muscle/tendon "snap" or "catching" sensation inside knee

[casual runner]

I've been doing conservative treatment for meniscus tears in my left knee for 10 months now. Still not sure if I can avoid surgery or not. But recently an even more annoying problem arose. I started feeling a "snapping" or "catching" sensation inside the left knee. After seeing two orthopedists and a physical therapist, nobody can say 100% sure exactly what is happening, but it appears that the muscles or tendons such as the gracilis or sartorius or semitendinosus muscles or their associated tendons are irritated or hardened and catching on each other instead of slipping by smoothly. The MCL was mentioned, but I'm not sure it is involved. The "catching" or "snapping" occurs just above the joint line on the inside of the knee. It doesn't hurt much, the general area is not swollen (I have some slight swelling that I cant eliminate entirely due to the meniscus), but the sensation is unbearably annoying. Just wondering if anyone else has experienced this, i can't find much information on it on the web. I'm icing it and stretching it, but it's not going away, and no better solutions have been offered. I feel that horrible snapping whenever I bend or straighten my knee, and its driving me nuts!! I thought it was the meniscus catching but I've been told by everyone who examined it that its above the meniscus.

[casual runner]

Oh yeah, one more little thing.


HEEEEELLLLPPPPPPPPP!!!! 

[knee2no]

How do you know its a meniscus tear? Is your meniscus tear in the medial or lateral meniscus and is the catching on the same side?

[casual runner]

I was told by several doctors I have a tear or tears in one or both compartments-lateral and medial. My knee swelled up last March, and I showed the classic symptoms of a tear according to them. I also had an MRI.

I'm told the worse tear is on the medial side, the same side where this catching/snapping is. But the snapping is pretty obviously not coming from the meniscus, though that was my initial fear 2 doctors and one PT say its not and I'm started to agree with them. It feels exterior to the joint itself, and you can feel the tendon "snap" with your fingers when I flex or extend the leg.

[Runner1993]

Maybe plica syndrome? Just an idea to look into...

[casual runner]

Maybe plica syndrome? Just an idea to look into...

Thanks for that idea. I read up on that and while there are some similarities, I don't think its my problem. I will keep it in mind though.
I don't think they can make a definite diagnosis of tendon snapping without doing an ultrasound. So far nobody has suggested it but I may have to ask for it. I keep hoping it just goes away as quickly as it came.

[allyd]

I think I have something similar going on with my knee. Like you say it snaps on the medial side a bit whenever I extend my knee, no pain or anything, just more annoying. This happened presurgery and postsurgery for me - so ongoing for 1.5 yrs now. Lately, I've notice it seems to dissapear when my knee is warmed from activity, biking, running, etc. Originally I thought it was something with my meniscus, or loose cartilage that needed to be cleaned out.

Well, after my scope came back clean, I asked my OS about it at one of my post op appointments. When I showed her where it was and she felt what was happening (because you can feel it catch) she quickly said "that's not on the 'inside' of your knee, but more superficial, and likely the hamstring tendons catching/snapping across the femur as you extend" I asked if it was going to cause problems, and she deferred a bit by simply saying "we'll see" I probed a little more but still got the "we'll see". I kind of got the impression it's not something they worry about to much as long as it's not causing pain? Actually, not sure I've ever seen or heard of a fix?

[casual runner]

"well see", good non-answer hehe. I dont think is something they encounter very often. When I asked my orthopedist what can be done about it he changed the subject.

If you google "snapping semitendinosus" and "snapping pes syndrome" you'll find a few references on this problem. It can be cured
with tendon surgery if all else fails, but I'm not too keen on that idea just yet. My PT has me doing some exercises to try to increase involvement of the other side of the hamstrings to reduce possible overuse on the snapping side. Too soon to tell if it helps.

This site talks about "snapping knee syndrome" which appears to be the same as "snapping pes syndrome"

http://www.ajronline.org/content/188/1/W63.long

This one shows surgical photographs (take that as a warning-I'm pretty squeamish but the pics are B&W so they dont bother me) of the procedure. That one appears to be one of the first reports on this issue in the medical literature. There are a couple more recent ones I've posted below it. I haven't read those yet.

http://www.joint.idv.tw/04/pub/snapping%20syndrome%20caused%20by%20the%20semitendinosus%20tendon.1989.pdf

Bollen SR, Arvinte D. Snapping pes syndrome: a report of four cases. J Bone Joint Surg Br. 2008; 90:334-5.

 Karataglis D, Papadopoulos P, Fotiadou A, et al. Snapping knee syndrome in an athlete caused by the semitendinosus and gracilis tendons. A case report. Knee. 2008;15:151-4.

[allyd]

Thanks for the info… I’ll read up on it. It was completely a non-answer by my OS. The non-answer of “I know exactly what’s wrong, but I’m not going to tell you, because it’s not something I want to deal with unless it becomes a major issue”

AND, to be honest… I kind of see it as a non-issue as well. It doesn’t cause me pain and I’m hoping as I continue to rehab it will disappear. Given all the other problems I’ve worked through, this is relatively minor to me at this point – not something I’d let them cut me open for again. But it sounds like yours may be causing you more pain/problems and definitely worth the probe with your OS. 

[casual runner]

Mine doesn't hurt too much, per se...It is just unbelievably annoying, and I take pains to avoid having it happen. Going up stairs for example, I will either go stiff legged on that knee or I will do a quick "high step" to get past the snap quickly rather than go through the slow process of feeling it catch, tighten (like drawing a bowstring back!) as I bend, then SNAP! It seems worse when I'm tiring, at the end of a walk or at the end of the day.

Fortunately it only happens when I bend the knee past a certain point, about 25-30 degrees. It doesn't do it when I'm walking on flat level surfaces.

[aaa]

just a word of advise ... i would try to get direction if it is safe to work through the snapping / catching while trying to progress with PT ... even if the snapping is annoying

modifying movement pattern to get around the snapping can lead to new problems ... muscles can get retrained to work differently, and end up being inhibited ... and believe me, that is not a fun problem to deal with

[casual runner]

just a word of advise ... i would try to get direction if it is safe to work through the snapping / catching while trying to progress with PT ... even if the snapping is annoying

modifying movement pattern to get around the snapping can lead to new problems ... muscles can get retrained to work differently, and end up being inhibited ... and believe me, that is not a fun problem to deal with

Absolutely excellent advice, that's part of why this is bothering me so much because I don't want to retrain myself to do things the wrong way. That may be part of the reason this started in the first place.  I'm waiting to see what they have me do in PT this week. The PT I saw last Friday sounded like he might want to back off the knee strengthening exercises (which seem to be working for the mesniscus pain, at least a little bit) in favor of resting that medial hamstring and working the other one more...

[allyd]

Definitely sounds like it is more bothersome for you. It sounds exactly the same as me, I will feel it catch at about 20 degrees when extending my knee – but not when I flex. Nothing about it causes me to modify my activity – which for me would be the first sign it needs to be addressed in some form, whether it’s a different PT program, rest, or something else.

I remember my PT also noted I seemingly have some chronic swelling in the area/fat pad which could be contributing to the tendon catching… Just wondering if the swelling from your meniscus maybe is causing some of it? Just a thought, nothing to base it on in terms of fact…

[casual runner]

I do think there is meniscus involvement, whether it be swelling from the meniscus area or more direct contact with the tendons. The epicenter of the snapping tendon (if thats what it is) seems to be right at the joint line. Maybe the tendons are catching the edge of the meniscus somehow. Or maybe it is the meniscus snapping, and it's just transmitting that to the tendons by contact.  I'm very discouraged today. I think I have to get arthroscopy. 

[casual runner]

I'm very happy to say that the snapping has improved/decreased considerably. I only feel it occasionally when tired or when the knee swells a bit (which may be when I'm tired). I never feel it when going up stairs anymore.

I wish everything else was going as well, but that was the most annoying part of my knee condition and I'm glad it is almost gone.
I believe the meniscus issue is also improving though and that probably has resulted in less swelling and less snapping.