Ultrasographic diagnosis and percutaneous treatment of insertional calcific tendinopathy of iliotibial band: case report

A 51-year-old woman underwent sonography for pain in the lateral aspect of the right knee with functional limitation. Pain was present mostly during the night and was partially responsive to cryotherapy and NSAID (Diclofenac 150 mg) treatments.
The clinical examination showed the lateral aspect of the right knee, battered, bruised, red and warm.

Ultrasound examination (Fig. 1) showed a soft, homogeneous, calcific deposition on the distal iliotibial band of 20 mm, without posterior acoustic shadow (Type III Uhthoff cycle); colour-power-Doppler showed peri-calcific hyperaemia (Fig. 2), correlating with neoangiogenesis and capillary proliferation.
An ultrasound-guided percutaneous treatment was proposed. After obtaining informed written consent of the patient and local anaesthesia, two 18 G needles were introduced into the calcification under ultrasound guidance and then the calcification was washed. After treatment there was a significant reduction of the symptoms.
After 15 days the pain was further reduced and the ultrasound check highlighted a slightly inhomogenous ecostructure of the insertion of the iliotibial band and small calcification (leftover) in the absence of abnormal vascularisation. After 30 days the symptoms had disappeared completely and function was clearly improved.

Calcific tendinopathy is a frequent pathology, particularly in women between 40 to 60 years of age.
The aetiology is not yet fully clarified, however, characterised by deposition of calcium salts in the tendons [1-3].
The tendons most frequently affected are those of the rotator cuff, particularly the supraspinatus, although cases of various other tendons are described [4]. It is a different pathology from calcifications in tendinosis, in fact the most common calcium salt in calcific tendinopathies is hydroxyapatite, rare in tendinosis.
Four stages are described in the Uhthoff cycle: pre-calcium, formative, resorptive, post-calcific. Pain is particularly important in stage 4. The diagnosis of calcific tendinitis is mainly based on standard radiographs and ultrasound examination. In recent years, ultrasonography has emerged as the imaging technique of choice also for guiding therapeutic procedures.
The ileo-tibial bandage is a lateral stabiliser of the knee [5-7], whose most frequent pathology is the Iliotibial band syndrome, while calcific tendinopathy at the insertion into the Gerdy tubercle of the tibia has never been reported, to our knowledge.
We thought, therefore, to publish this case report for its rarity and because it confirms how ultrasound-guided therapies can be successfully used in the management of calcific tendinopathy, even of the less common ones [7, 8].

Written informed patient consent for publication has been obtained.