Medline ® Abstracts for References 12-14
of 'Iliotibial band syndrome'
The functional anatomy of the iliotibial band during flexion and extension of the knee: implications for understanding iliotibial band syndrome.
Fairclough J, Hayashi K, Toumi H, Lyons K, Bydder G, Phillips N, Best TM, Benjamin M
J Anat. 2006;208(3):309.
Iliotibial band (ITB) syndrome is a common overuse injury in runners and cyclists. It is regarded as a friction syndrome where the ITB rubs against (and 'rolls over') the lateral femoral epicondyle. Here, we re-evaluate the clinical anatomy of the region to challenge the view that the ITB moves antero-posteriorly over the epicondyle. Gross anatomical and microscopical studies were conducted on the distal portion of the ITB in 15 cadavers. This was complemented by magnetic resonance (MR) imaging of six asymptomatic volunteers and studies of two athletes with acute ITB syndrome. In all cadavers, the ITB was anchored to the distal femur by fibrous strands, associated with a layer of richly innervated and vascularized fat. In no cadaver, volunteer or patient was a bursa seen. The MR scans showed that the ITB was compressed against the epicondyle at 30 degrees of knee flexion as a consequence of tibial internal rotation, but moved laterally in extension. MR signal changes in the patients with ITB syndrome were present in the region occupied by fat, deep to the ITB. The ITB is prevented from rolling over the epicondyle by its femoral anchorage and because it is a part of the fascia lata. We suggest that it creates the illusion of movement, because of changing tension in its anterior and posterior fibres during knee flexion. Thus, on anatomical grounds, ITB overuse injuries may be more likely to be associated with fat compression beneath the tract, rather than with repetitive friction as the knee flexes and extends.
School of Sport and Physical Recreation, University of Wales Institute Cardiff, UK.
Iliotibial band syndrome: an examination of the evidence behind a number of treatment options.
Falvey EC, Clark RA, Franklyn-Miller A, Bryant AL, Briggs C, McCrory PR
Scand J Med Sci Sports. 2010;20(4):580. Epub 2009 Aug 23.
Iliotibial band (ITB) syndrome (ITBS) is a common cause of distal lateral thigh pain in athletes. Treatment often focuses on stretching the ITB and treating local inflammation at the lateral femoral condyle (LFC). We examine the area's anatomical and biomechanical properties. Anatomical studies of the ITB of 20 embalmed cadavers. The strain generated in the ITB by three typical stretching maneuvers (Ober test; Hip flexion, adduction and external rotation, with added knee flexion and straight leg raise to 30 degrees ) was measured in five unembalmed cadavers using strain gauges. Displacement of the Tensae Fasciae Latae (TFL)/ITB junction was measured on 20 subjects during isometric hip abduction. The ITB was uniformly a lateral thickening of the circumferential fascia lata, firmly attached along the linea aspera (femur) from greater trochanter up to and including the LFC. The microstrain values [median (IQR)]for the OBER [15.4(5.1-23.3)me], HIP [21.1(15.6-44.6)me]and SLR [9.4(5.1-10.7)me]showed marked disparity in the optimal inter-limb stretching protocol. HIP stretch invoked significantly (Z=2.10, P=0.036) greater strain than the SLR. TFL/ITB junction displacement was 2.0+/-1.6 mm and mean ITB lengthening was<0.5% (effect size=0.04). Our results challenge the reasoning behind a number of accepted means of treating ITBS. Future research mustfocus on stretching and lengthening the muscular component of the ITB/TFL complex.
Department of Rheumatology, Cork University Hospital, Wilton, Cork, Ireland, UK. email@example.com
Anatomy, function, and surgical access of the iliotibial band in total knee arthroplasty.
Whiteside LA, Roy ME
J Bone Joint Surg Am. 2009 Nov;91 Suppl 6:101-6.
Missouri Bone and Joint Research Foundation, St. Louis, 63131, USA. firstname.lastname@example.org