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LETTER TO EDITOR
Year : 2019  |  Volume : 19  |  Issue : 2  |  Page : 66-67

Snapping and irritation of iliotibial band due to long-standing lateral femoral exostosis


1 Department of Orthopaedics, Government Medical College, Haldwani, Uttarakhand, India
2 Department of Pathology, Government Medical College, Haldwani, Uttarakhand, India

Date of Submission30-Oct-2018
Date of Acceptance03-Apr-2020
Date of Web Publication07-Jul-2020

Correspondence Address:
Dr. Ganesh Singh Dharmshaktu
Department of Orthopaedics, Government Medical College, Haldwani - 263 139, Uttarakhand
India
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DOI: 10.4103/sjsm.sjsm_26_18

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How to cite this article:
Dharmshaktu GS, Pangtey T, Bhandari SS. Snapping and irritation of iliotibial band due to long-standing lateral femoral exostosis. Saudi J Sports Med 2019;19:66-7

How to cite this URL:
Dharmshaktu GS, Pangtey T, Bhandari SS. Snapping and irritation of iliotibial band due to long-standing lateral femoral exostosis. Saudi J Sports Med [serial online] 2019 [cited 2020 Aug 11];19:66-7. Available from: http://www.sjosm.org/text.asp?2019/19/2/66/289158

Dear Editor,

We read with interest the article entitled, “Risk factors and impairments in iliotibial band friction syndrome among basketball players” by Panse et al.[1] The article highlights the disability caused by iliotibial band friction syndrome (ITBFS) and factors compounding the problem such as rigorous knee movements, footwear, running surfaces, and training errors among others. The morphological characteristics such as internal rotation of tibia and hip abductor weakness are other causes well mentioned in the article. We have no direct comment on the article, but we would like to state that very rarely, anatomical disorders around knee may cause ITBFS as a late presentation as depicted by a short case snippet though not in a basketball player.

A 26-year-old cyclist presented to us with disability to ride for long for apprehension of knee pain, loud snapping, and fear of tendon rupture. There was a history of bony growth over the lateral aspect of the left knee from adolescence that stopped growing after puberty. The lump did not cause any significant problem in the past but for the last 7 months, the movement of tendons across the hard lump was clinically noticeable and audible as snapping [Figure 1]. There is also acute pain on extreme knee movements in extension more than flexion periodically. The radiograph of the knee revealed a lateral distal femur sessile bony growth, suggestive of a bony exostosis or solitary osteochondroma [Figure 2]a. After informed consent, the excision of the exostosis was done as per the standard protocol with histopathological confirmation [Figure 2]b. There were marked clinical relief and functional improvement. There was no recurrence or remarkable complication noted in the follow-up.
Figure 1: The clinical images showing irritation of iliotibial band by lateral osteochondroma

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Figure 2: The radiograph of the knee showing lateral distal femur osteochondroma before (a) and after (b) excision

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Osteocartilaginous exostosis or osteochondroma is the most common benign bone lesion cartilage capped and mostly solitary.[2] Mechanical effects are common and the presentation is varied depending on the type of structure involved. There are reports of snapping of the knee due to irritation of lateral tendons such as biceps femoris over fibular[3] or medial hamstring by tibial exostoses.[4] Very rarely, the sharp and pointed end of some exostoses, also referred as “thorny exostoses,” may cause localized impingement around knee.[5] As exostoses are common clinical disorders, knowledge of their uncommon presentations, variants, and sites should be critical in prompt diagnosis and management. Our case describes an uncommon location and presentation and thus has educative potential.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Panse R, Diwaker N, Yeole U, Gharote G, Kulkarni S, Pawar P. Risk factors and impairments in iliotibial band friction syndrome among basketball players. Saudi J Sports Med 2018;18:75-8.  Back to cited text no. 1
  [Full text]  
2.
Kitsoulis P, Galani V, Stefanaki K, Paraskevas G, Karatzias G, Agnantis NJ, et al. Osteochondromas: Review of the clinical, radiological and pathological features.In vivo 2008;22:633-46.  Back to cited text no. 2
    
3.
Fung DA, Frey S, Markbreiter L. Bilateral symptomatic snapping biceps femoris tendon due to fibular exostosis. J Knee Surg 2008;21:55-7.  Back to cited text no. 3
    
4.
Yoong-Leong Oh J, Tan KK, Wong YS. 'Snapping' knee secondary to a tibial osteochondroma. Knee 2008;15:58-60.  Back to cited text no. 4
    
5.
Dharmshaktu GS, Pangtey T, Bhandari SS. Thorn-like exostoses: A rare presentation of hereditary multiple exostoses. J Musculoskelet Surg Res 2018;2:137-8.  Back to cited text no. 5
  [Full text]  


    Figures

  [Figure 1], [Figure 2]



 

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