Evaluation and Management of Knee Popping

Clinical Significance and Diagnostic Approach

• The American Academy of Orthopaedic Surgeons recommends that popping sensations in the knee be evaluated, especially when accompanied by other symptoms such as pain, swelling, locking, or giving way, as they may indicate underlying pathology such as osteochondritis dissecans (OCD), meniscal tears, or patellofemoral disorders 1, 2, 3
• When popping occurs with pain, swelling, locking, catching, or giving way, further evaluation with appropriate imaging is recommended by the American College of Radiology 1, 4
• For patients with knee popping accompanied by pain, swelling, locking, or giving way, radiographs (AP, lateral, sunrise/Merchant, and tunnel views) are recommended as the initial imaging modality by the American Academy of Orthopaedic Surgeons 1, 4
• Physical examination should assess for joint effusion, tenderness, loss of motion, and crepitus, which may accompany popping sensations, as suggested by the American Academy of Orthopaedic Surgeons 1, 5

Advanced Imaging and Management

• If radiographs reveal an OCD lesion or other structural abnormality, MRI is an appropriate next step to further characterize the lesion and evaluate for concomitant pathology, according to the American Academy of Orthopaedic Surgeons and the American College of Radiology 2, 6
• MRI is particularly valuable when initial radiographs are normal but symptoms persist, as it can detect meniscal tears, articular cartilage damage, and bone marrow lesions that may be associated with popping, as recommended by the American College of Radiology 6
• For popping associated with OCD, management depends on skeletal maturity and lesion stability, as suggested by the American Academy of Orthopaedic Surgeons 3, 7
• Surgical intervention may be necessary for unstable OCD lesions or severe traumatic meniscal tears causing mechanical symptoms, according to the American Academy of Orthopaedic Surgeons 3
• Popping that occurs after significant trauma requires prompt evaluation to rule out serious injury, as recommended by the American College of Radiology 8