Paper 22: Arthroscopic Treatment of the Iliotibial Band Syndrome

Abstract

Iliotibial Band Syndrome(ITBS) is an overuse injury mainly affecting runners. The initial treatment is conserative therapy. In recalcitrant cases surgery is indicated. The conventional technique is lengthening of the iliotibial tract(ITT) and removing a section of the posterior aspect of the ITT. The aim of this study was to evaluate the results of an arthroscopic technique to treat ITBS. Thirty six patients with an ITBS resistant to conservative therapy were managed arthroscopically. Thirty three were available for follow up. All patients had at least 6 months follow up with an average of 2 years 4 months. All the patients were recreational or professional athletes: long distance running(22), triathlon(5), soccer(1), rugby(3), athletics(3), swimming(1), fencing(1), basketball(1). There were 15 women and 21 men. The mean age was 31,1 years (range 19 to 44). All the patients had suffered from the ITBS for at least one year before passing to surgery. In all patients the diagnosis was confirmed by ultraonography or magnetic resonance imaging. We used a standardized arthroscopic technique. The patient is placed in supine position with the leg in 30 degrees of flexion. The joint space is inspected through the anteromedial and anterolateral portals. The lateral synovial recess is resected through a superolateral portal. A drain is placed during 24 hours. The procedure was well tolerated in all patients. In two patients a meniscal lesion was found, which required treatment. All patients went back to sports after 2 to 3 months. In 32 patients the results were good or excellent(no pain or much less pain in activity, complete return to preoperative sport level). One patient with only a fair result had associated cartilage lesions of the femoral condyle. In cadaveric studies it was found that the ITBS was associated with inflammation of fibrous strands anchored to the distal femur. Based on these findings an arthroscopic technique was developed. Our results show that arthroscopic treatment of resistant ITBS is a valid option with a consistently good outcome. In addition, this arthroscopic approach allows excluding or treating other intra-articular pathology.