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Objective:
Basketball players have one of the highest rates of patellar tendinopathy (PT) with a reported prevalence of up to 33%. Despite such high prevalence, there is no gold standard diagnostic criteria. There remains a need to effectively diagnose and monitor patellar tendinopathy, particularly in high-risk jumping athletes. This study of male collegiate basketball players aims to assess for change in patellar tendon (PT) morphology on MRI and US across a single season; to correlate patella tendinopathy grade on imaging to VISA-P scores; characterize non-PT-related knee pathology seen on MRI across a single season.

Materials and Methods:
26 male collegiate basketball players (mean age 19.7 years, range 18-21 years) were recruited for this IRB-approved study. Morphologic and qualitative US, MRI, and VISA-P questionnaire data were collected at the start and end of the basketball season. For 8 subjects, postseason data was not able to be collected due to the onset and continuation of the COVID-19 pandemic. A musculoskeletal radiologist graded patellar tendinopathy seen on MRI and US (0 = normal, 1 = mild, 2 = moderate, 3 = severe) and noted its location (proximal, distal). A Wilcoxon signed-rank test was performed to compare the average US and MRI grades at the pre-and post-season visits, accounting for leg dominance, and PT imaging grades were correlated to VISA-P scores using Spearman correlation coefficients. Non-PT-related pathology visible on knee MRI was also recorded at the pre-and post-season.

Results:
For US and MRI in both locations, morphology grades for every player either increased (worsened) or remained constant throughout the season. A statistically significant increase was found in average ultrasound morphology grades in the distal patellar tendon for dominant limbs (p = 0.046) at pre- (M = 0.67, s = 0.84) to postseason (M = 0.89, s = 0.90) and for non-dominant limbs (p = 0.034) at pre- (M = 0.44, s = 0.511) to postseason (M = 0.78, s = 0.732). Other imaging metrics showed similar trends of worsened morphologic grades, but none were significant. There were no statistically significant associations found between imaging morphology grades and VISA-P scores for any data points. At baseline, 81% (21) of non-dominant and 73% (19) of dominant limbs showed non-PT-related pathology. At postseason 72% (13) of non-dominant and 61% (11) of dominant limbs showed non-PT-related pathology. New non-PT-related pathology was recorded in 22% (4) of non-dominant limbs, and 39% (7) of dominant limbs.

Conclusion:
Our prospective study shows that both MRI and US detected worsening patellar tendinopathy in collegiate male basketball players across a single season. However, patient-reported VISA-P scores did not correlate, underscoring known limitations of conventional imaging techniques in characterizing patellar tendinopathy. Quantitative imaging modalities and other clinical assessments may be proposed to better characterize symptomatic patellar tendinopathy.