Anterolateral knee pain

I have a patient, 18 y.o elite triathlete c/o anterolateral knee pain when running only. Insideous onset when running a couple of weeks ago. No pain when cycling, swimming, or with normal ADLs. Pain is not present when she is warming up in her running sessions but about 15-20min into session feels sharp pain anterolaterally (right over her infrapatella fat pad). She initially has very tight ITB however with a couple of weeks rolling it out on a foam roller it is now fine. Her gluteal stability on single leg squat is good no pain however she does get pain with a single leg hop. Her ligamentous and meniscal tests are all NAD and she is not tender along her joint line, or over the fat pad.

Initially I was thinking ITBFS however I definitely don't think it is now. I was then thinking fat pad irritation however she really isn't tender on palpation of her fat pad (even though when she points to the pain that is where it is - very specific point). I am now potentially thinking a lateral plica syndrome (however this is very rare).

Any advice would be greatly appreciated.
Thanks

Have you tried taping the patella to offload the infrapatellar fat pad?? Leukotaping the top of the patellar down which will lift up the inferior border of the patella thus off loading the fat pad.

Yes I have tried to off load the infrapatella fat pad by taping the knee with rigid strapping tape. I also applied an anterior glide on the tibia as well but unfortunately this doesn't change her pain.

I have a patient with similar complaints. HE is a runner who began experiencing pain in the anterolateral aspect of his L knee at around the 3 mi point of his run. He was diagnosed with ITB syndrome and sent to me for PT. I took him off his running program while we addressed his tight ITB and weak hip musculature. He had been symptom free with all daily activities so I had him try to return to running but the pain returned. The pain comes on suddenly at around mi 3 and will last 24 hr. The patient reports the knee will feel like it's going to buckle with weightbearing once the pain begins. I assessed the patient immediately post running but was not able to elicit the pain with palpation. Has anyone know what can be causing this pain and has anyone had any success in treating? Thanks!

hi, haven't seen patients like this, but just get my some input here. Try slow motion of hopping, see if there is biomechanical control issue, especially knee adduction. that might build up lateral loading during running.