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A 25-year-old female marathon runner, who trained three times a week, consulted an orthopaedic surgeon due to lateral knee pain. It had been bothering her for 7 weeks. The onset was gradual. After several visits to her physiotherapist, where she performed exercises for coordination, strength and stability, she decided to seek further advice, because the problem was gradually getting worse. She experienced a sharp pain on the outside of the left knee. The pain worsened during activity after an often pain-free start and was exacerbated on running downhill. The pain disappeared hours after the exercise, and in rest she had no complaints at all.
Physical examination revealed a healthy female (1.70 m, 55 kg). Inspection of the knee showed a diffuse lateral swelling without erythema. There was no effusion. On palpation, there was tenderness over the whole lateral side of the knee, with the tenderest point being the lateral femoral condyl. The range of motion was normal.
When putting full weight on the injured leg during the Renne test, the lateral knee pain occurred. The Noble test (manual compression of the iliotibial band (ITB) on the lateral femur condyl during flexion and extension of the knee) was positive; the patient experienced pain at 30° of flexion during motion from 90° flexion to full extension. The McMurray test for a meniscal tear was not painful. Performance of the Ober test showed moderate tightness of the ITB. Neurovascular examination was normal.
The patient was referred …
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