Anatomy
Running externally from the iliac crest to the tibia is a strong tendon (tractus iliotibialis) to which many of the thigh muscles attach.
Knee, outer thigh
A. Tractus iliotibialis
B. M. vastus lateralis
C. M. biceps femoris
Cause of the problem
With repeated uniform movements of the knee joint (running, cycling), the strong tendon (tractus iliotibialis) slides over the outside of the femur (lateral femoral condyle) just above the knee. This can cause ‘inflammation’ in the tendon or in the underlying bursa.
Athletes with a tendency to bowleg, uneven leg length, tight iliotibial band and running on sloping terrain are at increased risk. Too quickly intensified and excessive training volume increases the risk of running knee.
See picture of runners-knee
Symptoms
Slow onset pain on the outside of the knee with worsening with pressure, stretching of the external ligaments (tractus iliotibialis) and running.
Examination
Usually, the diagnosis can be made by general clinical examination. There is tenderness on pressure over the outside of the femur (lateral femoral condyle) just above the knee. X-ray is normal. Ultrasound can show thickening of the tendon band and fluid deep to it (Jiménez Díaz F, et al. 2020).
Treatment
Treatment includes relief from pain-inducing activity, stretching of the external iliotibial tract and gradual rehabilitation within the pain threshold. If no progress is made, medical treatment can be supplemented with anti-inflammatory drugs (NSAIDs) or adrenal cortical hormone injections.
In severe cases without relief, proper rehabilitation or medical treatment, surgical treatment can be attempted, which is rarely indicated.
Complications
If no progress is made, you need to consider whether the diagnosis is correct. It will often require additional examinations (X-ray, ultrasound or MRI scan).
In particular, the following should be considered:
