Diagnosis and management of atypical and persistent anterolateral knee pain in a 16-year-old triathlete: an iterative process.

INTRODUCTION AND BACKGROUND

The subject of this case study, a 16-year-old female triathlete, presented to physiotherapy reporting a 6 month history of anterior knee pain, with symptoms unchanged upon resuming a graduated triathlon training program, despite 3 months rest from all training.

CASE DESCRIPTION

The case describes the differential diagnosis and management of patellofemoral pain syndrome (PFPS), iliotibial band syndrome (ITBS), and discoid lateral meniscus (DLM) in an adolescent female triathlete. Clinical reasoning and rehabilitation strategies are presented with respect to literature base. Final outcome was full resolution of symptoms and return to full athletic function, however, symptoms were relatively persistent and atypical.

PURPOSE

This case report discusses the differential diagnosis and management of persistent and atypical anterior knee pain in a sixteen-year-old female triathlete. In such cases, the diagnostic process is often iterative, where intervention serves both therapeutic and diagnostic purposes.

DISCUSSION

Recent changes in the understanding of the pathophysiology of ITBS and links between the anterior and lateral knee compartments through highly innervated knee synovial tissue assist the therapist's understanding of how these conditions may occur concomitantly, with resulting atypical symptoms. The potential influences of likely changes in the subject's peripheral and central nervous system on symptom perception is also discussed.

LEVEL OF EVIDENCE

Level 5; Single case report.