Snapping Pes Syndrome Caused by the Gracilis Tendon: Specifi
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A 26-year-old man presented with acute right knee pain and restricted extension. Although snapping could not be reproduced due to severe pain, the snapping of the gracilis tendon could be specifically diagnosed using ultrasonography and lidocaine injection. Because of the failure of conservative treatment, surgery was performed. The distal attachment of the gracilis tendon was released, and the symptom disappeared quickly. There was no recurrence at the 10-month follow-up.

Physical examination showed no redness, swelling, or ballottement in the right knee; range of motion restricted to extension -20° and flexion 120° due to severe pain; and tenderness seen in the medial joint space and proximal part of the medial tibial condyle.

Only US(Ultra sonography) showed snapping of the gracilis tendon. It was not possible to reproduce the snapping symptom due to pain, but when each tendon of the pes anserinus was slid manually under US, the pain was reproduced only in the gracilis tendon. Thus, lidocaine injection was performed under US guidance. Since selective injection of the local anaesthetic to only the gracilis tendon allowed the patient to fully extend the knee without pain, SPS was diagnosed. However, the injection's effect disappeared in half a day, and severe pain reappeared. Therefore, surgery was performed.

Under general anaesthesia, gracilis tendon snapping was confirmed visually. The distal attachment of the gracilis tendon was released, and the snapping disappeared. Immediately after the surgery, the patient could walk and fully extend the knee without pain. There was no recurrence at the 10-month follow-up. The Lysholm score improved from 35 before surgery to 100 at 10 months after surgery. This is the first report that specifically diagnosed the responsible structure of SPS and that was treated with selective, minimally invasive surgery.

Source: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7066395/
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