Although it is not a vital test for evaluating tendon structures, x-ray can help to exclude another pathology such as bone tumours or calcification of soft tissue. In immature skeletons, we can also see apophyseal avulsions injuries. X-ray can also demonstrate predisposing factors such as calcific tendinopathy, the position of the kneecap, and demonstrate an os trigonum syndrome, or calcaneal exostosis.
USS is the most widely used test at the moment due to its reliability and ease. This modality provides a good image of the condition of the collagen fibres, as well as the new vessels around the tendon. One of the main benefits of USS is that it is a dynamic exploration that can complement clinical examination. It therefore provides useful information on tendon function. Echography of the tendons requires experience and is operator-dependent. USS and Doppler can also identify neovascularity – in addition to the structural changes characteristic of tendinopathy.5
MRI is less widely used for the assessment of tendinopathy but can provide considerable information. The main advantage of this modality is that it provides data on the condition of the other articular structures and is vital for differential diagnosis. The main advantage of MR over echography is that it provides a reproducible image of the tendon – and from multiple angles.
Normal patella tendon
Note the dense packed longitudinally orientated fibres
Left knee patella tendon ossicle
An ossicle related to the proximal patellar tendon due to chronic tendinopathy
A hypoechoic area in the deep fibres of the patellar tendon. This is consistent with tendinopathy
Patella Tendinopathy Doppler
Neovascularity on this doppler USS image in keeping with tendinopathy
Left Knee Patella Tendinopathy Saggital
Note the increased signal (white appearance) and partial thickness tear on this sagittal MRI image
At present, the Victorian Institute Sports Assessment (VISA) scale enables us to clinically evaluate patellar tendinopathies and Achilles tendinopathies (VISA-A) and provides us with information about the symptomatic severity and sporting and functional capacity of the sportsperson being evaluated.