SYMPTOMS Gradual onset of diffuse or localised exercise-induced pain at the lateral aspect of the knee without preceding trauma. It is most common in long-distance runners and is often labelled 'runner's knee'.
AETIOLOGY This is a stress reaction; periostitis often combined with bursitis at the insertion of the iliotibial tract at the distal lateral femur condyle from excessive jumping or running exercises. This condition typically occurs as a result of sudden changes in training habits, such as increase in intensity or amount of impact. CLINICAL FINDINGS There is tenderness on palpation over the distal iliotibial tract at the distal lateral femur condyle, aggravated by pressing and flexing-extending the knee while pressing the insertion to the bone.
INVESTIGATIONS X-ray is normal. MRI may show superficial sub-chondral oedema or associated bursitis and can usually exclude a stress fracture. Ultrasound is also helpful in the
Fig. 104 Press with fingers over distal ITB whilst the player flexes and extends against resistance. If pain occurs the test is positive diagnosis. Repeating the clinical test before and after 1 ml of local anaesthetic is injected to the painful spot usually helps make the diagnosis clear.
TREATMENT This injury most often responds to conservative treatment including modification of training and stretching exercises of the iliotibial tract over three months. There is seldom any indication for immobilisation or surgery but if the symptoms persist for more than six months, a mini open release of the insertion and removal of the bursa may be indicated.
REFERRALS Refer to physiotherapist for planning of a three months' return programme back to sport. Refer to orthopaedic surgeon if non-operative treatment fails.
EXERCISE PRESCRIPTION Cycling and water exercises are good alternatives to keep up general fitness.
Normal clinical symptoms and signs. DIFFERENTIAL DIAGNOSES Popliteus tenosynovitis (effusion, positive resistance test), stress fracture (MRI differentiates), lateral meniscus tear (effusion and positive compression test), posterior lateral corner instability (previous trauma). PROGNOSIS Excellent.
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