![]() Muscle weakness of the hip abductors is also be associated with iliotibial band syndrome as this causes increased hip internal rotation and knee adduction. It is hypothesised that friction can therefore occur between the posterior edge of the iliotibial band and the underlying lateral femoral epicondyle. When the knee is positioned in 30° of flexion the band moves posteriorly to the lateral femoral epicondyle. When the knee is positioned in extension the iliotibial band lies anterior to the lateral femoral epicondyle. Although repeated tissue compression leading to irritation is best supported by recent evidence, there are a number of other trains of thought regarding the evolution of this condition. Long distance running is a common cause of ITBS, especially if running on slightly banked ground, as the subtle drop of the outside of the foot stretches the ITB, increasing the risk of injury, Sudden increases in activity levels can also lead to ITBS. The etiology of ITBS is often multifactorial. ![]() Further studies indicate that ITBS is responsible for approximately 22% of all lower extremity injuries. ITBS is one of the most common injuries in runners presenting with lateral knee pain, with an incidence estimated to between 5% and 14%. Figure This mechanosensory role may affect the interpretation of the ligament versus tendon function of the ITB from hip to lateral femoral epicondyle.Įpidemiology /Etiology Histologic and dissection study of the iliotibial band at the lateral femoral epicondyle and gluteus maximus and fascia lata suggest a mechanosensory role acting proximally on the anterolateral knee. ![]() While the iliotibial band does not have any boney attachments as it courses between the Gerdy tubercle and the lateral femoral epicondyle, this absence of attachment allows it to move anteriorly and posteriorly with knee flexion and extension. In its distal portion the iliotibial tract covers the lateral femoral epicondyle and gives an expansion to the lateral border of the patella. It descends along the lateral aspect of the thigh, between the layers of the superficial fascia, and inserts onto the lateral tibial plateau at a projection known as Gerdy’s tubercle. It is composed of dense fibrous connective tissue that appears from the m. The iliotibial tract is a thick band of fascia that runs on the lateral side of the thigh from the iliac crest and inserts at the knee. Image: Iliotibial tract (highlighted in green) - posterior view Clinically Relevant Anatomy During this impingement period in the running cycle, eccentric contraction of the tensor fascia latae muscle and of the gluteus maximus causes the leg to decelerate, generating tension (compression) in the iliotibial band. Studies have described an ‘impingement zone’ occurring at, or slightly below, 30° of knee flexion during foot strike and the early stance phase of running. The current theory is that this condition is likely to be caused by compression of the innervated local adipose tissue. It is considered a non-traumatic overuse injury, often seen in runners, and is often concomitant with underlying weakness of hip abductor muscles. Iliotibial band syndrome (ITBS) is a common knee injury that usually presents with pain and/or tenderness on palpation of the lateral aspect of the knee, superior to the joint line and inferior to the lateral femoral epicondyle.
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