at any flexion angle, with or without quadriceps muscle activation. The insertion site of the patellar tendon differed significantly but not the shape of the inferior pole of the patella. The volume and the signal difference-to-noise ratio of zones of increased intratendinous signal as well as the anteroposterior diameter of the proximal patellar tendon were increased in symptomatic knees.

Conclusions: The relationship between the patella and the patellar tendon was identical in both groups; therefore, chronic overload seems to be a major cause of patellar tendinitis.

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