A 20-year-old elite judo athlete was seen for snapping at her left knee for the last two years. Herewith, she had increased concern after a recent contralateral anterior cruciate ligament (ACL) reconstruction five months ago. She had no history of trauma to her left knee that would impede participation in training or competition. Radiographs were normal, magnetic resonance imaging (MRI) showed only slight effusion between the popliteal tendon and the lateral femoral condyle. The medical history was otherwise noncontributory. During physical examination, the left knee had full range of motion, no pain or mechanical symptoms during meniscus pain provocation tests, and no laxity during ligament examination. The biceps femoris distal tendon was not painful with palpation. The only positive finding was snapping in active flexion and extension between joint angles of 30°-40°. Snapping was less upon passive movements. There was slight tenderness at the popliteal tendon insertion. Thereafter, static ultrasound examination [1] was performed and it was normal. During dynamic examination (as the patient lied prone on the bed), snapping of the popliteus tendon was observed (Video S1). Since her complaints were mild and after reassurance with `sono-feedback`, the patient denied surgery and was followed up conservatively that is, rigid taping during sportive activities. After examination, patient told that taping was applied by the team physiotherapist to support her knee stabilization. Taping did not help the feeling of the snapping sensation. She continued to feel snapping with her movements but she learned to ignore this feeling. The diagnosis of snapping popliteal tendon is challenging. Likewise, its differential diagnosis from other lateral compartment pathologies (e.g., lateral meniscal injury, iliotibial band syndrome, popliteomeniscal fascicle tear, snapping biceps femoris tendon, discoid meniscus, lateral collateral ligament injury, os cyamella, and loose condral body) is also quite difficult [2]. Routine physical examination or standard imaging techniques often fail to provide conclusive evidence. While further methods like diagnostic arthroscopy would be beneficial, they are not convenient. Herein, dynamic ultrasound examination appears to be quite demonstrative as regards the diagnosis as well as patient reassurance [3]. For sure, it should be kept in mind that user dependency of the ultrasound examination necessitates expertise especially during further/dynamic imaging. Due to the absence of visual material in the pertinent literature, we aimed to illustrate how dynamic ultrasound examination would be done and show the actual snapping. The contribution of this simple and straightforward examination/approach in the psychosocial well-being of elite athletes who suffer frequent trauma/injury leading to kinesiophobia, depression, anxiety, and catastrophizing would be paramount [4].
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