Unusual Case of Lateral Knee Pain - Magnetic Resonance Imaging Evidence of Isolated Lateral Patellotibial Ligament Enthesopathy

Sep 29, 2026

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A 23-year-old athletic male presented with 2 weeks of activity-related lateral knee pain without preceding trauma. Examination showed focal tenderness at the tibial attachment of the lateral patellotibial ligament with no effusion, instability, or meniscal signs. MRI revealed linear thickening of the lateral patellar retinaculum from the inferolateral patella to the anterolateral proximal tibia, with tibial attachment bone marrow edema suggesting enthesopathy. Conservative care led to significant symptomatic improvement.

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Case Report Journal of Orthopaedic Case Reports 2025 December:15( 12) :Page 183-186 Unusual Case of Lateral Knee Pain: Magnetic Resonance Imaging Evidence of Isolated Lateral Patellotibial Ligament Enthesopathy Mayank Srivastava1, Namdev Seth1, Rajnand Kumar2, Ajay Bharti2, HarikeshYadav3 Learning Point of the Article: Isolated lateral patellotibial ligament enthesopathy, though rare, should be considered in athletes presenting with unexplained lateral knee pain, and MRI plays a key role in its diagnosis. Abstract Introduction: Patellofemoral stability is maintained by a complex interplay of osseous, muscular, and ligamentous structures, with theretinacular system playing a central role. While the medial patellofemoral and patellotibial ligaments are well characterized, the lateral patellotibial ligament (LPTL) has been less frequently described, and isolated pathology involving this structure is rarely reported in the literature. Case Report: We report the case ofa 23-year-old athletic male presenting with a 2-week history of activity-related lateral knee pain without preceding trauma. Clinical examination revealed focal tenderness atthe tibial attachment oftheLPTL without effusion, instability, ormeniscal signs. Magnetic resonance imaging (MRI) demonstrated linear thickening of the lateral patellar retinaculum extending from the inferolateral patella to the anterolateral proximal tibia, consistent with theLPTL, which appeared thickened compared to themedial counterpart. Associated bone marrow edema at the tibial attachment near Gerdy’s tubercle suggested enthesopathy. Other intra-articular structures were normal. The patient was treated conservatively with physiotherapy, activity modification, and non-steroidal anti-inflammatory drugs, resulting in significant symptomatic improvement. Conclusions: This case highlights isolated LPTL enthesopathyas ararebut important cause of lateral knee pain in athletes. Recognition of this entityon MRI is essential to prevent misdiagnosis and to facilitate appropriate conservative management. Keywords: Patellofemoral stability, lateral patellotibialligament, enthesopathy, overuse injury, knee magneticresonanceimaging. Introduction Patellofemoral stability is maintained through a balance of osseous anatomy, ligamentous constraints, and dynamic muscular control. Among soft tissue stabilizers, the retinacular structures are essential in guiding patellar motion and preventing pathological tilt or translation [ 1 ] . The lateral patellar retinaculum consists ofsuperficial fibers from the iliotibial band and vastus lateralis fascia, and a deeper layer comprising the lateral patellofemoral ligament (LPFL), lateral patellotibial ligament (LPTL), and patellomeniscal fibers [2]. While the medial patellofemoral ligament (MPFL) and medial patellotibial ligament (MPTL) have been extensively studied due to their role in recurrent patellar instability, their lateral counterparts remain less well described. The LPTL, a focal thickening of the deep lateral retinaculum, attaches from the inferolateral patella to the anterolateral tibia near Gerdy’s |
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Website: [www.jocr.co.in](www.jocr.co.in)

DOI:
[https://doi.org/10.13107/jocr.2025.v15.i12.6500](https://doi.org/10.13107/jocr.2025.v15.i12.6500) | Author’s Photo Gallery | | | | | | --- | --- | --- | --- | --- | --- | | | | | | | | | |
1Department of Radiodiagnosis, All India Institute of Medical Sciences, Gorakhpur, Uttar Pradesh, India, 2Department of Orthopaedics, All India Institute of Medical Sciences, Gorakhpur, Uttar Pradesh, India, 3Department of General Surgery, All India Institute of Medical Sciences, Gorakhpur, Uttar Pradesh, India.
Address of Correspondence:
Dr. Namdev Seth,
Department of Radiodiagnosis, All India Institute of Medical Sciences, Gorakhpur-273008, Uttar Pradesh, India. [Email:](Email: namdevseth@gmail.com)[ namdevseth@gmail.com](Email:

FAQs

What condition is highlighted in this case report?

Isolated lateral patellotibial ligament enthesopathy is presented as a rare but important cause of lateral knee pain in athletes, identified on MRI.

What were the key clinical findings on examination?

The patient had focal tenderness at the tibial attachment of the LPTL without effusion, instability, or meniscal signs.

How did MRI contribute to the diagnosis and management?

MRI demonstrated thickening of the lateral patellar retinaculum consistent with the LPTL and showed bone marrow edema at the tibial attachment, supporting enthesopathy. This recognition helped guide conservative treatment with physiotherapy, activity modification, and NSAIDs.

Sep 29, 2026

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