Skip to main content
Top
Published in: BMC Sports Science, Medicine and Rehabilitation 1/2009

Open Access 01-12-2009 | Case report

Iliotibial band release as an adjunct to the surgical management of patellar stress fracture in the athlete: a case report and review of the literature

Authors: Anthony Keeley, Paul Bloomfield, Peter Cairns, Robert Molnar

Published in: BMC Sports Science, Medicine and Rehabilitation | Issue 1/2009

Login to get access

Abstract

Stress fracture of the patella is rare. In this report, a case of patellar stress fracture occurring in an amateur athlete is presented, and an operative adjunct to the surgical management of this condition is proposed.
A review of the English literature identified 21 previous cases of stress fracture of the patella, the majority in young athletes. None of these reports discussed treatment addressing the pathological process contributing to patellar stress fracture.
The subject of this case report is a young male netballer who presented with a transverse stress fracture in the inferior third of his patella, on a background of patellofemoral overload. The patient underwent open reduction and internal fixation of his patella, combined with release of the iliotibial band. He returned to training after 6 weeks.
The previous literature suggests that operative fixation is indicated for the treatment of displaced patellar stress fractures. Iliotibial band release, as a surgical adjunct to this treatment, may address the pathology of these fractures, and facilitate a return to sport at the highest level.
Appendix
Available only for authorised users
Literature
1.
go back to reference Brogle PJ, Eswar S, Denton JR: Propagation of a patellar stress fracture in a basketball player. Am J Orthop. 1997, 26: 782-784.PubMed Brogle PJ, Eswar S, Denton JR: Propagation of a patellar stress fracture in a basketball player. Am J Orthop. 1997, 26: 782-784.PubMed
3.
go back to reference Devas MB: Stress fractures of the patella. J Bone Joint Surg Br. 1960, 42-B: 71-74.PubMed Devas MB: Stress fractures of the patella. J Bone Joint Surg Br. 1960, 42-B: 71-74.PubMed
4.
go back to reference Dickason JM, Fox JM: Fracture of the patella due to overuse syndrome in a child. A case report. Am J Sports Med. 1982, 10: 248-249. 10.1177/036354658201000412.CrossRefPubMed Dickason JM, Fox JM: Fracture of the patella due to overuse syndrome in a child. A case report. Am J Sports Med. 1982, 10: 248-249. 10.1177/036354658201000412.CrossRefPubMed
5.
go back to reference Garcia Mata S, Hidalgo Ovejero A, Martinez Grande M: Transverse stress fracture of the patella in a child. J Pediatr Orthop B. 1999, 8: 208-211.CrossRefPubMed Garcia Mata S, Hidalgo Ovejero A, Martinez Grande M: Transverse stress fracture of the patella in a child. J Pediatr Orthop B. 1999, 8: 208-211.CrossRefPubMed
6.
go back to reference Garcia Mata S, Martinez Grande M, Hidalgo Ovejero A: Transverse stress fracture of the patella: a case report. Clin J Sport Med. 1996, 6: 259-261.CrossRefPubMed Garcia Mata S, Martinez Grande M, Hidalgo Ovejero A: Transverse stress fracture of the patella: a case report. Clin J Sport Med. 1996, 6: 259-261.CrossRefPubMed
7.
go back to reference Iwaya T, Takatori Y: Lateral longitudinal stress fracture of the patella: report of three cases. J Pediatr Orthop. 1985, 5: 73-75.CrossRefPubMed Iwaya T, Takatori Y: Lateral longitudinal stress fracture of the patella: report of three cases. J Pediatr Orthop. 1985, 5: 73-75.CrossRefPubMed
8.
go back to reference Jerosch JG, Castro WH, Jantea C: Stress fracture of the patella. Am J Sports Med. 1989, 17: 579-580. 10.1177/036354658901700422.CrossRefPubMed Jerosch JG, Castro WH, Jantea C: Stress fracture of the patella. Am J Sports Med. 1989, 17: 579-580. 10.1177/036354658901700422.CrossRefPubMed
9.
go back to reference Orava S, Taimela S, Kvist M, Karpakka J, Hulkko A, Kujala U: Diagnosis and treatment of stress fracture of the patella in athletes. Knee Surg Sports Traumatol Arthrosc. 1996, 4: 206-211. 10.1007/BF01567964.CrossRefPubMed Orava S, Taimela S, Kvist M, Karpakka J, Hulkko A, Kujala U: Diagnosis and treatment of stress fracture of the patella in athletes. Knee Surg Sports Traumatol Arthrosc. 1996, 4: 206-211. 10.1007/BF01567964.CrossRefPubMed
10.
11.
go back to reference Rockett JF, Freeman BL: Stress fracture of the patella. Confirmation by triple-phase bone imaging. Clin Nucl Med. 1990, 15: 873-875. 10.1097/00003072-199012000-00004.CrossRefPubMed Rockett JF, Freeman BL: Stress fracture of the patella. Confirmation by triple-phase bone imaging. Clin Nucl Med. 1990, 15: 873-875. 10.1097/00003072-199012000-00004.CrossRefPubMed
13.
go back to reference Teitz CC, Harrington RM: Patellar stress fracture. Am J Sports Med. 1992, 20: 761-765. 10.1177/036354659202000621.CrossRefPubMed Teitz CC, Harrington RM: Patellar stress fracture. Am J Sports Med. 1992, 20: 761-765. 10.1177/036354659202000621.CrossRefPubMed
14.
go back to reference Bloomfield P, Watson A: A new clinical test: The iliotibial band/lateral retinaculum (ITB/LR) test description and reliability study. New Zealand Journal of Sports Medicine. 2000, 28: 4-8. Bloomfield P, Watson A: A new clinical test: The iliotibial band/lateral retinaculum (ITB/LR) test description and reliability study. New Zealand Journal of Sports Medicine. 2000, 28: 4-8.
15.
go back to reference McConnell J: The management of chondromalacia patellae: a long term solution. The Australian Journal of Physiotherapy. 1986, 32: 215-223.CrossRefPubMed McConnell J: The management of chondromalacia patellae: a long term solution. The Australian Journal of Physiotherapy. 1986, 32: 215-223.CrossRefPubMed
16.
go back to reference Muller W: Der militarische Abrissermudungsschaden. Deutsch Militararzt. 1943, 8: 283-286. Muller W: Der militarische Abrissermudungsschaden. Deutsch Militararzt. 1943, 8: 283-286.
17.
go back to reference Kaye JJ, Freiberger RH: Fragmentation of the lower pole of the patella in spastic lower extremities. Radiology. 1971, 101: 97-100.CrossRefPubMed Kaye JJ, Freiberger RH: Fragmentation of the lower pole of the patella in spastic lower extremities. Radiology. 1971, 101: 97-100.CrossRefPubMed
18.
go back to reference Mann M: [Fatigue fractures of the lower patellar pole in adolescents with cerebral movement disorders]. Z Orthop Ihre Grenzgeb. 1984, 122: 167-170. 10.1055/s-2008-1044603.CrossRefPubMed Mann M: [Fatigue fractures of the lower patellar pole in adolescents with cerebral movement disorders]. Z Orthop Ihre Grenzgeb. 1984, 122: 167-170. 10.1055/s-2008-1044603.CrossRefPubMed
19.
go back to reference Rosenthal RK, Levine DB: Fragmentation of the distal pole of the patella in spastic cerebral palsy. J Bone Joint Surg Am. 1977, 59: 934-939.PubMed Rosenthal RK, Levine DB: Fragmentation of the distal pole of the patella in spastic cerebral palsy. J Bone Joint Surg Am. 1977, 59: 934-939.PubMed
20.
go back to reference Grace JN, Sim FH: Fracture of the patella after total knee arthroplasty. Clin Orthop Relat Res. 1988, 168-175. Grace JN, Sim FH: Fracture of the patella after total knee arthroplasty. Clin Orthop Relat Res. 1988, 168-175.
21.
go back to reference McBryde AM: Stress fractures in athletes. J Sports Med. 1975, 3: 212-217. 10.1177/036354657500300502.CrossRefPubMed McBryde AM: Stress fractures in athletes. J Sports Med. 1975, 3: 212-217. 10.1177/036354657500300502.CrossRefPubMed
22.
go back to reference Hulkko A, Orava S: Stress fractures in athletes. Int J Sports Med. 1987, 8: 221-226. 10.1055/s-2008-1025659.CrossRefPubMed Hulkko A, Orava S: Stress fractures in athletes. Int J Sports Med. 1987, 8: 221-226. 10.1055/s-2008-1025659.CrossRefPubMed
23.
go back to reference Lombardo SJ, Benson DW: Stress fractures of the femur in runners. Am J Sports Med. 1982, 10: 219-227. 10.1177/036354658201000406.CrossRefPubMed Lombardo SJ, Benson DW: Stress fractures of the femur in runners. Am J Sports Med. 1982, 10: 219-227. 10.1177/036354658201000406.CrossRefPubMed
24.
go back to reference Matheson GO, Clement DB, McKenzie DC, Taunton JE, Lloyd-Smith DR, MacIntyre JG: Stress fractures in athletes. A study of 320 cases. Am J Sports Med. 1987, 15: 46-58. 10.1177/036354658701500107.CrossRefPubMed Matheson GO, Clement DB, McKenzie DC, Taunton JE, Lloyd-Smith DR, MacIntyre JG: Stress fractures in athletes. A study of 320 cases. Am J Sports Med. 1987, 15: 46-58. 10.1177/036354658701500107.CrossRefPubMed
25.
go back to reference Walter NE, Wolf MD: Stress fractures in young athletes. Am J Sports Med. 1977, 5: 165-170. 10.1177/036354657700500405.CrossRefPubMed Walter NE, Wolf MD: Stress fractures in young athletes. Am J Sports Med. 1977, 5: 165-170. 10.1177/036354657700500405.CrossRefPubMed
26.
go back to reference Stanitski CL, McMaster JH, Scranton PE: On the nature of stress fractures. Am J Sports Med. 1978, 6: 391-396. 10.1177/036354657800600615.CrossRefPubMed Stanitski CL, McMaster JH, Scranton PE: On the nature of stress fractures. Am J Sports Med. 1978, 6: 391-396. 10.1177/036354657800600615.CrossRefPubMed
27.
go back to reference Norfray JF, Schlachter L, Kernahan WT, Arenson DJ, Smith SD, Roth IE, Schlefman BS: Early confirmation of stress fractures in joggers. JAMA. 1980, 243: 1647-1649. 10.1001/jama.243.16.1647.CrossRefPubMed Norfray JF, Schlachter L, Kernahan WT, Arenson DJ, Smith SD, Roth IE, Schlefman BS: Early confirmation of stress fractures in joggers. JAMA. 1980, 243: 1647-1649. 10.1001/jama.243.16.1647.CrossRefPubMed
28.
go back to reference Terry GC, Hughston JC, Norwood LA: The anatomy of the iliopatellar band and iliotibial tract. Am J Sports Med. 1986, 14: 39-45. 10.1177/036354658601400108.CrossRefPubMed Terry GC, Hughston JC, Norwood LA: The anatomy of the iliopatellar band and iliotibial tract. Am J Sports Med. 1986, 14: 39-45. 10.1177/036354658601400108.CrossRefPubMed
29.
go back to reference Vieira EL, Vieira EA, da Silva RT, Berlfein PA, Abdalla RJ, Cohen M: An anatomic study of the iliotibial tract. Arthroscopy. 2007, 23: 269-274.CrossRefPubMed Vieira EL, Vieira EA, da Silva RT, Berlfein PA, Abdalla RJ, Cohen M: An anatomic study of the iliotibial tract. Arthroscopy. 2007, 23: 269-274.CrossRefPubMed
30.
go back to reference Perry J, Antonelli D, Ford W: Analysis of knee-joint forces during flexed-knee stance. J Bone Joint Surg Am. 1975, 57: 961-967.PubMed Perry J, Antonelli D, Ford W: Analysis of knee-joint forces during flexed-knee stance. J Bone Joint Surg Am. 1975, 57: 961-967.PubMed
31.
go back to reference Huberti HH, Hayes WC: Patellofemoral contact pressures. The influence of q-angle and tendofemoral contact. J Bone Joint Surg Am. 1984, 66: 715-724.PubMed Huberti HH, Hayes WC: Patellofemoral contact pressures. The influence of q-angle and tendofemoral contact. J Bone Joint Surg Am. 1984, 66: 715-724.PubMed
32.
go back to reference Reilly DT, Martens M: Experimental analysis of the quadriceps muscle force and patello-femoral joint reaction force for various activities. Acta Orthop Scand. 1972, 43: 126-137.CrossRefPubMed Reilly DT, Martens M: Experimental analysis of the quadriceps muscle force and patello-femoral joint reaction force for various activities. Acta Orthop Scand. 1972, 43: 126-137.CrossRefPubMed
33.
go back to reference Hayes WC, Snyder B: Toward a quantitative formulation of Wolff's law in trabecular bone. Am Soc Mech Eng Appl Mech Div. 1981, 45: 43-68. Hayes WC, Snyder B: Toward a quantitative formulation of Wolff's law in trabecular bone. Am Soc Mech Eng Appl Mech Div. 1981, 45: 43-68.
34.
go back to reference Raux P, Townsend PR, Miegel R, Rose RM, Radin EL: Trabecular architecture of the human patella. J Biomech. 1975, 8: 1-7. 10.1016/0021-9290(75)90037-8.CrossRefPubMed Raux P, Townsend PR, Miegel R, Rose RM, Radin EL: Trabecular architecture of the human patella. J Biomech. 1975, 8: 1-7. 10.1016/0021-9290(75)90037-8.CrossRefPubMed
35.
go back to reference Hayes WC, Boyle D, Velez A: Functional adaptation in the trabecular architecture of the human patella. Trans Orthop Res Soc. 1977, 2: 114. Hayes WC, Boyle D, Velez A: Functional adaptation in the trabecular architecture of the human patella. Trans Orthop Res Soc. 1977, 2: 114.
36.
go back to reference Fulkerson JP, Hungerford DS: Disorders of the Patellofemoral Joint. 1990, Baltimore: Williams and Wilkins, Second Fulkerson JP, Hungerford DS: Disorders of the Patellofemoral Joint. 1990, Baltimore: Williams and Wilkins, Second
37.
go back to reference Bizzini M, Childs JD, Piva SR, Delitto A: Systematic review of the quality of randomized controlled trials for patellofemoral pain syndrome. J Orthop Sports Phys Ther. 2003, 33: 4-20.CrossRefPubMed Bizzini M, Childs JD, Piva SR, Delitto A: Systematic review of the quality of randomized controlled trials for patellofemoral pain syndrome. J Orthop Sports Phys Ther. 2003, 33: 4-20.CrossRefPubMed
38.
go back to reference Puniello MS: Iliotibial band tightness and medial patellar glide in patients with patellofemoral dysfunction. J Orthop Sports Phys Ther. 1993, 17: 144-148.CrossRefPubMed Puniello MS: Iliotibial band tightness and medial patellar glide in patients with patellofemoral dysfunction. J Orthop Sports Phys Ther. 1993, 17: 144-148.CrossRefPubMed
39.
go back to reference Gerrard B: The patello-femoral pain syndrome: a clinical trial of the McConnell programme. The Australian Journal of Physiotherapy. 1989, 35: 71-80.CrossRefPubMed Gerrard B: The patello-femoral pain syndrome: a clinical trial of the McConnell programme. The Australian Journal of Physiotherapy. 1989, 35: 71-80.CrossRefPubMed
40.
go back to reference Winslow J, Yoder E: Patellofemoral pain in female ballet dancers: correlation with iliotibial band tightness and tibial external rotation. J Orthop Sports Phys Ther. 1995, 22: 18-21.CrossRefPubMed Winslow J, Yoder E: Patellofemoral pain in female ballet dancers: correlation with iliotibial band tightness and tibial external rotation. J Orthop Sports Phys Ther. 1995, 22: 18-21.CrossRefPubMed
41.
go back to reference Hudson Z, Darthuy E: Iliotibial band tightness and patellofemoral pain syndrome: a case-control study. Man Ther. 2009, 14: 147-151. 10.1016/j.math.2007.12.009.CrossRefPubMed Hudson Z, Darthuy E: Iliotibial band tightness and patellofemoral pain syndrome: a case-control study. Man Ther. 2009, 14: 147-151. 10.1016/j.math.2007.12.009.CrossRefPubMed
42.
go back to reference Doucette SA, Goble EM: The effect of exercise on patellar tracking in lateral patellar compression syndrome. Am J Sports Med. 1992, 20: 434-440. 10.1177/036354659202000412.CrossRefPubMed Doucette SA, Goble EM: The effect of exercise on patellar tracking in lateral patellar compression syndrome. Am J Sports Med. 1992, 20: 434-440. 10.1177/036354659202000412.CrossRefPubMed
43.
go back to reference Micheli LJ, Stanitski CL: Lateral patellar retinacular release. Am J Sports Med. 1981, 9: 330-336. 10.1177/036354658100900510.CrossRefPubMed Micheli LJ, Stanitski CL: Lateral patellar retinacular release. Am J Sports Med. 1981, 9: 330-336. 10.1177/036354658100900510.CrossRefPubMed
44.
go back to reference Wu CC, Shih CH: The influence of iliotibial tract on patellar tracking. Orthopedics. 2004, 27: 199-203.PubMed Wu CC, Shih CH: The influence of iliotibial tract on patellar tracking. Orthopedics. 2004, 27: 199-203.PubMed
45.
go back to reference Herrington L, Rivett N, Munro S: The relationship between patella position and length of the iliotibial band as assessed using Ober's test. Man Ther. 2006, 11: 182-186. 10.1016/j.math.2006.06.008.CrossRefPubMed Herrington L, Rivett N, Munro S: The relationship between patella position and length of the iliotibial band as assessed using Ober's test. Man Ther. 2006, 11: 182-186. 10.1016/j.math.2006.06.008.CrossRefPubMed
46.
go back to reference Kwak SD, Ahmad CS, Gardner TR, Grelsamer RP, Henry JH, Blankevoort L, Ateshian GA, Mow VC: Hamstrings and iliotibial band forces affect knee kinematics and contact pattern. J Orthop Res. 2000, 18: 101-108. 10.1002/jor.1100180115.CrossRefPubMed Kwak SD, Ahmad CS, Gardner TR, Grelsamer RP, Henry JH, Blankevoort L, Ateshian GA, Mow VC: Hamstrings and iliotibial band forces affect knee kinematics and contact pattern. J Orthop Res. 2000, 18: 101-108. 10.1002/jor.1100180115.CrossRefPubMed
47.
go back to reference Arno S: The a angle: a quantitative measurement of patella alignment and realignment. J Orthop Sports Phys Ther. 1990, 12: 237-242.CrossRefPubMed Arno S: The a angle: a quantitative measurement of patella alignment and realignment. J Orthop Sports Phys Ther. 1990, 12: 237-242.CrossRefPubMed
48.
go back to reference Davies GJ, Wallace LA, Malone T: Mechanisms of selected knee injuries. Phys Ther. 1980, 60: 1590-1595.PubMed Davies GJ, Wallace LA, Malone T: Mechanisms of selected knee injuries. Phys Ther. 1980, 60: 1590-1595.PubMed
49.
50.
go back to reference Fulkerson JP: The etiology of patellofemoral pain in young, active patients: a prospective study. Clin Orthop Relat Res. 1983, 129-133. Fulkerson JP: The etiology of patellofemoral pain in young, active patients: a prospective study. Clin Orthop Relat Res. 1983, 129-133.
51.
go back to reference Insall J: Current Concepts Review: patellar pain. J Bone Joint Surg Am. 1982, 64: 147-152.PubMed Insall J: Current Concepts Review: patellar pain. J Bone Joint Surg Am. 1982, 64: 147-152.PubMed
52.
go back to reference Kramer PG: Patella malalignment syndrome: rationale to reduce excessive lateral pressure. J Orthop Sports Phys Ther. 1986, 8: 301-309.CrossRefPubMed Kramer PG: Patella malalignment syndrome: rationale to reduce excessive lateral pressure. J Orthop Sports Phys Ther. 1986, 8: 301-309.CrossRefPubMed
53.
go back to reference Paulos L, Rusche K, Johnson C, Noyes FR: Patellar malalignment: a treatment rationale. Phys Ther. 1980, 60: 1624-1632.PubMed Paulos L, Rusche K, Johnson C, Noyes FR: Patellar malalignment: a treatment rationale. Phys Ther. 1980, 60: 1624-1632.PubMed
54.
go back to reference Yates CK, Grana WA: Patellofemoral pain in children. Clin Orthop Relat Res. 1990, 36-43. Yates CK, Grana WA: Patellofemoral pain in children. Clin Orthop Relat Res. 1990, 36-43.
55.
go back to reference Hungerford DS, Barry M: Biomechanics of the patellofemoral joint. Clin Orthop Relat Res. 1979, 9-15. Hungerford DS, Barry M: Biomechanics of the patellofemoral joint. Clin Orthop Relat Res. 1979, 9-15.
56.
go back to reference Larson RL, Cabaud HE, Slocum DB, James SL, Keenan T, Hutchinson T: The patellar compression syndrome: surgical treatment by lateral retinacular release. Clin Orthop Relat Res. 1978, 158-167. Larson RL, Cabaud HE, Slocum DB, James SL, Keenan T, Hutchinson T: The patellar compression syndrome: surgical treatment by lateral retinacular release. Clin Orthop Relat Res. 1978, 158-167.
Metadata
Title
Iliotibial band release as an adjunct to the surgical management of patellar stress fracture in the athlete: a case report and review of the literature
Authors
Anthony Keeley
Paul Bloomfield
Peter Cairns
Robert Molnar
Publication date
01-12-2009
Publisher
BioMed Central
Published in
BMC Sports Science, Medicine and Rehabilitation / Issue 1/2009
Electronic ISSN: 2052-1847
DOI
https://doi.org/10.1186/1758-2555-1-15

Other articles of this Issue 1/2009

BMC Sports Science, Medicine and Rehabilitation 1/2009 Go to the issue