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
Source: PubMed


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
    • "The ITB was then sharply detached from the intermuscular septum, and the lateral retinaculum and the fibers were reflected until their insertion at GT. An effort was made to identify the capsular–osseous layer (COL) described by Terry et al. [14] and Vieira et al. [12]. Subsequently, tenotomy of the biceps femoris was performed. "
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    ABSTRACT: Background: Recent studies have described the presence of the anterolateral ligament (ALL). However, there is still no consensus regarding the anatomy of this structure with the topic controversially discussed. The aim of this study was to provide an anatomical description of the ligamentous structures on the anterolateral side of the knee with special emphasis on the ALL. Methods: Forty-four human cadaveric knees were dissected to reveal the ALL and other significant structures in the anterolateral compartment of the knee joint. The ALL was defined as a firm structure running in an oblique direction from the lateral femoral epicondyle to a bony insertion at the anterolateral tibia. Results: The ALL was identified in 45.5% (n = 20) of the dissected knee joints. The structure originates together with the fibular collateral ligament (45%) or just posterior and proximal to it (55%). The ligament has an extra-capsular, anteroinferior, oblique course to the anterolateral tibia with a bony insertion between Gerdy's tubercle and the fibular head. The ALL had its greatest extend at 60° of knee flexion and maximal internal rotation. Conclusion: The ALL is a firm ligamentous structure in the anterolateral part of the knee present in 45.5% of the cases. Given the course and characteristics of this structure, a function in providing rotational stability by preventing internal rotation of the knee is likely. Clinical relevance: The ALL might be an important stabilizer in the knee and may play a significant role in preventing excessive internal tibial rotation and subluxation of the knee joint.
    No preview · Article · Dec 2015 · The Knee
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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.
    Full-text · Article · Jul 2015 · Orthopaedics & Traumatology Surgery & Research
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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.
    Full-text · Article · Mar 2015 · Arthroscopy The Journal of Arthroscopic and Related Surgery
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