PMC5672657_01
Transverse ultrasound of gracilis tendon posterior to medial condyle - Case 1. A 31-year-old male with right knee pain. Transverse sonogram showing the gracilis tendon in flexion before snapping over the medial femoral condyle of the right knee. The top of the picture is medial, bottom is lateral, left side is anterior knee, and right is posterior knee. The dynamic ultrasound of this image is demonstrated in Supplemental Video 1.
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F1
Transverse ultrasound of gracilis tendon anterior to medial condyle - Case 1. A 31-year-old male with right knee pain. Transverse sonogram showing the gracilis tendon in knee extension after snapping over the medial femoral condyle. The dynamic ultrasound of this image is demonstrated in Supplemental Video 1.
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Dynamic ultrasound of the medial knee - Case 1, A 31-year-old male with right knee pain. With repetitive flexion and extension, the gracilis tendon is seen snapping posterior to anterior over the medial femoral condyle just deep to the sartorius muscle belly. The top of the video is medial, bottom is lateral, right is posterior knee, and left is anterior knee.
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A corresponding magnetic resonance imaging of the region where the snapping occurred is shown in Figure 3 for correlation, and an ultrasound of the normal contralateral knee is shown in Figure 4.
Medial right knee MRI correlation - Case 1. A 31-year-old male with right knee pain. The region of interest corresponding to ultrasound in Figure 1 showing the sartorius muscle belly (asterisk), gracilis tendon (arrow), and approximating hamstring musculature.
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Dynamic ultrasound confirmed snapping of the gracilis tendon deep to the sartorius muscle from posterior to anterior of the medial femoral condyle during repeated flexion and extension [Figures 6, 7 and Supplemental Video 4].
Normal left knee ultrasound - Case 1. A 31-year-old male with right knee pain. Contralateral normal left knee ultrasound showing the fixed gracilis tendon posterior and deep to the sartorius muscle belly. The top of the picture is medial, the bottom is lateral, left side is posterior knee, and right is anterior knee. Dynamic flexion and extension ultrasound of the normal knee is shown in Supplemental Video 2.
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The soft tissue snapping resolved postoperatively [Figure 5] as did his knee pain.
PMC5672657_02
Medial right knee MRI correlation - Case 1. A 31-year-old male with right knee pain. The region of interest corresponding to ultrasound in Figure 1 showing the sartorius muscle belly (asterisk), gracilis tendon (arrow), and approximating hamstring musculature.
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F4
Dynamic ultrasound confirmed snapping of the gracilis tendon deep to the sartorius muscle from posterior to anterior of the medial femoral condyle during repeated flexion and extension [Figures 6, 7 and Supplemental Video 4].
Dynamic ultrasound of the normal left knee - Case 1, A 31-year-old male with right knee pain. With repetitive flexion and extension, the contralateral gracilis tendon is seen posterior to the medial femoral condyle and deep to the sartorius muscle belly. The top of the picture is medial, bottom is lateral, left side is posterior knee, and the right is anterior knee.
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Dynamic ultrasound confirmed snapping of the gracilis tendon deep to the sartorius muscle from posterior to anterior of the medial femoral condyle during repeated flexion and extension [Figures 6, 7 and Supplemental Video 4].
Postoperative ultrasound - Case 1. A 31-year-old male with right knee pain. Postoperative ultrasound appearance of the right medial knee after sartorius and gracilis hamstring harvest. The gracilis tendon is now absent deep to the sartorius muscle and instead seen as a large hypoechoic retracted stump positioned more posteriorly (asterisks and arrow).
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F7
Dynamic ultrasound confirmed snapping of the gracilis tendon deep to the sartorius muscle from posterior to anterior of the medial femoral condyle during repeated flexion and extension [Figures 6, 7 and Supplemental Video 4].