Disclosures: Bo Song, MD: Nothing to disclose

Case Description: The patient presented with a “pop” and right hip and knee pain after sharply pivoting while standing. He experienced locking, decreased knee range of motion, weakness, swelling, night-time pain, and right foot numbness/tingling. Initial x-rays were negative.

Setting: Outpatient Clinic

Patient: 49-year-old male with no medical history.

Assessment/Results: Knee examination demonstrated medial joint line tenderness, crepitus, deep pain with knee flexion, and positive McMurray’s test. Hip examination revealed diminished right hamstring strength, tenderness in the iliac crest, ASIS/AIIS, ischial tuberosity/hamstrings, and positive Ely, Scour’s, and FABER tests. Diagnostic ultrasound discovered a right sartorius, right medial meniscus, and a partial thickness right semimembranosus insertion tear with intra-sheath retraction and tendinopathy at the medial femoral condyle with continuity of the anterior and posterior fibers. It also showed a lobular cyst measuring 1.5 cm² at the joint line resulting in a communicating posterior horn of the medial meniscus. He was scheduled for a para-meniscal cyst aspiration which he tolerated well with symptomatic improvement.

Discussion: Meniscal cysts are most commonly associated with meniscal tears and are often located at the joint line with concurrent hydrarthrosis. Common physical exam findings can include joint line tenderness and a positive McMurray’s test. While the previously preferred treatment was open drainage with or without total meniscectomy, extraarticular drainage in addition to arthroscopy is now comparable to arthroscopy alone. Semitendinosus injuries are usually associated with noncontact activities involving rapid acceleration/deceleration such as competitive sprinting, most likely due to the abundance of type 2 muscle fibers. This typically presents as acute pain and sharp popping with tenderness in the distal posterior thigh which can manifest as posterior/medial knee ecchymosis and knee flexion weakness.

Conclusion: Noncontact injuries causing hip and knee pain should raise concerns for possible semitendinosus tendinopathies/tears and meniscal cysts, both of which can be visualized on ultrasound.

Level of Evidence: Level V

« Back to AAPM&R Annual Assembly 2019

PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/concomitant-presentation-of-an-intraarticular-perimeniscal-cyst-and-extraarticular-semitendinosus-tendinopathy-tear-a-case-report/