A 51-year-old woman underwent sonography for pain in the lateral aspect of the right knee with functional limitation. Pain was present mostly during the night and was partially responsive to cryotherapy and NSAID (Diclofenac 150 mg) treatments.
The clinical examination showed the lateral aspect of the right knee, battered, bruised, red and warm.
Ultrasound examination (Fig. 1) showed a soft, homogeneous, calcific deposition on the distal iliotibial band of 20 mm, without posterior acoustic shadow (Type III Uhthoff cycle); colour-power-Doppler showed peri-calcific hyperaemia (Fig. 2), correlating with neoangiogenesis and capillary proliferation.
An ultrasound-guided percutaneous treatment was proposed. After obtaining informed written consent of the patient and local anaesthesia, two 18 G needles were introduced into the calcification under ultrasound guidance and then the calcification was washed. After treatment there was a significant reduction of the symptoms.
After 15 days the pain was further reduced and the ultrasound check highlighted a slightly inhomogenous ecostructure of the insertion of the iliotibial band and small calcification (leftover) in the absence of abnormal vascularisation. After 30 days the symptoms had disappeared completely and function was clearly improved.
Calcific tendinopathy is a frequent pathology, particularly in women between 40 to 60 years of age.
The aetiology is not yet fully clarified, however, characterised by deposition of calcium salts in the tendons [1-3].
The tendons most frequently affected are those of the rotator cuff, particularly the supraspinatus, although cases of various other tendons are described [4]. It is a different pathology from calcifications in tendinosis, in fact the most common calcium salt in calcific tendinopathies is hydroxyapatite, rare in tendinosis.
Four stages are described in the Uhthoff cycle: pre-calcium, formative, resorptive, post-calcific. Pain is particularly important in stage 4. The diagnosis of calcific tendinitis is mainly based on standard radiographs and ultrasound examination. In recent years, ultrasonography has emerged as the imaging technique of choice also for guiding therapeutic procedures.
The ileo-tibial bandage is a lateral stabiliser of the knee [5-7], whose most frequent pathology is the Iliotibial band syndrome, while calcific tendinopathy at the insertion into the Gerdy tubercle of the tibia has never been reported, to our knowledge.
We thought, therefore, to publish this case report for its rarity and because it confirms how ultrasound-guided therapies can be successfully used in the management of calcific tendinopathy, even of the less common ones [7, 8].
Written informed patient consent for publication has been obtained.
Insertional calcific tendinopathy of iliotibial band
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Based on the provided ultrasound images, the lesion is located on the lateral side of the right knee, near the attachment of the iliotibial band at the Gerdy’s tubercle of the tibia, showing a distinct calcified echo. Under color Doppler mode, an increase in local blood flow signals indicates a significant inflammatory response. Overall, the imaging findings suggest that the lesion is confined to the distal end of the iliotibial band, presenting as patches or lumps with high echogenicity. Mild edema and hyperemia are observed in the surrounding soft tissues, consistent with changes related to a calcific lesion.
Taking into consideration the patient’s age (51 years), gender (female), characteristic symptoms (notable nocturnal pain, local tenderness, elevated temperature), and ultrasound findings of calcification, a comprehensive diagnosis can be made as follows:
Calcific Tendinopathy of the Iliotibial Band at the Gerdy’s Tubercle of the Tibia.
If any doubt remains, further MRI examinations or blood tests (such as inflammatory markers) could be considered to support the diagnosis. However, based on the current imaging and clinical presentation, this appears to be the most appropriate conclusion.
Based on the patient’s condition, a gradual, individualized rehabilitation plan should be followed.
Throughout the rehabilitation process, regular follow-up is advised to adjust the training plan based on clinical progress. If increased pain or new symptoms occur, consult a professional medical provider promptly.
This report is based on the currently available information and imaging findings, serving as a reference only. It should not replace an in-person consultation or the advice of certified medical professionals. If you have any concerns or if your condition changes, seek immediate medical attention and discuss with a specialist.
Insertional calcific tendinopathy of iliotibial band
