Jesse Parsons
Recently in clinic I evaluated a 14 yo girl who was complaining of anterior knee pain just below the apex of her patella. Originally, my CI believed that she most likely had patellar tendinopathy. As I listened to her subjective history, though, it became apparent that her pain was most likely stemming from other problems. She had sustained a fall in gym class where she landed on her patella on a wooden floor. While observing her standing posture and her walking form, it became apparent that she tended to stand with genu recurvatum and her knee went into excessive hyperextension during gait. She also had pain with end-range knee extension, but not with passive knee flexion or active knee extension. This led me to believe that patellar tendinopathy was less likely. I palpated the inferior pole of her patella where the patellar tendon attaches, and she said that it was not painful. She did have pain, however, when I palpated inferiorly along the tendon. I then remembered the fat pad that lies beneath the patellar tendon, because we had just learned about it in class that week. I palpated beneath the tendon and she reported a large increase in pain. This led me and my CI to believe that her pain was most likely stemming from her patella digging into her fat pad as she stands in knee hyperextension. It was really cool being able to apply knowledge from class in such a quick and relevant way.