HomeAnswersRadiodiagnosistendon injuryI had tendon repair surgery. Please review my MRI reports.

Is it possible to develop articular cartilage damage, chondromalacia patella, or arthritis after a quadricep tendon repair surgery?

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The following is an actual conversation between an iCliniq user and a doctor that has been reviewed and published as a Premium Q&A.

Answered by

Dr. Ruchi Sharma

Medically reviewed by

iCliniq medical review team

Published At January 4, 2023
Reviewed AtOctober 5, 2023

Patient's Query

Hello doctor,

I underwent quadriceps tendon repair surgery last year. After that, as per the magnetic resonance imaging (MRI) finding, I developed patchy marrow edema in the patella and lateral femoral condyle. However, MRI does not mention articular cartilage damage, chondromalacia patella, or arthritis in the reports. I have been running for the last 15 years till six months before the surgery. Please inform me if there are any indications of articular cartilage damage, chondromalacia patella, or arthritis in the MRI images attached herewith. Also, please inform me of any other material finding in the MRI, throwing light upon the possible reasons for the marrow edema or any other material finding noticed by you in the images.

Answered by Dr. Ruchi Sharma

Hello,

Welcome to icliniq.com.

I read your query and can understand your concern. So I went through your MRI (magnetic resonance imaging) images (attachment removed to protect the patient's identity) and made additional observations.

1. There is evidence of thinning and irregularity of the patellar articular cartilage (evident on sagittal cuts) along with abnormal PDFS (proton density fat saturated) signal within this cartilage (evident on axial cuts, see the second set of images, fourth image from the left) suggestive of chondromalacia patellae.

2. Chondromalacia patellae can result in patella alta or a high-riding patella, for which I need to make a few measurements requiring images in a DICOM (digital imaging and communications in medicine) format. However, measurements are impossible since you have uploaded scanned images of films provided by the laboratory. Also, I would like to know if these are the only images provided by the laboratory?

3. There is no obvious evidence of arthritic changes in the images provided. Please note that edematous changes in bones and myofascial tissues can be post-operative or post-traumatic. Changes can last anywhere from six to eight months up to a year. I hope this helps.

Thanks and take care.

Patient's Query

Hello doctor,

Thanks for the reply. I also have a compact disc (CD), but I am unsure if the CD image (ISO file) can be uploaded. However, I can come for an in-person consultation at your clinic address. Please let me know if it is advisable.

Answered by Dr. Ruchi Sharma

Hello,

Welcome back to icliniq.com.

I read your query and can understand your concern. You can try uploading the CD (compact disk). It might work. I hope this helps.

Thank you.

Patient's Query

Hello doctor,

That will be fine.

Answered by Dr. Ruchi Sharma

Hello,

Welcome back to icliniq.com.

You can upload the file on google drive and I can try opening it. Let us see if this works. As regards other queries; Osteonecrosis in its initial stage presents as bone edema on magnetic resonance imaging (MRI). Though there is evidence of distal femoral edema in your MRI images it could be posttraumatic or post-inflammatory. Other changes seen in osteonecrosis such as deformity of the femoral head and flattening are seen as the disease progresses. None of this is seen here at present. A dual X-ray absorptiometry (DEXA) scan is indicative of osteopenia for which bisphosphonate is given. Bone scan report indicates likely metabolic disease for which you can see an endocrinologist. You might or might not have a metabolic disorder. I say this because many different disorders have similar imaging features. In order to come to a particular diagnosis clinical correlation and blood workup is necessary. I hope this helps.

Thank you.

Patient's Query

Hello doctor,

I have uploaded the file of MRI. This was done a few days before the surgery. I am also uploading the report herewith. A noteworthy point in the report is that it said minimal articular cartilage erosion. Please along with patella alta, also check for tendinosis severity (grading), especially in comparison to pre-surgery status. My main issue is non-receding swelling or thickening in the patellar insertion area of the quad tendon leading to discomfort and pain while climbing and jumping (which might be because of tendinosis and or chondromalacia patellae), dull pain in the knee region (which might be because of bone marrow edema or chondromalacia patellae), and failure to fire up quad muscle in spite of physical therapy. The bone scan report mentions soft tissue thickening in the patellar insertion area of the quad tendon. Please throw some light on that also. Is it tendinosis or something else?

Answered by Dr. Ruchi Sharma

Hello,

Welcome back to icliniq.com.

So I was able to access your files (attachment removed to protect the patient's identity). As compared to the pre-surgical magnetic resonance imaging (MRI), the recent MRI also shows abnormal PDFS hyperintense signal in the distal portion of the quadriceps tendon, near its insertion over the patella and in the soft tissues anterior to it (findings are similar to the ones seen in the earlier MRI done) these are suggestive of tendinopathy with adjacent soft tissue edema. But it would be difficult to say whether these changes are purely from earlier post-traumatic periods (pre-surgical) or post-surgical. Few findings might be pre-surgical with some superadded changes in tissues occurring due to surgical interventional done later. Therefore, in quantitative terms, one might not see much change in imaging for a certain period following the surgery. I suggest you see your orthopedic and discuss with him or her regarding this. Note: No Patella Alta is noted.

Thank you.

Patient's Query

Hello doctor,

I had taken a platelet-rich plasma (PRP) injection two months ago, which the then orthopedic told me was a strong dose. Then I changed the orthopedic. I think the earlier PRP injection did the damage. Because initially, it was an interstitial tear only. But it seems the new orthopedic who did the surgery only repaired the visible tear and did not take care of the tendinopathy fully.

Answered by Dr. Ruchi Sharma

Hello,

Welcome back to icliniq.com.

PRP therapy does help in wound healing. Any medical treatment for muscles and joints does need supportive rehabilitative therapy. A good physiotherapist should be able to help.

Thank you.

Patient's Query

Hello doctor,

I have done physiotherapy for almost eight months. Four months before surgery and four months post-surgery. This seems to be incurable. My present doctor, who did the surgery, has now asked me to do isometric exercises only for now. I had a query that whether the soft tissue thickening mentioned in the bone scan report is tendinopathy or something else. I know it wud be difficult for you to make a suggestion without seeing the images, but a guess will also do. I am quoting the exact report wordings below- soft tissue thickening is noted at the distal end of the right quadriceps tendon at the site of insertion.

Answered by Dr. Ruchi Sharma

Hello,

Welcome back to icliniq.com.

The soft tissue thickening mentioned in the bone scan report is probably the soft tissue edema that is noted in the pre-patellar region on your magnetic resonance imaging (MRI). The probable diagnosis is tendinopathy.

Thank you.

Patient's Query

Hello doctor,

By any chance, is there any indication, whatsoever, of any bone cancer or any other cancer in the magnetic resonance imaging (MRI)? I had a carcinoembryonic antigen (CEA) and was diagnosed with Crohn's disease or IBD (inflammatory bowel disease) (no cancer of any kind). Since then, CEA has dropped to normal. All tests with respect to connective tissue disorder done last year also came negative except anti nuclear antibody (ANA), which was borderline positive, but the rheumatologist I consulted ruled out connective tissue disorder, still, it is better to reassure.

Answered by Dr. Ruchi Sharma

Hello,

Welcome back to icliniq.com.

There is no evidence of any mass lesion at present in the parts of the bones and soft tissues that have been scanned therefore do not worry about that account.

Thank you.

Patient's Query

Hello doctor,

Thank you.

Answered by Dr. Ruchi Sharma

Hello,

Welcome back to icliniq.com.

You are welcome.

Thank you.

Patient's Query

Hello doctor,

I am attaching my MRI reports. Kindly review.

Answered by Dr. Ruchi Sharma

Hello,

Welcome back to icliniq.com.

Based on the images provided by you and the magnetic resonance imaging (MRI) report, the observations mentioned are similar to what I see. PDFS hyperintense signal that is noted in the patellar articular cartilage could be due to edema or mild degeneration caused by wear and tear/ trauma. Please consult an orthopedic for further course of action. There is no tear in tendons or ligaments around the joint.

Thank you.

Patient's Query

Hello doctor,

Please answer the following questions:

1) Is marrow edema present in the lateral femoral condyle region? Is there any reduction in that region? (this question is important)

2) Also according to you though there is a mild reduction in marrow edema in the patellar region, the marrow edema is still present. Am I correct?

3) Is tendinosis the same as last time or is there any improvement?

Answered by Dr. Ruchi Sharma

Hello,

Welcome back to icliniq.com.

In the present MRI;

1) Lateral femoral condyle edema has resolved.

2) Mild reduction is seen in the patellar edema, it is less than before.

3) Mild tendinosis is still seen, it appears almost the same as seen last time.

Thank you.

Patient's Query

Hello doctor,

Can you please analyze the skyline X-ray view of both knees for patella positioning and comparison? I have attached the X-ray for your reference. The physiotherapist has told me that the patella in the right knee is tilted more than natural and is the cause of patella maltracking and thus PFPS (patella femoral pain syndrome). Whereas I do not see much difference between patella positioning in the right and the left knee. I think whatever patella maltracking (if any) is happening is because of weak quadriceps muscle especially quadriceps tendinosis.

Answered by Dr. Ruchi Sharma

Hello,

Welcome back to icliniq.com.

Both patellae are in their normal position in this X-ray (attachment removed to protect the patient's identity).

Thank you.

Patient's Query

Hello doctor,

Not well enough. Tendinosis is sticky, which is prohibiting quad muscle firing as well. Thanks for the reply.

Answered by Dr. Ruchi Sharma

Hello,

Welcome back to icliniq.com.

Well, I can understand. Musculoskeletal injuries sometimes take a long time to heal and it is never a 100 % recovery. I hope you get better soon.

Thank you.

Patient's Query

Hello doctor,

In reference to the MRI images provided earlier, I have three queries:

1. Is there any fusieform thickening? If yes, where exactly?

2. Is there any fibrosis? If yes, where exactly?

3. Is there any calcification in the quad tendon (calcific tendinosis) or anywhere else? If yes, where exactly?

Answered by Dr. Ruchi Sharma

Hello,

Welcome back to icliniq.com.

I hope you are well. No obvious fibrosis or calcification is noted on the magnetic resonance imaging (MRI).

Thank you.

Patient's Query

Hello,

I am trying to regain normality but have not succeeded till now. Please see the attached image. The thickening as shown in a black circle is the cause of limited motion and pain at the time of movement. Shock wave therapy has not helped in breaking and realigning it. Can this thickening be reconciled in the MRI? What exactly is it? I assumed it to be scar tissue/fibrosis, but as you say there is none.

Answered by Dr. Ruchi Sharma

Hello,

Welcome back to icliniq.com.

It is difficult to assess skin from a picture (attachment removed to protect the patient's identity). My advice would be to get a physical assessment done by a physician.

Thank you.

Same symptoms don't mean you have the same problem. Consult a doctor now!

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Dr. Ruchi Sharma

Radiodiagnosis

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