A 26 year old male patient, previously healthy with a sedentary life, presented with lateral left knee pain after two weeks of intensive walking. On physical examination the patient presented with tenderness over the lateral femoral condyle and pain while flexing the knee. Remaining physical examination was unremarkable.
Magnetic resonance of the left knee was performed. The fatty soft tissues surrounding the iliotibial band, mainly between the iliotibial band and the lateral femoral condyle, present high signal on Proton Density (PD) with fat suppression (figure 1a and 2) and low signal on T1 weighted images (figure 1b) due to edema. There is also articular effusion (figure 3). There were no other signal or morphological alterations in the remaining knee structures.
Iliotibial band syndrome results from the repetitive friction of the iliotibial band as it slides over the lateral femoral condyle, moving anterior to the condyle during knee extension and posterior region during knee flexion, remaining tense at both positions [1, 2, 3].
Iliotibial band syndrome is a common cause of lateral knee pain, related to intense practice of physical exercise, mainly in long distance runners and cyclists. It is the most common running injury of the lateral knee with a incidence of 1,6 to 12%, while in cycling accounts for 15 to 24% of overuse injuries [2].
The diagnosis of iliotibial band syndrome is essentially clinical, however MRI may be useful for diagnosis and to make the differential of lateral knee pain such as lateral meniscal rupture or lateral collateral ligament injury. MRI findings include ill defined signal changes in fatty soft tissue that lies between the iliotibial band and the lateral condyle of the femur, namely T1 low signal and T2 high signal due to edema and/or fluid [2, 3].
When long standing friction is maintained, thickening of the iliotibial band and T2 high signal may be identified in superficial tissues.
Initial treatment for iliotibial band syndrome is conservative with physical therapy, oral anti-inflammatory medication and eventually steroid injections [2]. For those not responding to conservative treatment there is a surgical option which consists in resection of the posterior aspect of the iliotibial band.
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Iliotibial band syndrome
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Based on the provided knee MRI images and clinical history, there is a T2 hyperintense signal in the soft tissue near the lateral femoral condyle of the knee, localized to the fat layer between the iliotibial band (IT band) and the lateral femoral condyle. The IT band itself may appear to have some thickening or localized signal changes, suggesting reactive edema in the surrounding soft tissues. No definite abnormalities are observed in the articular surfaces or menisci, and there is no obvious structural damage to the medial and lateral collateral ligaments or other main ligament structures on the current imaging sequences. Overall, the knee joint structure remains intact, with the primary changes focused on the soft tissue sliding plane in the lateral knee region.
Integrating the patient’s clinical symptoms (lateral knee pain, exercise history, physical examination results) with the imaging findings (T2 hyperintense edema/bursitis-like changes between the IT band and the lateral femoral condyle), the most likely diagnosis is Iliotibial Band Syndrome (ITBS).
1. Conservative Treatment:
① Reduce or temporarily cease activities that trigger symptoms, avoiding prolonged walking, running, or other activities that may aggravate lateral knee friction.
② Under medical direction, use non-steroidal anti-inflammatory drugs (NSAIDs) to alleviate pain and inflammation.
③ Physical therapy and rehabilitation: including IT band stretching, hip abductor strength training, joint mobilization, local ice application, ultrasound, or low-frequency physiotherapy.
④ If necessary, consider local corticosteroid injection to relieve acute inflammation.
2. Surgical Treatment:
For patients whose pain remains stubborn and affects their quality of life despite adequate conservative treatment, surgery may be considered. Procedures might involve partial resection of the posterior portion of the IT band to reduce friction. However, this should be carefully evaluated and undertaken with caution.
3. Rehabilitation/Exercise Prescription (FITT-VP Principle):
① Frequency: Perform stretching and strength training 3–4 times per week. Once pain subsides, gradually increase frequency to 5 times per week.
② Intensity: Begin with low to moderate intensity stretching (hold 20–30 seconds, avoid aggressive stretches that cause pain). Start strength training with low-to-moderate resistance.
③ Time: 20–30 minutes per session, incorporating stretching, resistance band exercises for hip muscles, and core stability training.
④ Type: Focus on improving IT band flexibility and strengthening the hip abductor muscles (groin area, gluteus medius) for stability, combined with low-impact aerobic activities like cycling or using an elliptical machine.
⑤ Progression: As symptoms improve, increase training load (e.g., use heavier resistance bands or weights), extend session duration to 30–45 minutes, and gradually reintroduce running if tolerated. Monitor for lateral knee discomfort; if significant pain or swelling occurs, adjust the plan and consult a physician promptly.
During rehabilitation, closely monitor knee pain levels and any limitations in range of motion. Maintain communication with healthcare professionals and rehabilitation therapists to ensure safe training and optimal recovery outcomes.
This report is only a reference analysis based on the provided images and clinical history. It is not a substitute for an in-person examination or professional medical advice. If your condition worsens or new symptoms arise, please seek medical attention and further evaluation promptly.
Iliotibial band syndrome
