Question
Hi Dr Leatherman,

I experience this clicking within my right knee and some pain in the posteromedial side of my knee. Mainly on the posterior aspect of the medial femoral condyle. The pain comes only in certain positions that I take, for example getting out of the car, when the knee femur is slightly rotated on the tibia. The clicking occurs both during flexion and extension of the knee at the end ranges. When I do squats, it feels like something is locked in the knee as I squat lower and this occurs only after 90 degrees of flexion.

I am an javelin thrower and I haven't been training for a week preparing for exams and I experienced this clicking and pain after my exam few days ago. I hope it is not a serious problem as it will affect my career both as an athlete and professionally.

Hope to hear from you soon.

Best regards,
Johan

Answer
Dear Johan,

You need to get to an orthopedist to have this evaluated.  You are exhibiting the classic signs of a meniscus tear in the knee:  clicking, popping, and locking...you don't want to make the damage worse if it is actually there.  The most common place for this to occur is in the posterior horn of the meniscus, and often occurs in sports where this is a twisting in the knee joint. Is it in the knee where you plant to throw the javelin?

If you have access to an athletic trainer on your team, then get it evaluated there first.  There is a specific test called the McMurrays test which can evaluate the meniscus and is considered to be the hallmark orthopedic test to perform when you suspect a tear.  The trainer or ATC should know how to perform the test and what the implications are.  If the test is positive for pain, clicking or locking, then you need to get an MRI of the knee to look at the internal anatomy.  

This could be a torn meniscus, or a piece of cartilage in the joint space...either way, you may need to have surgery to remove the obstruction and repair any damage.  But here is the good news...these issues have a very favorable healing and success rate with surgical intervention, and your return to active sport should be uneventful with short term rehab.  Not to mention the surgery is often done with a scope to clean up the area and requires very little trauma to the joint...often patients can be up and walking the next day.

Bottom line is you need to have this assessed.  Sooner rather than later.  Good luck.

Respectfully,
Dr. J. Shawn Leatherman
www.suncoasthealthcare.net