Patient Positioning
Primary (recommended) position: the patient is placed in a supine position on the examination table with the knee flexed at 20–30 degrees, supported by a triangular cushion under the popliteal fossa. The hip should remain in a neutral position, avoiding rotation. It is essential that the quadriceps muscle is completely relaxed to optimize visualization of the tendinous structures.

Alternative position: the patient may sit on the edge of the examination table with the feet resting on a stool and the knee flexed at 90 degrees. This position facilitates access to the anterior structures and allows for dynamic maneuvers during the examination.

Anatomy to Identify

• Quadriceps tendon (lesions, musculotendinous junction, tendinitis)
• Suprapatellar bursa (simple/complex bursitis, synovial thickening, loose bodies)
• Patella (macroscopic alterations, erosions, bipartite patella, fractures)
• Patellar tendon (lesions, tendinitis, insertional enthesopathy)
• Infrapatellar bursa (tendinosis, lesions, bursitis, fat pad changes)
• Inferomedial region – Pes anserine bursa

Probe
A high-frequency linear transducer (7–12 MHz) is essential for evaluating the superficial structures of the knee.
Accurate scanning technique is crucial to avoid anisotropy and potential diagnostic errors.
Beam steering or compound imaging may help reduce anisotropy in linear structures such as tendons.
Good color, power, and Doppler sensitivity are required to assess the vascularization of the structures.
It is advisable to adjust the transducer frequency to adequately examine both superficial and deeper structures.