THE CORRELATION OF BONE-SCINTIGRAPHY AND HISTOLOGICAL-FINDINGS IN PATELLAR TENDINITIS

Patellar tendinitis is a chronic overuse injury causing pain and tende rness over the proximal insertion of the patellar tendon. Its manageme nt is usually conservative, but in intractable cases surgery is effect ive. Bone scintigraphy has been suggested as a useful investigation in these patients, although we are aware of no large series supporting t his. Thirty-four patients with intractable symptoms of patellar tendin itis were treated surgically. The operative specimens were graded hist ologically and compared with preoperative radionuclide bone scans. The histological findings confirmed tendon and or tendon sheath abnormali ties in all the samples. The predominant abnormalities were increased vascularity, fibroblast proliferation, acid mucopolysaccharide and hae mosiderin deposition. Bone scintigraphy showed 24 (71%) patients to ha ve abnormalities on the delayed images, 8 with diffusely increased act ivity in the patella and 16 with increased activity localized to the l ower pole. Patients with abnormal bone scans had significantly more se t ere histological changes in their tendons. These findings support th e use of radionuclide bone scans in the pre-operative assessment of pa tellar tendinitis correlating well with histopathological severity of the disease process. The 10 false-negative cases (29%), however, sugge st that bone scans are unhelpful in the routine diagnosis and manageme nt of this condition.