Síndrome de la banda iliotibial / Iliotibial band syndrome

Introducción: El dolor en la rodilla responde a múltiples causas. Entre ellas se encuentra el síndrome de la banda iliotibial que afecta, principalmente, a pacientes jóvenes que practican cierta actividad deportiva. Objetivo: Actualizar y ofrecer información sobre el síndrome de la banda iliotibial. Métodos: La búsqueda y análisis de la información se realizó en un periodo de 92 días (01 de julio al 30 de septiembre de 2020). Se emplearon las siguientes palabras: iliotibial band syndrome, iliotibial band friction syndrome AND lateral knee pain. Se realizó una revisión bibliográfica de un total de 186 artículos publicados en las bases de datos PubMed, Hinari, SciELO y Medline mediante el gestor de búsqueda y administrador de referencias EndNote, de ellos se utilizaron 40 citas seleccionadas para realizar la revisión, 38 de los últimos cinco años. Desarrollo: Se mencionan las características anatómicas más importantes relacionadas con la banda iliotibial. Se refiere a las maniobras empleadas, así como los exámenes imagenológicos de mayor utilidad. Se exponen las principales entidades implicadas en el diagnóstico diferencial. Con relación al tratamiento se mencionan las modalidades conservadoras y quirúrgicas. Conclusiones: El síndrome de la banda iliotibial es una enfermedad que tiene como característica fundamental dolor lateral de la rodilla el cual aumenta con la actividad física. El tratamiento conservador constituye la primera línea y el quirúrgico está justificado a los seis meses de respuesta limitada a la primera modalidad del enfrentamiento terapéutico(AU)

Introduction: Knee pain responds to multiple causes such as the iliotibial band syndrome that mainly affects young patients who practice certain sports activities. Objective: To update and offer information on iliotibial band syndrome. Methods: The search and analysis of the information was carried out in a period of 92 days - from July 1 to September 30, 2020, with the words iliotibial band syndrome, iliotibial band friction syndrome AND lateral knee pain. A bibliographic review of 186 articles published in PubMed, Hinari, SciELO and Medline databases was carried out using the EndNote search manager and reference manager, Forty citations were selected to perform the review, 38 of them were from the last five years. Development: The most important anatomical characteristics related to the iliotibial band are mentioned. They refer to the maneuvers used, as well as the most useful imaging tests. The main entities involved in the differential diagnosis are presented. Regarding treatment, conservative and surgical modalities are mentioned. Conclusions: The iliotibial band syndrome is a disease, main characterized by lateral knee pain, which increases with physical activity. Conservative treatment constitutes the first option; in addition, surgical treatment is justified after six months of limited response to the first option of therapeutic management(AU)

Measurement of iliotibial band diameter in iliotibial band friction syndrome and comparison with an asymptomatic population.

BACKGROUND: Iliotibial band friction syndrome (ITBFS) is an overuse injury of the lateral aspect of the knee. This syndrome classically affects the active young population. PURPOSE: To determine the diameter of the ITB using magnetic resonance imaging (MRI) in patients clinically diagnosed with ITBFS, compare the results with asymptomatic patients, and assess the inter-observer agreement between a senior and a junior radiologist with different levels of experience in musculoskeletal imaging. MATERIAL AND METHODS: From April 2014 to October 2019, 78 knee MRI scans of 78 patients were included in the study group who were referred from the orthopedic clinic with a clinical diagnosis of ITBFS. In the control group, there were 114 knee MRI scans of 114 patients who had knee MRI for various reasons and had no radiological abnormality on the performed knee MRI. The ITB diameters, cut-off values, and interclass correlation coefficient (ICC) were calculated. RESULTS: Mean thickness of the ITB was higher in the study group compared to the control group in measurements done by both the senior and junior radiologists and this was statistically significant (P < 0.001). Cut-off values of the diameters of the ITB were calculated as 2.385 for the senior radiologist and 2.420 for the junior radiologist. ICC of 0.80 was determined, which showed excellent agreement among interpreters. CONCLUSION: ITB thickness in the study group was significantly higher than in the control group. There was also excellent agreement among the two observers. Measurement of ITB thickness on axial plane knee MRI is one of the reliable criteria for ITBFS.

Sex Differences in Iliotibial Band Strain under Different Knee Alignments.

BACKGROUND: Increased strain of the iliotibial band (ITB) is a plausible contributing factor for the development of iliotibial band syndrome (ITBS). Although several studies have found relationships between the strain of the ITB and kinematic factors during running, the associations of the ITB strain with knee alignment and sex, which are considered intrinsic factors, are not well understood. OBJECTIVE: To clarify the sex differences in the ITB strain between genu varum and normal knee alignments in different postures. DESIGN: Observational cross-sectional study. SETTING: Laboratory research within a university. PARTICIPANTS: Forty-four healthy recreational athletes (21 men and 23 women) volunteered for this study and were divided into four groups by sex and knee alignment: men with genu varum alignment, men with normal knee alignment, women with genu varum alignment, and women with normal knee alignment. METHODS: An ultrasound real-time elastography (RTE) unit was used for distal ITB strain measurements in weight bearing and for different non-weight-bearing: neutral, knee flexion, hip adduction, and hip adduction with knee flexion. Gender information and the intercondylar distance data were collected to divide the participants into two groups. MAIN OUTCOME MEASUREMENTS: Main Outcome was the ITB strain (strain ratio) measured by the RTE. RESULTS: There were no significant differences in neutral and hip adduction postures among the four groups. However, during weight-bearing, the women's genu varum group (6.91 ± 1.69; Mean ± SD) exhibited greater strain than both the men's normal group (3.50 ± 1.04, P = .005) and the women's normal group (4.42 ± 1.42, P = .048). In addition, there were significant positive correlations between the intercondylar distance and the ITB strain during weight-bearing (r = 0.315, P = .037). CONCLUSIONS: The women's genu varum group exhibited a higher ITB strain during weight-bearing, which may be related to the high incidence of ITBS in women athletes. Furthermore, the changes in alignment and muscle activities during weight-bearing could influence the strain of the ITB. LEVEL OF EVIDENCE: III.

The relationship between lateral epicondyle morphology and iliotibial band friction syndrome: A matched case-control study.

BACKGROUND: Iliotibial band friction syndrome (ITBFS) is an overuse injury with pain at the level of the knee lateral epicondyle. We sought to determine whether there is greater knee lateral epicondyle prominence among patients with ITBFS versus matched controls. METHODS: Seventy five patients with ITBFS and 75 age-, height-, and sex-matched controls (n = 150 total patients) with knee magnetic resonance imaging from 2015 to 2017 were included. All cases had a diagnosis of ITBFS and a lack of other identified lateral knee injuries on magnetic resonance imaging. Controls had medial knee pain with medial meniscus tear on MRI and no clinical evidence of ITBFS. Lateral knee epicondyle height in millimeters was measured. RESULTS: Mean patient age was 39.1 years (SD 15.1), 57% were female, and mean height was 170.0 cm (SD 9.3) with no difference between cases and controls. Mean lateral epicondyle height for cases was 13.1 mm (SD 1.6) and for controls was 12.2 (SD 1.4) with a mean difference of 0.9 mm (95% CI 0.4-1.3 mm) between matched pairs (p < 0.001). Mean epicondyle height:condylar AP width ratio was 0.211 (SD 0.023) for cases and 0.198 (SD 0.020) for controls with a mean difference of 0.013 (95% CI 0.006-0.020) between matched pairs (p < 0.001). CONCLUSIONS: There is a significant association between greater lateral epicondyle prominence and IT band friction syndrome, suggesting another anatomic risk factor for this multifactorial condition.

Friction Syndromes of the Knee: The Iliotibial Band and Anterior Fat Pads.

As participation in sporting activities increases among the general population, the incidence of overuse injuries continues to rise. Friction syndromes of the knee are common and are often clinically diagnosed without the need for imaging. However, clinical symptoms may overlap with other joint abnormalities, and physical examination may be limited in individuals with excessive pain. Magnetic resonance imaging has remained the modality of choice for the evaluation of internal derangements of the joints and is a useful aid in the diagnosis of friction syndrome of the knee. This case report provides clinicians with an understanding of the most common friction syndromes of the knee joint as well as their imaging findings. (Journal of Surgical Orthopaedic Advances 27(1):77-80, 2018).

Outcome of Low-Invasive Local Split-Thickness Lengthening for Iliotibial Band Friction Syndrome.

Conventional surgical methods for iliotibial band friction syndrome (ITBFS) may affect the iliotibial band (ITB), delaying return to sports activities or impeding performance. We have developed a minimally invasive method. This study retrospectively analyzed the outcomes of this procedure in individuals with ITBFS. This study included 34 knees of 31 individuals. Surgery involved lengthening the central part of the ITB by splitting it into a superficial and a deep layer, maintaining the anterior and posterior fibers immediately above the lateral epicondyle. Outcomes included time to resume sports activity, personal best times to run a 5000-m race before and after surgery, and 2-month post-surgery muscle strengths. The mean postoperative time to return to competition was 5.8 weeks. Personal best times of 5000-m race improved in 13 of 17 runners. Two months post-surgery, the mean extensor muscle strengths on the healthy and affected sides did not significantly differ nor did the flexor muscle strengths. In ITBFS, the ITB itself is normal. Lengthening the limited region of the ITB immediately above the lateral femoral epicondyle removes the cause of ITBFS, with a reduction in inflammation. This technique resulted in early return to competition without degrading performance.

The iliotibial tract: imaging, anatomy, injuries, and other pathology.

The iliotibial tract, also known as Maissiat's band or the iliotibial band, and its associated muscles function to extend, abduct, and laterally rotate the hip, as well as aid in the stabilization of the knee. A select group of associated injuries and pathologies of the iliotibial tract are seen as sequela of repetitive stress and direct trauma. This article intends to educate the radiologist, orthopedist, and other clinicians about iliotibial tract anatomy and function and the clinical presentation, pathophysiology, and imaging findings of associated pathologies. Specifically, this article will review proximal iliotibial band syndrome, Morel-Lavallée lesions, external snapping hip syndrome, iliotibial band syndrome and bursitis, traumatic tears, iliotibial insertional tendinosis and peritendonitis, avulsion fractures at Gerdy's tubercle, and Segond fractures. The clinical management of these pathologies will also be discussed in brief.

Problems With Large Joints: Knee Conditions.

As a large joint dependent on ligaments for stability and muscles and tendons for function, the knee is susceptible to a spectrum of acute and overuse injuries. Acute injuries involve the ligaments, menisci, and weight-bearing surfaces. Overuse injuries commonly affect the patellar tendon, iliotibial band, and patellofemoral complex. Acute and overuse knee injuries can be debilitating but most can be diagnosed and managed by family physicians. An appropriate history and physical examination are essential to guide diagnosis and management decisions. X-ray imaging often is required. Magnetic resonance imaging study, computed tomography scan, or ultrasonography also may be indicated to guide diagnosis and management. Knee injuries often improve with bracing, activity modification, weight loss, and physical therapy. Referral to an orthopedic subspecialist can be considered when these measures are not effective.

Ultrasound-Guided Knee Procedures.

Most knee structures can be accurately targeted using ultrasound guidance. These structures are usually superficial, and the overlying soft tissues are mobile and compressible, facilitating excellent visualization with a high-frequency linear array transducer. The circumferential accessibility to the knee affords flexibility and often multiple procedural approach options. In most cases, an in-plane approach is easily achieved. Studies of ultrasonography-guided knee procedures have consistently shown high accuracy, and its use is particularly beneficial for obese patients, diagnostic injection specificity, safety, and precise targeting of pathology. More studies are needed to assess the clinical efficacy and cost-effectiveness of ultrasonography-guided knee procedures.

The source of fluid deep to the iliotibial band: documentation of a potential intra-articular source.

OBJECTIVE: To determine whether there is a consistent extension of the lateral synovial recess under the iliotibial band (ITB) in an unembalmed cadaveric model. DESIGN: A prospective laboratory investigation. SETTING: A procedural skills laboratory of a tertiary medical center. SUBJECTS: Twelve unembalmed cadaveric knee specimens. METHODS: The suprapatellar recess, ITB, and region deep to the ITB were examined sonographically to document the absence of fluid in each knee. Thereafter, 60 mL of normal saline solution was injected into each knee to distend the joint recesses. Postinjection sonographic examination of the ITB at the level of the lateral femoral epicondyle was repeated at 0°, 25°, and 45° of knee flexion to detect and characterize any fluid visualized in the region of the ITB. The location of fluid in relation to the ITB was recorded as anterior, deep, posterior, or a combination of these positions. RESULTS: Fluid was observed anterior and deep to the ITB in 100% of 12 specimens. In 2 specimens, fluid also was noted posterior to the ITB. The presence and location of the fluid did not appear to change as a function of knee position. Using dynamic sonographic evaluation, we could track the fluid deep to the ITB back to the knee joint. CONCLUSIONS: The lateral synovial recess appears to regularly extend beneath the anterior ITB. Fluid deep to the ITB should precipitate further evaluation of the knee joint when clinically indicated. Although distention of the lateral synovial recess is not always symptomatic, synovial irritation may be a pathoetiologic factor in the production of lateral knee pain syndromes, including ITB syndrome.

Sonographic evaluation of the iliotibial band at the lateral femoral epicondyle: does the iliotibial band move?

OBJECTIVES: The purpose of this study was to determine whether the iliotibial band (ITB) moves relative to the lateral femoral epicondyle (LFE) as a function of knee flexion in both non-weight-bearing and weight-bearing positions in asymptomatic recreational runners. METHODS: Five male and 15 female asymptomatic recreational runners (10-30 miles/wk) aged 18 to 40 years were examined with sonography to assess the distance between the anterior fibers of the ITB and the LFE in full extension, 30° of knee flexion, and 45° of knee flexion. Measurements were obtained on both knees in the supine (non-weight-bearing) and standing (weight-bearing) positions. RESULTS: The distance between the anterior fibers of the ITB and the LFE decreased significantly from full extension to 45° of knee flexion in both supine (0.38-cm average decrease; P < .001) and standing (0.71-cm average decrease; P < .001) positions. These changes reflect posterior translation of the ITB during the 0° to 45° flexion arc of motion in both the supine and standing positions. CONCLUSIONS: Sonographic evaluation of the ITB in our study population clearly revealed anteroposterior motion of the ITB relative to the LFE during knee flexion-extension. Our results indicate that the ITB does in fact move relative to the femur during the functional ranges of knee motion. Future investigations examining ITB motion in symptomatic populations may provide further insight into the pathophysiologic mechanisms of ITB syndrome and facilitate the development of more effective treatment strategies.

The prevalence of fluid associated with the iliotibial band in asymptomatic recreational runners: an ultrasonographic study.

OBJECTIVE: To evaluate the prevalence and distribution of fluid associated with the iliotibial band (ITB) in asymptomatic recreational runners. DESIGN: Prospective cohort study. SETTING: Sports medicine center at a tertiary medical center. PATIENTS: Five male and 15 female asymptomatic recreational runners (10-30 miles per week) ages 18-40 years. METHODS: Participants were examined with the use of ultrasonography to assess for the presence of fluid at the level of the lateral femoral epicondyle and determine its relationship to the ITB at 0 and 30° of knee flexion in both supine (non-weight-bearing) and standing (weight-bearing) positions. RESULTS: Fluid was associated with the ITB in 100% of asymptomatic recreational runners and was bilateral in 90%. When examined in full extension with the subject supine, fluid was seen in 67.5% of knees (n = 40) compared with 95% of the knees when standing. When examined in 30° of flexion, the presence of fluid decreased to 30% when supine and 22.5% when standing. With the knee in full extension in a supine/standing position, fluid was located anterior and deep 70%/74% of the time and was anterior only 11%/0% of the time. With the knee flexed to 30° in a supine/standing position, fluid was located anterior and deep 50%/33% of the time and anterior only 33%/67% of the time. CONCLUSION: The prevalence of fluid associated with the ITB varied with body and knee position, was most common in the standing position with the knee extended, and was generally located anterior or anterior and deep to the ITB. The clinical significance of our findings are 2-fold: (1) body position should be considered when searching for fluid in the vicinity of the ITB, and (2) clinicians and imagers should exercise caution when interpreting the clinical significance of fluid associated with the ITB during ultrasonographic evaluation of runners with lateral knee pain.

Sonographic measurement of iliotibial band thickness: an observational study in healthy adult volunteers.

PURPOSE: Iliotibial tract friction syndrome (ITBFS) might be caused by repetitive friction and abrasion of the iliotibial (ITB) tract across the lateral femoral epicondyle. Thickening in the ITB adjacent to the lateral femoral epicondyle has been reported. The values of ITB thickness at the lateral femoral epicondyle in healthy adult volunteers were determined, and the association between the thickness of the ITB and the subjects' age, weight, height, dominant limb and the volume of training or sporting activity was assessed. METHODS: An Ultrasound Scan (high resolution 3-2 MHz transducer Voluson-i G E Medical Systems, UK) was used to measure the thickness of the ITB in 38 healthy volunteers (30 men and 8 women, mean age 22.5 ± 1.5 years, range 18-25 years). One measurement from each of the subjects' knees at the level of lateral femoral epicondyle was taken. Reliability was established by measuring 11 of the subjects on three separate occasions at least I week apart. RESULTS: The thickness of the ITB on the right and left knees was 1.1 ± 0.2 mm. There was no evidence of a significant association between the thickness of the ITB and the subjects' age, weight, height, dominant limb and the volume of training or sporting activity. CONCLUSIONS: There is no evidence of significant correlation between the thickness of the ITB and subjects' age, weight, height, dominant limb and volume of training or sporting activity.