AIM: To propose a standardized, high-resolution ultrasound (US) protocol to assess the patellar tendon-Hoffa fat pad interface (PTHFPI) in patients with (proximal) patellar tendinopathy (PPT). METHODS: Using a high-frequency transducer and a high-level machine, we matched the cadaveric and histological microarchitecture of the PTHFPI with multiple sonographic patterns of patients with PPT. Likewise, high-sensitive color/power Doppler assessments were also performed to evaluate the microcirculation of the soft tissues beneath the patellar tendon. RESULTS: Modern US equipment allows for detailed assessment of the potential pain generators located inside the PTHFPI in patients with PPT. They include anterosuperior portion of the Hoffa body and the loose connective tissue of the deep paratenon with its microvascular plexus. CONCLUSIONS: In patients with PPT, accurate sonographic assessment of the PTHFPI can be performed using adequate technological equipment. Accordingly, tailored ultrasound-guided interventions can also be planned if/when clinically indicated.

Department of Neuroscience Imaging and Clinical Sciences Gabriele d'Annunzio University of Chieti and Pescara Chieti Italy

Department of Physical and Rehabilitation Medicine Hacettepe University Medical School Ankara Turkey

Department of Physical Medicine and Rehabilitation and Community and Geriatric Research Center National Taiwan University Hospital Bei Hu Branch Taiwan

Department of Rehabilitation Medicine 1st Faculty of Medicine Charles University and General University Hospital Prague Czech Republic

Institute of Anatomy 1st Faculty of Medicine Charles University Prague Czech Republic

Physical and Rehabilitation Medicine Unit Luigi Sacco University Hospital ASST Fatebenefratelli Sacco Milan Italy

Physical Medicine and Rehabilitation Centro Hospitalar de Lisboa Ocidental EPE Lisboa Portugal

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