This 45-year-old recreational futsal player presented with an insidious onset of anterior knee pain. The pain was clearly made worse by activity and improved by rest. He described having experienced a long history of what sounds like patella tendinopathy during his twenties. He had recently returned to football after a ten year break. On examination he had localised tenderness over the proximal patella tendon with no other significant findings on clincial examination.
A lateral x-ray shows an ossicle related to the proximal patella tendon. This has been better defined with an MRI. This shows the ossicle sitting within the proximal and lateral fibres of the patella tendon. There is increased signal related to the ossicle, the adjacent patella tendon and patella.
This man’s symptoms likely relate to the sequelae of his past patella tendinopathy. The ossicle likely reflects longstanding dystrophic ossification or enthesopathic changes. While initial attempts were made to manage this by avoiding activities which provoke the player’s pain this strategy was not successful. He was very keen to continue to play recreational football and to participate in other weight-bearing exercise. As a result he eventually decided to undergo excision of the ossicle. This was done relatively uneventfully. He was able to return to football, and other activities, at around six months post op.
In most cases patella tendinopathy is a self-limiting problem and causes no long-term morbidity. It is however important to understand that in some situations there can be more longstanding symptoms. These are not always apparent and can be provoked by sudden increases in activity level.
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