Friction Syndrome Research Articles

Iliocostal Friction Syndrome Causing Flank Pain in a Patient with a History of Stroke with Scoliosis and Compensated Trendelenburg Gait

Iliocostal Friction Syndrome Causing Flank Pain in a Patient with a History of Stroke with Scoliosis and Compensated Trendelenburg Gait

MR manifestations and clinical significance of iliotibial band friction syndrome

To describe the MRI features of Iliotibial band friction syndrome (ITBFS), in order to improve the understanding and diagnosis of ITBFS. The MR findings of 16 patients (18 knees )of clinically diagnosis ITBFS were reviewed retrospectively. The MRI features of ITBFS:(1)Ill- defined abnormal signal intensity extended to the lateral femoral epicondyle.(2) Poorly defined abnormal signal intensity presented deep to the ITB adjacent to the lateral femoral epicondyle. (3) Fluid collections medial to the ITB adjacent to the lateral femoral epicondyle. (4) The part of ITB over the lateral femoral epicondyle was thicker. (5) Joint effusion. (6)Other abnormal signs. MRI is a relatively good method for detection of ITBFS.

Isolated Iliotibial Band Rupture After Corticosteroid Injection as a Cause of Subjective Instability and Knee Pain in a Military Special Warfare Trainee

Iliotibial band friction syndrome (ITBFS) of the knee is a common overuse injury in athletes, especially in runners. The syndrome occurs when the ITB, a lateral thickening of the fascia lata of the thigh moves repetitively over the lateral femoral condyle. A variety of nonoperative measures are used for ITBFS treatment, including stretching, core strengthening, and therapeutic injection. Isolated distal ITB rupture is a rare entity and has never yet to be reported in the orthopedic literature. We present a case of isolated ITB rupture as a cause of varus instability and knee pain in a Naval Special Warfare candidate diagnosed with ITBFS and previously treated with several local corticosteroid injections before ITB rupture. Because of continued knee pain and a sense of instability, along with an inability to return to his military special warfare duties, the ITB was surgically repaired. This case highlights the presentation and management of isolated distal ITB rupture and discusses some of the potential risk factors for rupture, including prior local corticosteroid injection.

THE RUN CLEVER STUDY PROTOCOL: THE DESIGN OF A RANDOMIZED CONTROLLED TRIAL

BackgroundWebpages, blogs and various magazines continuously publish “Start to Run” training programs with the purpose of guiding novice runners towards increased running performance and minimizing the risk of sustaining a...

Patellofemoral Friction Syndrome

This study aimed to investigate whether patellofemoral T2 cartilage changes are associated with lateral patellofemoral friction syndrome (PFS), as indicated by an edema-like signal within the superolateral infrapatellar (Hoffa) fat pad. In this institutional review board-approved retrospective study of 510 consecutive patients, 49 patients with 50 knee magnetic resonance imaging examinations demonstrating normal or low-grade patellofemoral cartilage abnormalities (whole-organ magnetic resonance imaging score [WORMS] score, ≤2) were included. Twenty-two examinations with PFS (cases) were compared with an age- and sex-matched cohort of 28 examinations without PFS (controls). A 3-T magnetic resonance imaging was performed with multi-echo, spin-echo T2 mapping. Two readers measured in consensus malalignment parameters, including patellar height index, tibial tuberosity to trochlear groove distance, and sulcus angle. Bulk T2 cartilage values in the lateral and medial patellofemoral compartment, central weight-bearing medial and lateral femoral condyles were measured independently. Interobserver agreement was quantified using concordance correlation coefficients. Demographics, anatomic measurements, whole-organ magnetic resonance imaging scores, and cartilage T2 values were compared between cases and controls using Fisher exact test, Wilcoxon rank sum test, and mixed-effects models. Cases demonstrated higher patellar height index (P = 0.002) and tibial tuberosity to trochlear groove distance (P = 0.02). Interobserver agreement for T2 values was good overall (concordance correlation coefficient range, 0.65-0.93). Cases demonstrated higher medial facet patellar bulk T2 (38.1 [7.5] ms) versus controls (33.6 [7.3] ms) (P = 0.02); otherwise, there were no significant differences in regional T2 values. T2 mapping in patients with PFS demonstrates increased cartilage T2 in the medial patellar facet, possibly reflecting collagen alteration from early chondromalacia (softening) or increased water content related to altered contact pressures.

Pelvic Deformity Secondary to Tensor Fascia Lata Tightness Associated With Desmoid Tumor

The iliotibial band is a thick, condensed fascia that, when contracted, leads to a hip flexion, abduction, and external rotation contracture in addition to other joint contractures. Iliotibial band tightness occurs secondary to iliotibial band friction syndrome, which commonly occurs at the lateral femoral epicondylar region. However, a proximal cause of iliotibial band/tensor fascia lata friction syndrome leading to a secondary hip contracture is swelling around the hip; this swelling being a desmoid tumor has not been explicitly described in the literature. The authors present a rare case of a hip contracture in a 28-year-old active man who presented with a functionally disabling hip flexion contracture of 20° with further flexion possible up to 130°, a 45° abduction contracture, and a 20° external rotation contracture with further rotation possible up to 40° with a bony hard swelling in the left gluteal region. Ober’s test was positive. Opposite hip and spine examinations were normal. The goals of treatment were to establish the causality between the 2 and to diagnose the etiology of the gluteal mass. Radiographs were normal, with only a pelvic obliquity evident. Magnetic resonance imaging revealed an extra-articular mass abutting the iliac blade. Histopathology confirmed the mass to be a desmoid tumor in the left gluteal region. A wide surgical excision of the mass was performed with negative margins; no postoperative radiotherapy was administered. After rigorous physiotherapy, the hip deformity disappeared at 6 months and there was no evidence of recurrence at 2.5-year follow-up, with the patient able to sit cross-legged and squat.

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.

A ganglion of the patellar tendon in patellar tendon-lateral femoral condyle friction syndrome

Intratendinous ganglia are rare. We report the case of a sedentary woman with chronic mechanical anterolateral pain of the knee and an extensive ganglion of the patellar tendon as indicated on magnetic resonance (MR) and ultrasound (US) examinations. There was evidence of a high-riding patella, patellar malalignment and patellar tendon-lateral femoral condyle friction syndrome with significantly close contact between the patellar tendon and the lateral facet of the femoral trochlea. The ultrasound-guided aspiration of the ganglion enabled a localized injection of an anti-inflammatory drug (cortivazol) and the cytopathological examination of the fluid, which confirmed the diagnosis. Clinical improvement was maintained with knee rehabilitation and was satisfactory at follow-up after 1year. To our knowledge, we report the first case of a ganglion of the patellar tendon subsequent to patellar tendon-lateral femoral condyle friction syndrome. We found that this case was illustrative of mucoid degeneration in connective tissue due to chronic repetitive microtraumas. Additionally, this case provided the opportunity to discuss the management of this condition in a sedentary individual with a high-riding patella and patellar malalignment.

Paper 180: Examination Techniques for Diagnosing Iliotibial Friction Syndrome (Runner's Knee): Reliability and Validity Compared to Ultrasound Examination

Paper 180: Examination Techniques for Diagnosing Iliotibial Friction Syndrome (Runner's Knee): Reliability and Validity Compared to Ultrasound Examination

Magnetic resonance imaging in patellar lateral femoral friction syndrome (PLFFS): Prospective case-control study

To describe morphologic abnormalities and signs of patellar lateral femoral friction syndrome (PLFFS) detected by magnetic resonance imaging (MRI). Prospective study of 56 knees (21 patients and 30 controls) studied by 3Tesla MRI. Comparative analysis of clinical data, quantitative and qualitative imaging criteria in a population of patients with anterior knee pain associated with an abnormal MRI signal along the lateral alar folds of the infrapatellar fat pad, a characteristic sign of PLFFS, and a control population with no anterior knee pain or abnormal signal from the infrapatellar fat pad. Patients with PLFFS have anterior and/or lateral knee pain. Their knee has anatomical predispositions for instability, primarily with patella alta (P<0.0001), patellar tilt more than 13.5° (P<0.0001), a patellar nose length less than 9 mm (P=0.0037), a patellar nose ratio less than 0.25 (P<0.0001), a TT-TG distance more than 10 mm (P<0.0001), and a trochlear prominence more than 4 mm (P=0.0056). In 35% of patients, patellar chondropathy is visible, and 48% of patients have patellar or trochlear subchondral abnormalities. Anterior, lateral, and medial knee pain may be related to PLFFS. Anatomical predispositions contributing to instability are found in these patients. There may be associated chondropathies and osteochondropathies.

Risk factors and injury mechanism in Triathlon

In the triathlon the combined practice of swimming, cycling and running permits the reduction of overuse injuries compared to the practice of the running alone. Redistribution of stress over several part of the body and correction of muscle imbalance are cited as reasons for the reduction in injuries occurrence. Nonetheless, like other endurance sports, 80-85% of triathlon injuries can be scribed to overuse. From an etiopathogenetic point of view the overuse injuries must be studied in relation to the technical characteristics of the triathlon, to the transitional phases between the disciplines and particularly to the cycle-run transition, to the different load of training that the preparation of the Olympic distance requires compared to the long distance triathlon. Most of the injuries are caused by running and athletes most at risk are former swimmers and cyclists, since they lack of running experience and muscle elasticity. The triathlon cycle-run transition (T2) is a period of particular risk for knee and lower back injury. The knee, the ankle/foot and the lower back are the anatomic site most at risk of injuries. Ileotibial band friction syndrome is common in age groupers whereas Achilles tendon injuries and stress fractures occur more in elite athletes. Previous injuries are correlated with injuries occurrence and the sudden changes in training intensity or volume, hill training and the insufficient development of running technical ability are injuries extrinsic factors. The acute traumatology is due almost exclusively to falls in training and competition in cycling. The episodes of rhabdomiolysis are instead not rare, associated or not to exertional heat/idratation injuries. Injury prevention is based in particular on the learning of the correct technique of the three disciplines, on the right programming of the training sessions, on the study of the overload that the biomechanics of the transition phases between the three sports act on the locomotor apparatus and on the suitability of the technical instruments used.

Examining Biomechanical and Anthropometrical Factors as Contributors to Iliotibial Band Friction Syndrome

Examining Biomechanical and Anthropometrical Factors as Contributors to Iliotibial Band Friction SyndromeThis study was conducted in an attempt to determine if the biomechanical parameters thought to predict iliotibial band injury could accurately differentiate between iliotibial band (IT band) injured and healthy runners. 20 injured and 20 healthy runners were tested. Injured subjects were randomly assigned into groups of ten (INJ-1 or INJ-2). Ten healthy runners acted as controls (CON) and ten healthy (EXP) subjects trained for 1 week with a 1.27 cm felt heal pad in the shoe of their longer leg. All subjects completed a runner's questionnaire, and 13 lower extremity anatomical measurements, four clinical lower extremity assessments, and 2D kinematics from the sagittal and frontal planes during treadmill running were recorded. Comparison of kinematic values between INJ-1 vs. CON and INJ-2 vs. EXP indicated the INJ-1 group had a greater knee flexion angle than the CON group. No other direct comparisons revealed statistically significant differences between groups, nor did a discriminant function based on nine anatomical measurements or analysis of the running questionnaire responses. It was not possible to clearly distinguish between the healthy and injured runners of this study based on the biomechanical factors most commonly thought to predispose individuals to iliotibial band injury.

Complications Using Bioabsorbable Cross-Pin Femoral Fixation: A Case Report and Review of the Literature

The use of bioabsorbable cross-pin transcondylar fixation has remained a viable option for femoral fixation in anterior cruciate ligament reconstruction. Although numerous biomechanical studies have demonstrated high fixation strength and minimal slippage with use of this method of fixation, there have been increasing reports of a variety of clinical complications associated with these implants. We reviewed the literature for all complications associated with the Bio-TransFix implant and present a case report of a patient status after ACL reconstruction using Bio-TransFix cross-pin femoral fixation with iliotibial band friction syndrome from a broken cross-pin four month post-operatively.

Sonographic measurement of iliotibial band thickness: an observational study in healthy adult volunteers

Iliotibial tract friction syndrome (ITBFS) might be caused by repetitive friction and abrasion of the iliotibial (ITB) tract across the lateral femoral epicondyle. Thickening in the ITB adjacent to the lateral femoral epicondyle has been reported. The values of ITB thickness at the lateral femoral epicondyle in healthy adult volunteers were determined, and the association between the thickness of the ITB and the subjects' age, weight, height, dominant limb and the volume of training or sporting activity was assessed. An Ultrasound Scan (high resolution 3-2MHz transducer Voluson-i G E Medical Systems, UK) was used to measure the thickness of the ITB in 38 healthy volunteers (30 men and 8 women, mean age 22.5±1.5years, range 18-25years). One measurement from each of the subjects' knees at the level of lateral femoral epicondyle was taken. Reliability was established by measuring 11 of the subjects on three separate occasions at least I week apart. The thickness of the ITB on the right and left knees was 1.1±0.2mm. There was no evidence of a significant association between the thickness of the ITB and the subjects' age, weight, height, dominant limb and the volume of training or sporting activity. There is no evidence of significant correlation between the thickness of the ITB and subjects' age, weight, height, dominant limb and volume of training or sporting activity.

Iliotibial band friction syndrome

Published articles on iliotibial band friction syndrome have been reviewed. These articles cover the epidemiology, etiology, anatomy, pathology, prevention, and treatment of the condition. This article describes (1) the various etiological models that have been proposed to explain iliotibial band friction syndrome; (2) some of the imaging methods, research studies, and clinical experiences that support or call into question these various models; (3) commonly proposed treatment methods for iliotibial band friction syndrome; and (4) the rationale behind these methods and the clinical outcome studies that support their efficacy.

Z-Plasty Lengthening for Iliotibial Band Friction Syndrome

Iliotibial band friction syndrome presents with lateral knee pain usually in runners. When conservative treatment fails, surgical lengthening, or Z-plasty, can provide symptomatic relief. This retrospective study evaluated the long-term results of iliotibial band Z-plasty for chronic iliotibial band friction syndrome in a consecutive series of patients. Inclusion criteria were failed nonoperative treatment for symptomatic iliotibial band friction syndrome for at least 3 months, minimum age of 17 years, and closed growth plates. Exclusion criteria were history of significant trauma, prior knee surgery, lateral compartment pathology, and anterior or posterior cruciate ligament instability. Postoperative evaluation included annual physical examination consisting of Tegner, Lysholm, Cincinnati, and International Knee Documentation Committee (IKDC) activity scores. Of an initial group of 11 patients, 8 were evaluated an average of 75.6 months postoperatively (range: 59-97 months). Average length of preoperative symptoms was 15.6 months (range: 3-36 months), and average length of nonoperative management was 6.9 months (range: 3-24 months). Postoperatively, mean Cincinnati score was 82.9 (range: 55-95), Tegner score was 4.4 (range: 2-7), Lysholm score was 88.6 (range: 57-100), and IKDC activity score was 2.6 (range: 1-4). No adverse events occurred during surgery. All patients reported complete resolution of lateral knee pain and a full return to preoperative activity levels. Iliotibial Z-plasty was successful for refractory iliotibial band friction syndrome. This improvement was maintained out to 8 years after surgery.

MR Imaging of Complications of Anterior Cruciate Ligament Graft Reconstruction

During the past 3 decades, graft reconstruction of the anterior cruciate ligament (ACL) has become an accepted treatment for symptomatic ACL deficiency. The goal of surgery is to prevent joint instability, which may further damage articular cartilage and menisci. Graft failure is defined as pathologic laxity of the reconstructed ACL. The prevalence of recurrent instability after primary ACL reconstruction ranges from 1% to 8%. Early failures, those that occur within the first 6 months, often are secondary to poor surgical technique, failure of graft incorporation, or errors in rehabilitation. Late failures, those that occur more than 1 year after surgery, likely are related to new trauma and graft tearing. Other complications of ACL reconstruction include roof impingement, postoperative stiffness, tunnel widening due to cyst formation, iliotibial band friction syndrome, hardware failure, and infection. Magnetic resonance imaging is the preferred advanced imaging modality for the evaluation of symptomatic ACL graft reconstructions.

Intraoperative complications using the Bio-Transfix femoral fixation implant in anterior cruciate ligament reconstruction

The use of biodegradable Transfix femoral fixation technique is a safe and well-accepted method when performing anterior cruciate ligament reconstruction. We report on three cases of deformation and back out of the Bio-Transfix implant over the lateral, distal femoral cortex, with failure of the passing wire when advancing the graft into the femoral tunnel in one of these patients. Two of the patients presented with symptoms of iliotibial band friction syndrome, while the third patient was asymptomatic. The graft had clinically integrated demonstrating AP and rotational stability. The symptoms relieved after removal of the failed Bio-Transfix implants in the symptomatic patients. The aetiology of the implant failure and the alternative methods to avoid such complications are discussed.

Treatment of Recalcitrant Iliotibial Band Friction Syndrome with Open Iliotibial Band Bursectomy

Background Iliotibial band friction syndrome (ITBFS) is an overuse injury causing lateral knee pain. There is evidence that the pathological lesion is in fact an inflamed bursa underlying the iliotibial band (ITB) rather than an inflamed ITB itself. Hypothesis Resection of the bursa underlying the ITB in ITBFS patients will relieve their pain and allow them to return to their preinjury activity level. Study Design Case series; Level of evidence, 4. Methods We describe the technique of ITB bursectomy and report a minimal 20-month follow-up of patients who had ITB bursectomies performed by a single surgeon. The patients completed a survey detailing their preoperative and postoperative symptoms and activities. Results The senior author performed 12 consecutive cases of ITB bursectomies (12 patients). One was excluded from the study (previous microfracture). The average age at surgery was 32 years (standard deviation, 5; range, 24-41). There were 7 men and 4 women. Postoperatively, patients were able to return to their preinjury Tegner activity levels, and the visual analog pain scores decreased by an average of 6 points (P < .001). Six patients were completely satisfied with the surgical outcome, 3 were mostly satisfied, 2 were somewhat satisfied, and none were dissatisfied. Nine of 11 patients said that knowing what they know now, they would have the surgery performed again for the same problem. Conclusion Iliotibial band bursectomy successfully reduces knee pain in patients with ITBFS and allows them to return to their preinjury level of activity. The great majority of patients were satisfied with the results of the procedure.

Synovial Sarcoma Presenting as Iliotibial Band Friction Syndrome

Iliotibial band friction syndrome is a common entity that is often quickly diagnosed in orthopedic clinics. However, synovial sarcoma is an elusive clinical entity that appears around many joints with variable presentations. This case report is an example of a patient with a classic presentation of iliotibial band friction syndrome that was diagnosed as a synovial sarcoma on further investigation.