Clinical signs and anatomical correlation of patellar tendinitis

Background: Patellar tendinitis is one of the several differential diagnosis of anterior knee pain. The clinical diagnosis of patellar tendinitis is based on tenderness to palpation at the inferior pole of the patella. The tenderness has been noted to be maximal when the knee is extended and the quadriceps relaxed, but a definite clinical sign for diagnosis is lacking. The accuracy of two clinical signs was assesed by a two-stage study which included physical examination, MRI and a cadaveric study. Materials and Methods: Two clinical signs, the "passive flexion-extension sign" and the "standing active quadriceps sign" were assessed in 10 consecutive patients with presumed patellar tendinitis. Five patients had an MRI, showed focal abnormality in the tendon. The location of the MRI finding corresponded, to the region of maximal tenderness. A cadaveric dissection was undertaken to describe the anatomy of the patella and the patellar tendon during these tests. Results: Both tests showed a significant decrease in tenderness at the area of inflammation when the patellar tendon was under tension. The cadaveric dissection showed that when the knee is flexed to 90 or when the quadriceps is tensioned the deep fibers of the tendon do not deform to anteriorly applied pressure. Conclusion: We suggest using these studies routinely in the evaluation of patients with anterior knee pain.