Background Iliotibial band syndrome (ITBS) is the most common cause of lateral knee pain in runners¹. It is an overuse injury that results from repetitive friction of the iliotibial band (ITB) over the lateral femoral epicondyle. Initial treatment includes activity modification, nonsteroidal anti-inflammatory medication, taping, stretching exercise and in severe cases, a corticosteroid injection². Treatment of symptoms and return to activity are variable and can be intractable.

Objectives To evaluate the efficacy and safety on pain and return to activity of a single, local injection of ITBS with combination hyaluronate and Botulinum toxin in 45 runners.

Methods 45 runners with at least grade 2 ITBS underwent baseline investigations including pain following symptom-limited treadmill running test during which pain was recorded on a visual analogue scale (VAS 0–10) every minute. Runners then had injection in the area where the iliotibial band crosses the lateral femoral condyle with 2.5 ml combination hyaluronate (750–1300 kDa) with 40 U Botulinum toxin. Additionally, standard of care (RICE: Rest, Ice, Compression and Elevation) and stretching was prescribed but participants were instructed not to use NSAIDS or taping. The same pain VAS measures as well as peak exercise time, patient global satisfaction and patient assessment of normal running function (all measured using 5-point categorical scale) were repeated after 2, 7, 14 and 30 days. The primary outcome was peak pain during symptom-limited treadmill running.

Adverse events were recorded for safety purposes.

Results 45 consecutive runners with acute (within 7 days) ITBS were included and completed the study procedures. A statistically significant reduction from baseline in VAS peak treadmill exercise was observed at all time points (p<0.05). This was associated with significantly longer exercise time at 7, 14 and 30 days. Patient global satisfaction was increased progressively after 7, 14 and 30 days and assessment of normal running function was described in >75% at 14 days. No serious adverse were reported. 3 subjects described transient (<24 hours) weakness in knee extension and 2 subjects described mild pain at the time and location of injection.

Conclusions A single local injection of combination hyaluronate + Botulinum toxin for ITBS in runners improved pain and exercise time with treadmill running by 7 days post treatment and continued to 30 days. This treatment was satisfactory to runners and resulted in few, limited adverse events.

References

1. Louw M, Deary C. The biomechanical variables involved in the aetiology of iliotibial band syndrome in distance runners - A systematic review of the literature. Phys Ther Sport. 2014 Feb;15(1):64–75.

2. Fredericson M, Wolf C. Iliotibial band syndrome in runners: innovations in treatment.Sports Med. 2005;35(5):451–9.

References

Disclosure of Interest None declared