In this article, we will discuss the phenomenon of knee snapping due to thin muscle injury.
I believe that learning about cases is essential for learning about diseases that you may encounter in clinical practice.Knowing what kind of case, what kind of treatment, and what kind of outcome is important to extend the basic knowledge of the disease.In this article, I would like to introduce a case report of knee snapping phenomenon, which was caused by a thin muscle tendon.
Case
A 30-year-old woman.
She complained of pain as her main complaint for two years, and the snapping phenomenon occurred on the inner side of her left knee without any injury in the past.
At another clinic, she was diagnosed with suspected meniscus injury by arthroscopy, but the examination did not confirm meniscus injury.On physical examination, a snap was observed at the posterior medial angle of the medial femoral condyle at approximately 30° of flexion during active and passive flexion/extension.The snapping was palpable and the tendon's inversion motion appeared to move posteriorly during flexion and anteriorly during extension on the medial femoral condyle.There were no findings indicating damage to the meniscus or ligaments.On imaging studies, anteroposterior weight-bearing radiographs showed normal coronal alignment, and CT of the extremities showed no abnormal findings or changes in the flexor tendons and bones that would identify a tendon rupture.Root sagittal and coronal plane MRI of the knee showed no significant changes.Based on the results of the physical and imaging studies, snapping of the medial hamstring tendon was attributed as the cause of the symptoms.
Gross observation of the thin muscle tendon at the time of surgery did not reveal any abnormal findings such as tendon injury, thinning, hypertrophy, or scar formation.Considering the persistent discomfort and disability caused by the snapping phenomenon, surgical treatment was indicated.During the surgery, which was performed under general anesthesia, the snapping phenomenon could not be reproduced.However, the thin muscle tendon was observed to move beyond the posterior border of the medial femoral condyle during flexion/extension of the knee.
No bony abnormality such as local prominence or elevation was identified.Based on these intraoperative findings, it was thought that the cause of the symptoms was reversal of the thin muscle tendon at the posterior medial angle of the femoral condyle.The thin muscle tendon was cut at the level of the medial femoral epicondyle, and the proximal cut end was sutured to the adjacent semitendinosus tendon in a proximally retracted position.After the surgery, the snapping phenomenon was resolved, but the result was not clearly different from the preoperative condition.And the snapping phenomenon recurred 5 months after the surgery.
What we can learn from this case
There are individual differences in the pathway of the thin muscle, and in this case, the thin muscle tendon was running in a position that was not considered physiologically possible.
Frequent movements can cause tendon subluxation and tendonitis.
In the case of the abnormally running tendon, surgical treatment is available to suture the target tendon to another tissue.
Conclusion
I read this case report with the thought, "What if I were to see this in my clinical practice? This was a case report that I read with the feeling that "I don't know, but I think I would have encouraged the patient to go to a specialized institution for imaging without knowing.The snapping phenomenon can also occur in other joints, and is caused by intra-articular tumors, synovial plica, ligament friction, tendon subluxation, etc.This was a case where I learned that if you are only concerned about tissue damage, you may not be able to notice the different pathways of travel, such as subluxation.
JY Dupont
Synovial plica of the knee. Controversy and review.
CLIN Sports Med, 16 (1997 ), pp. 87 - 122
Download the article PDFView the record in ScopusGoogle Scholar
2
MJ Kissenberth , JH Wilckens
The snapping biceps femoris tendon.
Am J Knee Surg , 13 (2000 ), p. 25 - 28
View the record in ScopusGoogle Scholar
3
BR Bach, K. Minihane.
Subluxating biceps femoris tendon: an unusual case of lateral knee pain in a soccer player. A case report.
Am J Sports Med, 29 (2001 ), pp. 93 - 95
View record in CrossRefScopusGoogle Scholar
4
F. Lokiec , S. Velkes , A. Schindler , M. Pritsch.
Snap biceps femoris syndrome.
CLIN Orthopaedics Relat RES , 283 (1992), pp. 205 - 206.
View record in ScopusGoogle Scholar
5
SR Liu, JJ Wu.
Snapping syndrome caused by the semitendinosus tendon. A case report.
J Bone Joint Surg Am, 71 (1989 ), pp. 303-305
View record in CrossRefScopusGoogle Scholar
6
M. Kuehne , N. Boniquit , N. Ghodadra , AA Romeo , MT Provencher
Snapping of the scapula: diagnosis and treatment.
Arthroscopy, 25 ( 2009 ), pp. 1298 - 1311
Download the article PDFView the record in ScopusGoogle Scholar
7
RJ Spinner, RD Goldner, RA Fada, DG Sotereanos.
Snapping of the triceps muscle over the lateral epicondyle.
J Hand Surg Am, 24 (1999), pp. 381 - 385
Download the article PDFView the record in ScopusGoogle Scholar
8
B. Zacchaeus, L. Desmet, G. Fabry.
Loosening of the body and breaking of the wrist. Arthroscopic diagnosis and treatment.
Arthroscopy, 9 (1993 ), pp. 117 - 118
Download the article PDFView the record in ScopusGoogle Scholar
9
VM Ilizaliturri Jr, C. Chaidez, P. Villegas, A. Briseño, J. Camacho, Galindo.
A prospective randomized trial of two different techniques for endoscopic iliopsoas tendon release in the treatment of internal snapping hip syndrome.
Arthroscopy, 25 (2009 ), pp. 159 - 163
Download the article PDFView the record in ScopusGoogle Scholar
10
GJ Sammarco , C. Henning.
The peroneus tertius muscle as a cause of snap and ankle pain: a case report.
Am J Sports Med, 35 (2007 ), pp. 1377 - 1379.
View record in CrossRefScopusGoogle Scholar
11
SC Dickhaut , JC DeLee
Discoid lateral meniscus syndrome.
J Bone Joint Surg Am, 64 (1982), pp. 1068 - 1073
View record in CrossRefScopus Google Scholar
12
D. Karataglis , P. Papadopoulos , A. Fotiadou , AG Christo.
Snapping knee syndrome in athletes caused by semitendinosus and thin muscle tendons. A case report
Knee, 15 (2008), pp. 151 - 154
Download the article PDFView the record in ScopusGoogle Scholar
13
DK Bae, OS Kwon.
Knee snapping caused by tendons of the thin and semitendinosus muscles. A case report.
Bull HOSP JT Dis, 56 (1997 ), pp. 177 - 179
View record in ScopusGoogle Scholar
14
SR Bollen , D. Arvinte
Snapping peas syndrome: a report of four cases.
J Bone Joint Surg Am, 90 (2008 ), pp. 334 - 335
Google Scholar View Full Record in Scopus
15
AG Geeslin , RF LaPrade
Surgical treatment of the snapping medial hamstring tendon.
Knee Surg Sport Traumatol Arthrosc, 18 (2010), pp. 1294-1296
View record in CrossRefScopus Google Scholar
16
K. Eriksson , LG Kindblom , P. Hamberg , H. Larsson , T. Wredmark.
The semitendinosus tendon regenerates after resection: morphological and MRI analysis in six patients after resection for anterior cruciate ligament reconstruction.
Acta Orthopaedica Scand, 72 (2001 ), pp. 379-384
View record in ScopusGoogle Scholar
