Research progress of lower limb muscle strength training in the treatment of lliotibial band syndrome / 中国骨伤

Iliotibial band syndrome (ITBS), as an overused injury of the lower extremities, has developed into a common cause of lateral knee pain. At present, the treatment of ITBS includes drug therapy, muscle strength training, physical therapy, and surgical treatment. Among these methods, physical therapy, drug therapy, and surgical treatment can only alleviate the symptoms of patients. As a safe and effective treatment, lower limb muscle strength training can improve patients' muscle strength, correct abnormal gait, and reduce the recurrence rate of the disease by paying attention to the dynamic changes of patients' recovery process. At present, the pathogenesis of ITBS remains unclear, and the treatment methods are not unified. It is necessary to further study the biomechanical factors related to the lower extremities and develop more scientific and comprehensive muscle strength training methods.

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)

Repair of soft tissue defect around posterior calcaneal region combined with Achilles tendon defect by the thin-layer free anterolateral thigh flap with iliotibial band / 中华显微外科杂志

Objective To investigate the clinical effect of thin-layer free anterolateral thigh flap with iliotibial tract for reconstruction of heel soft tissue and Achilles tendon defect.Methods From January,2017 to December,2017,11 cases of heel soft tissue and Achilles tendon defect were repaired by thin-layer free anterolateral thigh flap with iliotibial tract.There were 5 cases with tibia/fibula fracture,3 cases with ankle fracture and 1 case with calcaneal fracture.The area of soft tissue defect was 6.5 cm×10.0 cm-8.0 cm×13.0 cm,and the length of Achilles tendon defect was 5.5-11.5 cm.All wounds were treated with debridement and negative pressure sealing drainage technique at first stage.After 6 days,the soft tissue defect around posterior calcaneal region combined with Achilles tendon defect were repaired by the thin-layer free anterolateral thigh flap with iliotibial tract.Reasonable rehabilitation training was established after operation.Results The flaps survived in 11 cases and the donor region healed in one stage.The patients were followed-up for 8 to 20 (mean,15.74) months by outpatient review,calling or WeChat.Slightly bloated in appearance in 2 cases,and were thinned by orthopedic operation 1 year later.The other flaps were well shaped and moderately thick.At the last follow-up,the flaps were soft in texture and elastic.The sensory recovery of the flap was good,and the two-point discriminant perception in the posterior region of the heel was 3.0-5.0(mean,4.11) mm.Thompson's sign was negative,double or one-foot heel lift test was negative,and there was no recurrence of Achilles tendon rupture or skin ulceration in the heel region.The range of motion (ROM) of affected side was (23.1 1±1.17)°of extension and (43.67±1.06)°of flexion,and the ROM of normal side was (23.79±1.03)°of extension and (44.03±0.94)°of flexion.There was no statistical difference between them (P＞0.05).Postoperative follow-up was conducted according to the Thermann's function evaluation system,the evaluated result was excellent in 8 cases,good in 2 cases,and receivability in 1 case.Conclusion It is a reliable and effective method to repair heel soft tissue and Achilles tendon defect by thin-layer free anterolateral thigh flap with iliotibial tract.And this method can better restore foot ankle shape and function.

Clinical diagnosis and treatment for iliotibial band syndrome / 中国骨伤

As an usually occurs in athletes, iliotibial band syndrome is payed more attention for people, the disease is diagnosed mainly by clinical symptoms, physical examination and MRI, but there is no uniform diagnostic criteria. The pathogenesis of iliotibial band syndrome is considered to be related to pressure and friction factors. As for the treatment, manipulation, muscle exercise, mainly drugs and physical therapy and so on both at home and abroad are recognized to use to achieve desired effect. For conservative failure, refractory iliotibial band syndrome patients, arthroscopy, or release of iliotibial band syndrome surgery are performed. While conservative local drug injection combined with muscle exercise could play a role in pain management besides, arthroscopic as operation method is more advanced, and applicable to all types of patients without absolute contraindication, so it is helpful for patients with early activity. At present, there is still a great deal of controversy about its pathogenesis, and there is no obvious limit for the specific indications of its various therapies in clinic, so it needs further specification.

Research progress on clinical diagnosis and treatment for external snapping hip / 中国骨伤

External snapping hip(ESH) is a vague term used to describe palpable or auditory snapping with hip movements with or without pain. The pathogenesis of ESH is related to the specific anatomical structure and friction factor. The clinical symptom is auditory snapping during activities, physical examination, X-ray, magnetic resonance imaging(MRI), dynamic ultrasound and other imaging techniques can be used to diagnose. Conservative medical management includes rest, avoidance of aggravating activities, and antiinflammatory medications. Treatment Patients with mild symptoms can achieve good results by medication, rest and physiotherapy. Surgical treatment for patients with ineffective conservative treatment was performed. All kinds of open surgery method can achieve good clinical curative effect, arthroscopic surgery is gradually been promoted due to small trauma, less complications. Besides, there are some reports that traditional treatments such as massage, acupuncture and acupotomology have achieved good clinical results, which deserve further study and promotion.

The transition of tensor fasciae latae and iliotibial band hardness after hip abduction exercise and the effect of vibration stimulation / 体力科学

The aim of this study was to evaluate the transition of the tensor fasciae latae (TFL) and the iliotibial band (ITB) hardness after repetitive hip abduction exercise (RE) and the effect of vibration stimulation immediately after RE. Nine healthy man performed the RE (20 reps×5 sets) and the TFL and the ITB hardness were measured before and after RE. Participants were performed RE by 2 conditions(i.e. with and without vibration stimulation after RE). The results showed that with no vibration condition, hardness of the TFL significantly increased immediately, 15 min, 30 min, and 24 hours and the ITB significantly increased immediately, and 24 hours after RE compared with before RE, respectively. With vibration condition, vibration after RE, both of the TFL and the ITB hardness significantly increased only immediately after compared with before RE. On the other hand, TFL and ITB hardness significantly decreased 15 min, 30 min, and 24 hours compared with immediately after RE. In addition, with vibration condition, TFL and ITB hardness significantly decreased 15 min, 30 min, 24 hours compared with no vibration condition, respectively. This study indicated that the ITB hardness might be increased with excessive activity of TFL, and the vibration stimulation immediately after exercise is effective for decreasing the hardness.

External Snapping Hip Treated by Effective Designed N-plasty of the Iliotibial Band / 대한고관절학회지

PURPOSE: The purpose of this study is to present the effective design of N-plasty of the iliotibial band and surgical results of its use as a treatment for refractory external snapping hip. MATERIALS AND METHODS: We evaluated 17 patients (24 cases) with external snapping hip who underwent N-plasty between October 2013 and May 2016 and who were followed up for at least 12 months. All patients were male and the mean age was 20.8 years. The mean duration of symptoms prior to surgical intervention was 28.5 months with an average follow up of 24.5 months. Surgery was defined as being successful when patients could carry out their daily activities and exercise without a clicking sensation or pain 6 months after surgery until their last follow-up. Failure was defined when either a clicking sensation or pain was present. The visual analog scale (VAS) and modified Harris hip score (mHHS) were measured and compared preoperatively and at last follow-up. RESULTS: All patients had complete resolution of pain and snapping. The VAS decreased from 6.77 preoperatively to 0.09 postoperatively and mHHS improved from 69.5 to 97.8 after surgery. CONCLUSION: Modified designed N-plasty is considered to be an excellent treatment method facilitating operation reproducibility with maximum elongation effect of the iliotibial band.

External Snapping Hip Treated by Effective Designed N-plasty of the Iliotibial Band / 대한고관절학회지

PURPOSE: The purpose of this study is to present the effective design of N-plasty of the iliotibial band and surgical results of its use as a treatment for refractory external snapping hip. MATERIALS AND METHODS: We evaluated 17 patients (24 cases) with external snapping hip who underwent N-plasty between October 2013 and May 2016 and who were followed up for at least 12 months. All patients were male and the mean age was 20.8 years. The mean duration of symptoms prior to surgical intervention was 28.5 months with an average follow up of 24.5 months. Surgery was defined as being successful when patients could carry out their daily activities and exercise without a clicking sensation or pain 6 months after surgery until their last follow-up. Failure was defined when either a clicking sensation or pain was present. The visual analog scale (VAS) and modified Harris hip score (mHHS) were measured and compared preoperatively and at last follow-up. RESULTS: All patients had complete resolution of pain and snapping. The VAS decreased from 6.77 preoperatively to 0.09 postoperatively and mHHS improved from 69.5 to 97.8 after surgery. CONCLUSION: Modified designed N-plasty is considered to be an excellent treatment method facilitating operation reproducibility with maximum elongation effect of the iliotibial band.

Intra-Articular Fibroma of Tendon Sheath in a Knee Joint Associated with Iliotibial Band Friction Syndrome

Iliotibial band (ITB) friction syndrome is a common overuse injury typically seen in the active athlete population. A nodular lesion on the inner side of the ITB as an etiology or an accompanying lesion from friction syndrome has been rarely reported. A 45-year-old male presented with recurrent pain and a movable nodule at the lateral joint area, diagnosed as ITB friction syndrome. The nodule was confirmed as a rare intra-articular fibroma of the tendon sheath (FTS) on the basis of histopathologic findings. We describe the MRI findings, arthroscopic and pathologic features, in this case of intra-articular FTS presenting with ITB friction syndrome.

Synovial Cyst: A Culprit for Recalcitrant Iliotibial Band Syndrome: A Case Report

We present the case of a 56-year old gentleman who presented with recalcitrant iliotibial band (ITB) friction syndrome which did not improve with various modalities of conservative treatment. Magnetic Resonance Imaging (MRI) of the affected knee did not show pathology typical of ITB friction syndrome. However, open exploration revealed a synovial cyst deep to the iliotibial band, abutting against the anterolateral capsule. The presence of distinctive clinical signs on physical examination should alert clinicians to consider knee synovial cyst as a differential diagnosis when dealing with recalcitrant ITB syndrome.

Sonography of the iliotibial band: spectrum of findings / Ultrassonografia do trato iliotibial: espectro de achados

Iliotibial band lesions constitute a potential source of discomfort and are frequently confounded with other conditions which cause pain on the lateral aspect of the hip, thigh and knee. Ultrasonography is usually regarded as a first-line imaging modality in the assessment of such conditions because of its excellent diagnostic accuracy, low cost and wide availability. The correct identification of the structure involved in the production of symptoms leads to an appropriate management and to a higher probability of resolution of the clinical complaint. The present article is aimed at reviewing the different sonographic presentations of iliotibial band syndromes.

Lesões no trato iliotibial constituem potencial fonte de desconforto e são frequentemente confundidas com outras enfermidades causadoras de dor na face lateral do quadril, coxa e joelho. A ultrassonografia é reconhecida como um método de imagem de primeira linha na investigação destas alterações, em virtude da excelente capacidade diagnóstica, baixo custo e ampla disponibilidade. A correta identificação da estrutura geradora dos sintomas resulta em tratamento específico e maior probabilidade de resolução da queixa clínica. O objetivo deste artigo é revisar as diferentes apresentações ultrassonográficas de doença do trato iliotibial.

Reliability of Iliotibial Band Morphologic Measurement Using Musculoskeletal Ultrasound Imaging / 中国康复理论与实践

Objective To investigate the reliability of the morphologic measure of the iliotibial band (ITB) with musculoskeletal ultra-sound imaging. Methods 20 healthy young subjects were measured with the musculoskeletal ultrasound imaging of the thickness of bilateral ITB at the levels of the femoral condyle by 2 testers, and one of the testers measured again 3-5 days later. The intraclass correlation coeffi-cient (ICC) and minimum detectable change (MDC) were calculated, and the thickness of ITB in both sides was compared. Results The ICC of test-retest was 0.89 (R) and 0.85 (L), and it was 0.82 (R) and 0.84 (L) of inter-testers. The MDC was 0.41-0.51 mm. There was no signifi-cant different between right and left sides for the ITB thickness among healthy subjects (P=0.97). Conclusion Musculoskeletal ultrasound imaging is a feasible and reliable to measure the ITB thickness among young healthy subjects.

Transplantation of the free anterolateral thigh flap combined with iliotibial band for reconstruction of children's soft tissue defects at foot and ankle / 中华显微外科杂志

Objective To investigate the clinical effect of transplantation of the free anterolateral thigh flap and iliotibial band for the repair of soft tissue defects at foot and ankle and functional reconstruction.Methods From January,2008 to January,2013,25 pediatric patients with soft tissue defects at foot and ankle were transplantation of the free anterolateral thigh flap and iliotibial band.Of the 25 cases,there were 12 cases at heel,8 cases at dorsum of foot,3 cases at medial malleolus and 2 cases at external malleolus.All the cases were accompanied with different degree of fracture or dislocation,and with soft tissue defect such as achilles tendon,extensor tendon of dorsal,collateral ligament of ankle.The length of soft tissue defect which were reconstructed with iliotibial band were 3 cm to 16 cm.The causes of injury:19 cases were crushed by motorcycle or bicycle,4 cases were crushed machines,2 cases were injuryed in traffic accidents.The areas of free anterolateral thigh flaps were 8 cm × 5 cm to 18 cm × 12 cm.All the patients begined to early rehabilitative exercise under the protection of orthosis after 2 weeks of the operation.Results All cases were followed up from 6 to 24 months,averaged of 14 months.All the flaps survived,and only 2 cases with necrosis of small area in distal,and which were healed by dressing.The healing time were 12 to 24 days,and the average of 15.1 days; The surgery function were assessed according to Thermann's scale,and the results was 14 cases for excellent,9 cases was good,the general was 2 cases,and the excellent and good rate was 92％.Conclusion The transplantation of the free anterolateral thigh flap and iliotibial band for the repair of soft tissue defect at foot and ankle and functional reconstruction is a safe and effective strategy,and it has the advantages such as covering the wound at foot and ankle approvingly,reconstruction of power device once,the flap and iliotibial band were in the same wound,the trauma of doner site is small invasive,early recovery functional exercise,shorten the treatment cycle,and relieve the suffering of children.

Arthroscopic Treatment for External Snapping Hip / 대한고관절학회지

PURPOSE: The purpose of this study was to evaluate the clinical outcome of arthroscopic treatment for recalcitrant external snapping hip. MATERIALS AND METHODS: Between September 2011 and June 2013, we evaluated 7 patients (10 cases) with snapping hip who were refractory to conservative treatments for at least 3 months. Two patients (4 cases) were impossible to adduct both knees in 90degreesof hip flexion. Surgery was done in lateral decubitus position, under spinal anesthesia. We made 2 arthroscopic portals to operate the patients, and used cross-cutting with flap resection technique to treat the lesion. We performed additional gluteal sling release in those 2 patients (4 cases) with adduction difficulty. Average follow-up length was 19 months (range, 12-33 months). Clinical improvement was evaluated with visual analog scale (VAS), modified Harris hip score (mHHS), and also investigated for presence of limping or other complications as well. RESULTS: The VAS decreased from 6.8 (range, 6-9) preoperatively to 0.2 (range, 0-2) postoperatively, and the mHHS improved from 68.2 to 94.8 after surgery. None of the patients complained of post-operative wound problem or surgical complications. CONCLUSION: The clinical outcome of arthroscopic treatment for recalcitrant external snapping hip was encouraging and all patients were also satisfied with the cosmetic results.

Proximal iliotibial band syndrome: case report / Sindrome da banda iliotibial proximal: relato de caso

OBJECTIVE: The overuse injuries in the hip joint occur commonly in sports practitioners and currently due to technical advances in diagnostic imaging, especially magnetic resonance imaging (MRI), are often misdiagnosed. Recently, a group of people were reported, all female, with pain and swelling in the pelvic region.T2-weighted MRI showed increased signal in the enthesis of the iliotibial band (ITB) along the lower border of the iliac tubercle. We report a case of a 34 year old woman, non-professional runner, with pain at the iliac crest with no history of trauma and whose MRI was compatible with the proximal iliotibial band syndrome. .

As lesões por sobrecarga na articulação do quadril ocorrem comumente em praticantes de esporte e atualmente, por causa do avanço das técnicas de diagnóstico por imagem, especialmente a ressonância magnética (RM), são frequentemente diagnosticadas. Recentemente, foi estudado um grupo de pacientes, todos do sexo feminino, com quadro de dor e edema na região do tubérculo ilíaco. A RM ponderada em T2 demonstrava aumento de sinal na êntese da banda iliotibial (BIT) ao longo da margem inferior do tubérculo ilíaco. Relatamos um caso de uma mulher de 34 anos, corredora não profissional, com quadro de dor na crista ilíaca sem história de trauma e cuja RM era compatível com a síndrome da banda iliotibial proximal. .

Diagnosis of Iliotibial Band Friction Syndrome and Ultrasound Guided Steroid Injection

A 64-year-old woman visited our pain clinic with the pain of right lateral side of thigh for one year. Her pain always started from knee and was radiated to buttock area when symptom was severe. She showed significant tenderness at knee lateral side and local tightness at lateral thigh. Magnetic resonance image of the knee was performed and we could identify high signal intensity of iliotibial band through coronal and axial view. In spite of medication and physical stretching exercise of iliotibial band for one month, she did not show any improvement of pain. To alleviate her symptom, ultrasound guided local corticosteroid injection targeting beneath the iliotibial band was performed. After the procedure, the reduction of pain was significant and there was no need for further management.

Evaluation of anterior cruciate ligament repair with iliotibial band.

Reconstruction of the anterior cruciate ligament (ACL) is the surgical treatment of choice as direct primary repair of the ligament has been shown to result in persistent laxity and instability of the knee. The aim of reconstruction is to restore stability of the knee without restricting its functions. Anterior cruciate ligament reconstruction requires a graft which may be either an autograft or an allograft or a synthetic graft. Most studies agree that using the patient’s own tissue (autograft) to repair an anterior cruciate ligament tear is the way to go. Graft taken from patellar tendon gives good results but muscle weakness, pain, tendonitis and kneecap fracture are just a few of the possible post-operative problems. In this prospective study of ACL reconstruction, tendon material from iliotibial tract was used in a special way for adding stability to the knee called iliotibial band tenodesis. Herein, 17 cases of ACL repair and augmantation with iliotibial tract is being evaluated.

The anatomical characteristics and clinical application of the lateral superior genicular artery perforator iliotibial band flap / 中华显微外科杂志

Objective To discuss anatomical characteristics and clinical results of the lateral superior genicular artery perforator iliotibial band flap. Methods From September 1999 to July 2009, the origin,course, branches and distribution of the lateral superior genicular artery and blood supply of iliotibial band were observed on 40 sides adult lower limbs perfused with red latax. Five perforator iliotibial band and 4 perforator iliotibial band flaps of 9 cases were treated with anastomosis of lateral superior genicular artery perforating rami. Results The lateral superior genicular artery of 35 cases (80%) originates from the popliteal artery. Its originated external diameter was (1.8 ± 0.4) mm. It divides into ascending branch and descending branch, and they gives off septofascio-cutaneous perforator, or anatomoses the lateral uppermost genicular artery in the vastus lateralis muscle, and then formes the musculocutaneous perforator of iliotibial band. The originated external diameter of the larger perforator of iliotibial bands was ( 1.0 ± 0.2) mm and they provides for the skin and iliotibial band of lateral superior genicular area. Nine cases, including 5 cases of simple Achilles tendon defects, two cases of achilles tendon defects with skin defects, and 2 cases of lower extremity and foot soft tissue defects were treated with transplantation of the vascularized iliotibial band (flap) with perforator vascular anastomoses. All cases were followed up 6 - 92 months. The results showed significant improvement in "heel test" and Thompson sign in the rerupture of the Achilles tendon occurred. Four perforator iliotibial band flaps survived well. Conclusion The lateral superior genicular artery perforator iliotibial band flap is a practical, simple and new donor in the reconstruction of soft tissue and composite defects.

Normal and abnormal iliotibial band:sonographic assessment / 中华超声影像学杂志

Objective To measure the thickness of the iliotibial band(ITB)in normal adult volunteers and to evaluate the value of ultrasonography in the diagnosis of ITB injury.Methods Ultrasonography was used to measure the thickness of the ITB in 20 normal adult volunteers,which were compared with the sonographic findings in 11 patients with iliotibial band friction syndrome(ITBFS).Results The thickness of the ITB in normal volunteers was(1.55±0.40)mm at the level of the femoral condyle and(2.05±0.30)mm at the insertions of tibial tubercle(Gerdy's tubercle).There were no significant differences between the right and left sides.In each of 11 patients with ITBFS,there was a more ITB thickness in symptomatic side than that of asymptomatic side(more than 30% in the difference between two sides).The ITB had a area of decreased echoginicity in symptomatic side.The thickened position of ITB were at insertion resion in 6 cases,at the level of femoral condyle in 3 cases and diffuse in 2 cases.Bursa fluid were found in 4 cases.Conclusions Ultrasonography can effectively evaluate the degree and range of ITB injury,and can give important information for clinical theraphy.

Reconstruction of Anterior Cruciate Ligament with Iliotibial Band Transfer / 대한정형외과학회잡지

Ligamentous injury of the knee which could be easily occur in sports or traffic accidents resulted in more and severe disability than that of other joints. Rupture of the anterior cruciate ligament which restrain hyperextension, excessive rotation and anterior motion of tibia on femur is the most frequent and significant injury of the knee. Its treatment and clinical significance is one of the most controversial issue and its incidence tends to increase. From 1983 to 1985, modified Scott operation were performed on 10 patients at the department of orthopedic surgery, Chung Ang university hospital. Following results are obtained. 1. No limitation of range of motion of the knee was developed. 2. Intra-articular fixation by use of pull-out wire was done and special consideration was done for the site of fixation on tibia plateau and method of dilatation of posterior capsule. 3. Of the ten patients, nine had negative anterior drawer test, postoperatively.