An Anatomic Study of the Iliotibial Tract

Universidade Federal de São Paulo, San Paulo, São Paulo, Brazil
Arthroscopy The Journal of Arthroscopic and Related Surgery (Impact Factor: 3.21). 04/2007; 23(3):269-74. DOI: 10.1016/j.arthro.2006.11.019
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To identify the structure of the iliotibial tract at knee level, as well as its insertions, layer arrangement, and relationship with other structures of the lateral region of the knee and to compare the findings with available literature.
Ten detailed anatomic dissections were performed by using incisions as recommended by the literature in fresh cadaver knees identifying the iliotibial tract components.
The authors observed an iliotibial tract arrangement in superficial, deep, and capsular-osseous layers. Insertions have been described as follows: at linea aspera, at the upper border of the lateral epicondyle, at the patella, and at Gerdy's tibial tuberculum and across the capsular-osseous layer.
The iliotibial tract (ITT) has important interconnections to the femur, the patella, and the lateral tibia; the iliopatellar band joins the ITT to the patella through the superficial oblique retinaculum and the lateral femoropatellar ligament, and the ITT capsular-osseous layer presents differentiated fibers in an arched arrangement that borders the femoral condyle and inserts laterally to the Gerdy's tubercle.
The iliotibial tract can be considered as an anterolateral knee stabilizer, particularly its capsular-osseous layer, which, together with the anterior cruciate ligament, constitutes a functional unit forming a spatial "horseshoe" form. The detailed description of the structures forming iliotibial tract plays an important role in the study of knee instabilities. Its important tibial, femoral, and patellar connections are described so that better understanding of tibial femoral instability on the lateral side as well as patellofemoral instability can be achieved and mechanisms of repair can be conceived.

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Available from: Rogerio Teixeira Silva, Apr 22, 2014
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    • "In 1982 Muller [22] used the term " lateral femorotibial ligament. " Terry et al. [19] and Viera et al. [20] described the existence of capsular-bony fibers of the iliotibial tract that they considered to be an anterolateral ligament, thus generating confusion with the current description. For Johnson [23] this was a " lateral capsular ligament, " for Campos et al. [24] an " anterior oblique band, " and for Hughston et al. [25], LaPrade and Terry [26], Haims et al. [27], and Goldman et al. [28] the " mid-third lateral capsular ligament. "
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    ABSTRACT: Introduction Since the recent descriptions of the anterolateral ligament (ALL), the role played by the anterolateral peripheral structures in the rotational control of the knee is again being debated. The objective of this study was to identify the structures during internal tibial rotation and then to define their anatomical characteristics. We hypothesized that internal rotation would tighten several anatomical formations, both superficial and deep, with the ALL one part of these structures. Material and methods Nine fresh-frozen cadaver knee specimens were studied. The anterolateral structures tightened were identified from superficial to deep at 30° of flexion. Each was selectively dissected, identifying its insertions and orientations, and measuring its size. The length variations of the ALL during internal tibial rotation were measured by applying a 30-N force using a dynamometric torque wrench at the tibiofibular mortise. Results The superficial structures tightened were the iliotibial tract and the Kaplan fibers. In internal tibial rotation, the Kaplan fibers held the iliotibial tract against the lateral epicondyle, allowing it to play the role of a stabilizing ligament. The Kaplan fibers were 73.11 ± 19.09 mm long (range, 63–82 mm) and at their femoral insertion they were 12.1 ± 1.61 mm wide (range, 10–15 mm). The deep structures tightened covered a triangular area including the ALL and the anterolateral capsule. The ALL was 39.11 ± 3.4 mm long (range, 35–46 mm) in neutral rotation and 49.88 ± 5.3 mm long (range, 42–58 mm) in internal rotation (p < 0.005). Its femoral insertion area was narrow at 5.27 ± 1.06 mm (range, 3.5–7 mm) and was mainly proximal and posterior at the lateral epicondyle. Its tibial insertion zone was wide, with a clearly differentiated anterior limit but a posterior limit confused with the joint capsule. In the vertical plane, this insertion was located 6.44 ± 2.37 mm (range, 2–9) below the joint space. Discussion This study demonstrates two distinct anterolateral tissue planes tightened during internal rotation of the tibia: a superficial plane represented by the iliotibial tract and the Kaplan fibers, which acts as a ligament structure, and a deep plane represented by a triangular capsular ligament complex within which the ALL and the anterolateral capsule are recruited.
    Orthopaedics & Traumatology Surgery & Research 07/2015; 101(5). DOI:10.1016/j.otsr.2015.04.007 · 1.26 Impact Factor
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    • "Hughston et al. 27 ; " lateral capsular " ligament by Johnson, 18 Patella et al., 13 and Dietz et al. 25 ; " anterior slip " of the lateral collateral ligament by Fulkerson and Gos- sling 12 ; " capsulo-osseous layer " of the iliotibial tract by Terry et al. 14 ; " anterior oblique band " by Irvine et al. 17 and Campos et al. 19 ; and " anterolateral ligament " first introduced by Vieira et al. 7 in 2007. "
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    ABSTRACT: Purpose: The purpose of this systematic review was to evaluate the anatomic structure and function of the anterolateral ligament (ALL) of the knee. Methods: The Medline, Embase, and Cochrane databases were screened for all studies related to the ALL of the knee. Two reviewers independently reviewed all eligible articles and the references of these articles. Inclusion and exclusion criteria were applied to all searched studies. Quality assessment was completed for the included studies. Results: Nineteen studies were identified for final analysis. Pooled analysis identified the ALL in 430 of 449 knees (96%) examined. The ligament was found to originate from the region of the lateral femoral epicondyle and insert on the proximal tibia midway between the Gerdy tubercle and the fibular head. The ALL was found to be 34.1 to 41.5 mm in length, 5.1 to 8.3mmin width above the lateralmeniscus, and 8.9 to 11.2mmin width below the lateral meniscus. By use of magnetic resonance imaging, the ALLwas identified in 93%of knees examined (clinical, 64 of 70; cadaveric, 16 of 16). In one case study the ligament was clearly visualized by ultrasound examination. Histologic analysis across 3 studies showed characteristics consistent with ligamentous tissue. Though not shown in biomechanical studies, it is hypothesized that the ALL provides anterolateral stability to the knee, preventing anterolateral subluxation of the proximal tibia on the femur.One study identified a network of peripheral nerves, suggesting a proprioceptive function of the ALL. Conclusions: This systematic review shows the ALL to be a distinct structure with a consistent origin and insertion sites. The ALL is an extra-articular structure with a clear course from the lateral femoral epicondyle region, running anteroinferiorly, to the proximal tibia at a site midway between the Gerdy tubercle and the head of the fibula. The function of this ligament is theorized to provide anterolateral knee stability. Level of Evidence: Level IV, systematic review of cadaveric and imaging studies.
    Arthroscopy The Journal of Arthroscopic and Related Surgery 03/2015; 31(3):569-582. DOI:10.1016/j.arthro.2014.12.015 · 3.21 Impact Factor
    • "Thus, a quantitative SWE could be useful in the measurement of ITB hardness. The ITB is a lateral thickening of the fascia in the thigh, connecting the hip and knee muscles, i.e., the gluteus maximus (Gmax), gluteus medius (Gmed), tensor fasciae latae (TFL), and vastus lateralis (VL) [20] [21] [22]. Therefore, an excessive hip adduction , increase of external joint moment, and contraction of the above-described muscles could contribute to the increase in ITB hardness. "
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    ABSTRACT: Although several studies have described kinematic deviations such as excessive hip adduction in patients with iliotibial band (ITB) syndrome, the factors contributing to increased ITB hardness remains undetermined, owing to lack of direct in vivo measurement. The purpose of this study was to clarify the factors contributing to an increase in ITB hardness by comparing the ITB hardness between the conditions in which the angle, moment, and muscle activity of the hip and knee joint are changed. Sixteen healthy individuals performed the one-leg standing under five conditions in which the pelvic and trunk inclination were changed in the frontal plane. The shear elastic modulus in the ITB was measured as an indicator of the ITB hardness using shear wave elastography. The three-dimensional joint angle and external joint moment in the hip and knee joints, and muscle activities of the gluteus maximus, gluteus medius, tensor fasciae latae, and vastus lateralis, which anatomically connect to the ITB, were also measured. ITB hardness was significantly increased in the posture with pelvic and trunk inclination toward the contralateral side of the standing leg compared with that in all other conditions (increase of approximately 32% compared with that during normal one-leg standing). This posture increased both the hip adduction angle and external adduction moment at the hip and knee joint, although muscle activities were not increased. Our findings suggest that coexistence of an increased adduction moment at the hip and knee joints with an excessive hip adduction angle lead to an increase in ITB hardness. Copyright © 2014 Elsevier B.V. All rights reserved.
    Gait & Posture 12/2014; 41(2). DOI:10.1016/j.gaitpost.2014.12.006 · 2.75 Impact Factor
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