Disclosures: Hayden Franz, DO: Nothing to disclose

Case Description: A 21-year-old female respiratory therapy student presented with a 6-year history of right knee pain. Pain initially began in 2012 after fall with possible medial meniscus injury needing nonsurgical intervention. Previous imaging of MRI knee was limited due to artifact secondary to movement. Physical exam showed mild effusion and ecchymosis of right knee as well as pain with palpation of anterior patella, medial joint, and with varus stress. Snapping/popping was appreciated on the medial aspect of the knee with extension. Dynamic ultrasound performed in clinic demonstrated subluxation of semitendinosus across gracilis with snapping. Subsequent MRI knee showed increased edema at the gracilis and semitendinosus tendon interface consistent with tenosynovitis.

Setting: Outpatient Clinic

Patient: Previously healthy 21-year-old female.

Assessment/Results: Pt had diagnostic injection between semitendinosus and gracilis with almost complete relief of neuropathic sensations. Pt’s pain returned several weeks after diagnostic injection and eventually underwent hydrodissection with D5 W. Pt received significant relief of her symptoms 6 weeks post procedure without snapping.

Discussion: Snapping knee syndrome caused by gracilis and semitendinosus tendons is a very rare condition with very few cases reported throughout the literature. This case represents a rare diagnosis with limited evidence of effective treatment.

Conclusion: Snapping knee syndrome is a rare condition that can be diagnosed by using dynamic US in the clinical setting and confirmed by MRI and or diagnostic block. We found hydrodissection to be a good treatment option to help alleviate pain symptoms and snapping.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/unusual-cause-of-chronic-medial-knee-pain-in-a-healthy-21-year-old-female/