Iliotibial Band Research Articles

Sustainability studies in orthopaedic surgery: The carbon footprint of anterior cruciate ligament reconstruction depends on graft choice.

Environmental sustainability in medicine is a growing concern. Determining the carbon footprint of medical procedures may aid in selecting a less impactful technique moving forward. The purpose of this study was to understand the environmental impact of different anterior cruciate ligament reconstruction techniques, for which there is no consensus in terms of optimal graft. A life cycle analysis of different anterior cruciate ligament reconstruction techniques was performed. These included quadrupled semitendinosus graft, bone-patellar tendon-bone graft, iliotibial band augmented with gracilis graft, doubled semitendinosus and doubled gracilis graft, and quadriceps tendon graft. All procedures were systematically paired with a lateral extra-articular procedure. The study was conducted in a specialised centre using surgeon preference cards, with the help of a dedicated organisation for calculation according to the ISO 14044 standard. The primary outcome measure was the carbon footprint of each of the five techniques. Secondary outcomes included other environmental impact indicators, including human carcinogenic toxicity and mineral resource scarcity, among others, based on the ReCiPe 2016 midpoint guideline. The analysis had three scopes, each encompassing varying numbers of processes: graft implantation, full procedure, and entire environmental impact, from medical prescription to patient discharge. Results were reported as percentage increases compared to the graft technique with the lowest environmental impact. It was demonstrated that the surgical procedure itself accounted for <40% of the life cycle, with arthroscopy being 88% of surgery's GHG emissions, and scrubbing and draping contributing 39% to the carbon footprint. The iliotibial band augmented with gracilis tendon technique had the lowest carbon footprint (0.199 Kg Co2 eq), and the least impact in most categories at all scopes of the life cycle analysis. Using this technique as a reference, in terms of graft implantation, it was determined that extensor mechanism grafts had the highest carbon footprint (300% higher than the reference). Greater scopes showed a similar trend, with percentage differences decreasing significantly, reaching 1-3% when considering the entire environmental impact for most categories. Nevertheless, among the aforementioned factors of the ReCiPe 2016 guidelines, the semitendinosus graft paried with a lateral extra-articular procedure displayed greater difference in human carcinogenic toxicity and mineral resource scarcity (6% and 10% respectively) compared to the reference. The individual processes with the highest impact were also highlighted. In the institution where the study was conducted, the studied iliotibial band graft option was found to have the lowest environmental impact. Such analyses of standardised procedures can be replicated in individual institutions in order to determine their environmental impact. Identification of procedures with comparable results and differing environmental consequences may influence the future decision-making process. Level II, prospective cohort study.

Outcome of combined anatomic reconstruction of the anterior cruciate ligament with anterolateral ligament reconstruction versus with iliotibial band tenodesis

Abstract Background Isolated anterior cruciate ligament (ACL) tears without anterolateral structures injuries are treated successfully by isolated reconstruction of ACL. However, most ACL injuries are associated with the injuries of anterolateral stabilizers of the knee; mainly the iliotibial tract (ITB) and the anterolateral ligament (ALL). If ACL is only reconstructed in such a case, the incidence of postoperative rotational instability reaches 18%. New directions guided towards combined ACL reconstruction with extraarticular anatomical and nonanatomical reconstructions to improve knee rotation and translation and prevent pivot shift phenomena. Patients and methods We retrospectively reviewed all patients operated on for combined injuries of ACL and anterolateral stabilizers from February 2019 to February 2021. Preoperatively and postoperatively, all patients were examined clinically by knee stability tests: anterior drawer, Lachman, and pivot shift tests, applying the International Knee Documentation Committee score and return time to the sport. Results Forty patients were included with a mean age of 28 ± 8.33 years (range, 18–44 years). Patients were divided into two groups, group A 20 patients (18 males and two females) were treated by combined ACL with ALL reconstruction, and group B 20 patients (18 males and two females) were treated by combined ACL with ITB tenodesis. Sports injuries were the cause in 15 patients in group A and 14 in group B, while five injuries were due to nonsport activity in group A and six in group B. The mean follow-up period was 33.5 ± 2.1 months. Median postoperative subjective International Knee Documentation Committee scores in groups A and B were 95.4 and 94.25, respectively, without any statistically significant difference. Group A shows better postoperative improvement in pivot shift and one-leg hop test than group B with a significant difference (P&lt;0.05). Conclusion No significant difference between ALL reconstruction or ITB tenodesis with ACL reconstruction according to subjective knee functions but there was a significant difference according to objective functions, also lateral knee pain was reported in group B and not observed in group A.

Effects of conservative treatment strategies for iliotibial band syndrome on pain and function in runners: a systematic review.

This systematic review summarizes the efficacy of conservative treatment strategies on pain and function in runners with iliotibial band syndrome (ITBS), a prevalent running injury constituting about 10% of all running-related injuries. The multifactorial nature of ITBS necessitates diverse treatment approaches; yet, a consensus on an optimal conservative regimen remains unreported. This review seeks to update and expand upon existing literature with recent rehabilitative approaches. A systematic search was conducted in Medline, Web of Science, and CINHAL databases, from inception to June 31, 2024. Inclusion criteria were: (1) reporting of conservative treatments for ITBS in adult runners and (2) pain and function defined as main outcome parameters. The methodological quality was evaluated using the NIH Quality Assessment Tool. Thirteen out of 616 records met the inclusion criteria (201 participants), including five randomized controlled trials, one case-control study, one pre-test post-test study, and six case studies. Different active and passive treatment strategies were applied as single (five studies) or combined (eight studies) treatments. The average methodological quality was deemed good. Large between-study heterogeneity was present, impeding a meta-analysis to be performed. Hip abductor strengthening (HAS) exercise emerged as a common strategy. The intervention effects on pain reduction ranged from 27% to 100%, and functional improvement from 10% to 57%, over 2 to 8 weeks. A conservative treatment approach incorporating HAS exercises, possibly augmented by shockwave or manual therapy, is effective for mitigating pain and enhancing function in ITBS-afflicted runners. Finally, the potential of emerging strategies like gait retraining requires further exploration through rigorous trials and comprehensive evidence. Addressing these gaps could refine ITBS management, enhancing treatment outcomes and facilitating runners' return to sport.

The Triple Varus Knee: A Case Presentation

Background: Knee instability due to posterior cruciate ligament (PCL) and posterolateral corner (PLC) deficiency is a devastating condition that negatively affects patient quality of life. This video presents the surgical management of a triple varus knee, including combined high tibial osteotomy (HTO), revision PCL and PLC reconstruction, and meniscus root repair. Indications: Combined HTO and revision PCL and PLC reconstruction is indicated for patients with previously failed PCL and PLC reconstruction in the setting of varus malalignment. Technique Description: The procedure begins with a medial opening-wedge biplanar HTO, which is fixed with a patient-specific locking plate. The PCL femoral tunnel is drilled via a low anterolateral portal, and the tibial insertion is debrided via a posteromedial portal. The medial meniscus is carefully freed from the posterior capsule, and 2 luggage tag sutures are placed through the posterior root. The PCL tibial tunnel and meniscus root tunnels are drilled via their respective guides. The meniscal sutures are passed through the tunnel but not fixed. An Achilles bone-block allograft is passed through the PCL tibial tunnel and fixed with suspensory fixation and an interference screw on the femoral side, while the tibial side is left free. A peroneal nerve neurolysis is performed. A fibular tunnel is drilled, and a semitendinosus allograft is whip-stitched on both sides and passed through the tunnel. A Beath pin is inserted into the femur, and the tunnel is over drilled. Both limbs of the graft are passed deep to the iliotibial band and into the tunnel. The tibial side of the PCL is fixed with an interference screw at 90° of knee flexion. The PLC grafts are fixed with an interference screw at 30° of knee flexion with slight valgus. The medial meniscus root sutures are tied over a button, with 60° of knee flexion. Screws from osteotomy fixation are replaced as needed. Results: Although outcomes following the combined procedure are lacking, good to excellent clinical outcomes have been reported in isolation following each procedure. Conclusion: A combination of HTO and revision PCL and PLC reconstruction should be considered for patients with persistent instability and/or pain in the setting of triple varus knee. Patient Consent Disclosure Statement: The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication.

Physiotherapy Management for Cases of Iliotibial Band Syndrome in Indonesian Para Athletics Athletes : Case Report

Iliotibial band syndrome (ITBS) is an overuse syndrome that commonly causes knee pain and is common in athletics. The prevalence of ITBS in runners ranges from 5%-14%, with a higher prevalence in women (16%-50%) than in men (50%-81%). ITBS can limit Indonesia's athletic performance due to pain on the side of the knee during running, walking and jumping. The aim of this study was to evaluate the physiotherapy management for ITBS cases in Indonesian para-athletics. This research is a descriptive case study involving one client with a participatory observation method. The physiotherapy intervention involved Shock Wave Therapy (SWT) and Static Stretching Exercise. The subject of the study was 22 year old national para athlete with height 182 cm, weight 70 kg, and BMI 21.1 in the ideal category. The patient came to the physiotherapy clinic of NPC Indonesia on 20 August 2023 with complaints of pain in the outer side of the right knee. Physical examination showed normal results except for pain examination using Numeric Rating Scale (NRS), where silent pain 2/10, tenderness 4/10, and motion pain 5/10 were found. The diagnosis of ITBS dextra was confirmed through specific examination. After six physiotherapy sessions with SWT and Static Stretching Exercise, there was a significant decrease in pain and an increase in functional activity in ITBS patients. Patients are advised to undergo physiotherapy regularly, do stretching exercises before and after activities, and compress with warm water if experiencing pain.

Lateral Opening-Wedge Distal Femoral Osteotomy Made Easy: Tips and Tricks

A lateral opening-wedge distal femoral osteotomy is useful to offload the lateral tibiofemoral compartment for focal chondral defects or isolated lateral compartment arthritis. Although beneficial for these lateral compartment disorders, a distal femoral osteotomy requires careful forethought to optimize correction accuracy and safety. We recommend the following for effective execution of a distal femoral osteotomy: (1) Plan the desired correction preoperatively while accounting for an individual patient’s anatomy and femoral width. (2) Perform an iliotibial band Z-lengthening for large deformity corrections to not overconstrain the lateral structures. (3) Use the plate to help guide the level of the osteotomy, which will facilitate bony contact after the osteotomy and decrease plate prominence. (4) Perform the osteotomy with a saw anteriorly and an osteotome posteriorly for safety and stop the osteotomy approximately 1 cm short of the far cortex. (5) Fashion tricortical wedge grafts at the height of the planned correction to maintain reduction and facilitate plate placement. (6) Control the plate position to lie optimally at the level of the osteotomy, ensuring it is not proud and is parallel with the femoral shaft. With these presurgical and intraoperative steps, a lateral opening-wedge distal femoral osteotomy can be performed effectively.

Comparison of Revision ACL Reconstruction Using Iliotibial Band Augmented With Allograft Versus Bone-Patellar Tendon-Bone Autograft With Lateral Extra-articular Tenodesis.

Bone-patellar tendon-bone (BTB) anterior cruciate ligament reconstruction (ACLR) is one of the conventional techniques in the revision setting especially after a primary hamstring tendon graft. The use of the iliotibial band (ITB) augmented with allograft (AG) is an encouraging graft alternative for ACLR in terms of clinical and biomechanical data in the literature. To compare the clinical outcomes of BTB graft with lateral extra-articular tenodesis, modified Lemaire (BTB-LET), and an ITB graft augmented with hamstring AG (ITB-AG) in the setting of revision ACLR. Cohort study; Level of evidence, 3. Descriptive data and clinical outcomes were prospectively collected from patients who underwent revision ACLR with either the BTB-LET or ITB-AG technique between 2012 and 2020 and who had a minimum follow-up of 2 years. The clinical outcomes were assessed by the Lysholm, Tegner, Anterior Cruciate Ligament-Return to Sport after Injury, International Knee Documentation Committee subjective knee evaluation form, and Knee injury and Osteoarthritis Outcome Score. Return to sports, complications, and revisions were also analyzed. A total of 167 patients were included, with 106 patients in the BTB-LET group and 61 patients in the ITB-AG group. There were no significant group differences in sociodemographic characteristics; however, the mean follow-up was significantly longer in the BTB-LET compared with the ITB-AG group (52.0 vs 38.8 months, respectively; P = .0001). There were no significant differences in postoperative outcome scores; however, patients in the ITB-AG group had a higher rate of return to competitive pivoting sports (32.8% vs 17.9%; P = .0288) and a higher overall rate of return to preinjury sport (63.9% vs 47.2%; P = .0365). Complications, including revisions for meniscal or chondral lesions and retears (8 [8.3%] in the BTB-LET group and 2 [4.0%] in the ITB-AG group), were not significantly different. All retears were due to sports-related accidents. In this study, ITB-AG was not different from BTB-LET in terms of functional outcomes scores but allowed better return to sport rate. Performing ITB-AG reconstruction in the setting of revision ACLR appears to be safe, effective, and associated with a satisfying return-to-sports rate.

Similar Clinical Outcomes for Arthroscopic Labral Reconstruction in Irreparable Cases Using the Indirect Head of the Rectus Femoris Tendon With an All-Inside Technique for Small Defects and the Iliotibial Band for Large Defects

To evaluate the clinical outcomes and satisfaction rate of patients who underwent arthroscopic labral reconstruction for an irreparable labral tear with a minimum follow-up period of 2 years. Additionally, this study aimed to compare 2 different reconstructive techniques for small and large labral defects: the indirect head of the rectus femoris tendon (IHRFT) autograft with an all-inside technique used to repair small defects (≤3 hours) and the iliotibial band (ITB) autograft for large defects (>3 hours). A total of 24 hips treated with the IHRFT were compared with 24 hips treated with the ITB. All patients underwent clinical evaluation before surgery and during the most recent follow-up (42 ± 18 months). The evaluation included patient satisfaction, the modified Harris Hip Score, the Non-Arthritic Hip Score, the Hip Outcome Score, the Hip Outcome Score-sport subscale, the 12-item International Hip Outcome Tool, and the visual analog scale pain score. All clinical scores were significantly improved (P < .001) at the latest follow-up in both groups. The final satisfaction was 7.1 ± 2.8 and 8.8 ± 1.6 for the IHRFT and ITB groups, respectively (P= .006). There was a significant difference in age (41.2 ± 6.0 years for the IHRFT group and 33 ± 8.5 for the ITB group; P= .004) and in surgery time (147.3 ± 39.4 minutes for the ITB group and 105.3 ± 25.7 for the IHRFT group; P < .001). One patient (4.2%) in the IHRFT group underwent total hip arthroplasty after 21.3 months (P= .999). At the 2-year follow-up, treating small defects using IHRFT and larger defects using ITB resulted in good patient-reported outcome measures with a low rate of complications and failures. The ITB group reported a higher level of satisfaction at the final follow-up. Level III, retrospective comparative therapeutic trial.

PLAR: a combined percutaneous and arthroscopic treatment for iliotibial band syndrome description of surgical technique and short-term results: description of surgical technique and short-term results

IntroductionDescription of a new surgical procedure (percutaneous lengthening and arthroscopic release, PLAR) that combines all the possible interventions on the iliotibial band (ITB), and evaluates its outcomes in a group of distance runners diagnosed with ITBS.MethodsA prospective observational study was made of distance runners diagnosed with ITBS and operated upon using the PLAR technique between 1 and 2018 and 31 June 2020. The surgical technique is described in detail, and the demographic data and functional outcomes measured by the sports performance scales Activity Rating Scale (ARS) and International Knee Documentation Committee (IKDC) are presented.ResultsA total of 14 patients were included, with a mean follow-up of 16 months (range 12–42 months). All the patients resumed their previous sporting activity after an average of 4 (range 2.5-6) months, and no complications were recorded. In all cases, statistically significant improvement was evidenced by the ARS and IKDC scales following PLAR (p < 0.001), with excellent outcomes in 71% of the cases according to the ARS scale and in 86% according to the IKDC scale (mean difference between preoperative and final follow-up scores of 12.1/16 and 34.2/100 points, respectively).ConclusionThe PLAR technique is effective in allowing a return to previous sports performance levels in a short period of time among patients with ITBS refractory to conservative management, with a high satisfaction rate and the absence of complications.

Anterior Cruciate Ligament Reconstruction With Iliotibial Band Autograft in Skeletally Immature Prepubescent Children: A Physeal-Sparing Technique

Background: As there has been an increasing incidence of anterior cruciate ligament (ACL) tears in children and adolescents in the past few decades, nonoperative management is seen to result in less favorable clinical outcomes, resulting in meniscal and cartilage damage, and arthritic changes. Despite the risk of iatrogenic physeal injuries with operative approach, several reconstruction options, such as physeal-sparing techniques for skeletally immature patients, are described to restore joint stability. Indications: We bring a combined extra-articular and intra-articular ACL reconstruction technique using autogenous iliotibial band (ITB), which is indicated for prepubescent patients (Tanner stages 1 or 2) with open physes, significant growth potential (≤11 years for girls and ≤12 years for boys) and smaller knees, where an all-epiphyseal ACL reconstruction would lack epiphyseal space Technique Description: The technique consists of a modified MacIntosh intra-articular and extra-articular ITB reconstruction, described by Micheli and further characterized by Kocher. The central portion of the ITB is harvested proximally (at least 15 cm) and left attached to Gerdy's tubercle distally. The harvested graft is brought from over-the-top posteriorly and passed under the intermeniscal ligament anteriorly through an epiphyseal groove on the tibia. Results: The outcomes shown for the Kocher ITB ACL reconstruction technique are favorable at a mean follow-up of 5.3 years: from 44 patients, 41 returned to sports involving cutting or pivoting, and the revision rate was low at 4.5%. Discussion/Conclusion: The awareness of physeal injury related to the operative treatment of ACL tears in the pediatric population has resulted in several physeal-sparing and physeal-respecting techniques of reconstruction. Some of these have shown to reduce the risk of physeal damage, maintaining stability and providing excellent functional outcomes, with low revision rates in long-term follow-up and minimal risk of growth disturbance. Patient Consent Disclosure Statement: The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication.

Distal Kaplan Fiber Tenodesis Surgical Technique

Anterior cruciate ligament tears are a common knee injury, and even after reconstruction, some patients may still experience instability in their knee. To address this, extra-articular reinforcement may be necessary to prevent anterior translation and internal rotation of the tibia. Kaplan fibers (KFs), which are the attachments of the iliotibial band to the distal femur, can help improve anterolateral rotatory stability in the knee, especially in greater degrees of knee flexion. Our technique for KF reconstruction involves making a 10-cm incision in the skin and subcutaneous tissue of the distal and lateral thigh. We release a 10-cm × 1-cm strip of the iliotibial band while maintaining its tibial insertion and then stitch the free end of the strip before attaching it to the distal femur using a ToggelLoc (Zimmer Biomet). The advantage of this technique is that the tension of the iliotibial band strip can be adjusted using the ToggelLoc, allowing the surgeon to increase tension in the graft as needed to achieve ideal tension in knee flexion.

Introducing Skeletally-Mature Anterior Cruciate Ligament Reconstruction Technique Using Reinforcement (SATURN) With Iliotibial Band Autograft

Anterior cruciate ligament (ACL) injuries are increasingly common in the adolescent age group. Recent literature has endorsed combining ACL reconstruction with lateral extra-articular procedures to minimize residual rotatory knee instability and reduce the risk of reinjury in this age group. This technique describes a single-bundle combined anatomical ACL reconstruction and lateral extra-articular reinforcement performed with a single iliotibial band autograft. Also this technique allows for the ACL reconstruction and lateral extra-articular stabilization to be performed through a single surgical incision while obtaining autograft tissue without disruption of the extensor or hamstring mechanisms.

Frequency of Iliotibial Band Tightness and Its Association with Anterior Knee Pain in Healthcare Workers

Purpose: Iliotibial band tightness can raise the risk of injury by altering biomechanics. ITB tightness leads to abnormal patellar alignment and tracking and causes pain and several other problems. To assess the frequency of iliotibial band tightness and its relation with anterior knee pain in health-care workers&#x0D; Methodology: It was a cross-sectional research conducted from September 2021 to February 2022. Sample size of the study was 210. Study settings included the government and private hospitals of Faisalabad. In order to recruit healthcare providers, a convenient sampling technique was utilized. Inclusion criteria of the study were both male and female healthcare workers of age between 21 to 45 years working from at least 2 years. Ober's test was used to determine the tightness of the IT band. The anterior knee pain was evaluated by numeric pain rating scale (NPRS). Data was analyzed and interpreted by SPSS version 25. Data was presented in forms of tables and charts.&#x0D; Findings: Out of 210 subjects, 64.76% were men and 35.23% were women. Iliotibial tightness was found to be present in 110(52.38%). On NPRS, 100(47.61%) participants reported mild to moderate pain and 30(14.28%) reported severe to worst pain in the anterior knee. Chi-square tests shows a statistical significant association (p&lt;0.05) between iliotibial band and anterior knee pain.&#x0D; Recommendations: In conclusion, iliotibial tightness was found to be present in 52.38% of the health workers. Results of the study showed that anterior knee pain occurs in iliotibial band tightness. This study, grounded in biomechanical and anatomical theories, demonstrated a significant association between iliotibial band tightness and anterior knee pain. Healthcare workers should focus on proper body biomechanics and incorporate regular muscle stretching in their routine to prevent the muscle tightness and associated problems.

Anterior Cruciate Ligament Reconstruction Using Femoral Cortical Button Fixation: A Case Series of Intraoperative Malpositioning.

Malpositioning of the femoral button is a known technical complication after anterior cruciate ligament (ACL) reconstruction with cortical suspensory fixation. The incidence of malpositioning, as well as the efficacy of methods to prevent malpositioning of cortical suspensory fixation devices, has not been reported. To determine the rate of malpositioned cortical suspensory fixation devices after ACL reconstruction, investigate which intraoperative technique yields the lowest rate of malpositioning, and determine the return-to-duty rate for active-duty service members with malpositioned buttons and the revision rate for malpositioned buttons. Case series; Level of evidence, 4. The records of patients who underwent primary ACL reconstruction with a cortical suspensory fixation device between 2008 and 2018 were reviewed at our institution. Postoperative radiographs were reviewed for evidence of malpositioned femoral buttons. Malpositioned buttons were classified as (1) fully positioned in the bone tunnel, (2) partially positioned in the bone tunnel, (3) >2 mm from cortical bone, or (4) deployed over the iliotibial band. Operative reports were reviewed to determine the intraoperative methods undertaken to verify the button position. The rate of malpositioned cases with subjective instability and revision surgery performed were determined. The ability of patients to return to full military duty was reviewed for active-duty personnel. A total of 1214 patients met the inclusion criteria. A 3.5% rate (42 cases) of malpositioned cortical suspensory fixation devices (femoral buttons) was identified. For patients with malpositioned buttons, 7 (16.7%) patients underwent revision surgery in the immediate postoperative period. Techniques used to avoid malpositioning included direct arthroscopic visualization, direct open visualization, intraoperative fluoroscopy, and first passing the button through the skin before positioning on the femoral cortex. There was a 4.6% malposition rate using direct arthroscopic visualization and a 5.1% malposition rate using passage of the button through the skin, while no malpositioning occurred with intraoperative fluoroscopy or direct open visualization (P < .05). Overall, 12 (28.6%) patients with malpositioned buttons ultimately underwent revision surgery. Despite having been diagnosed with malpositioned buttons, 21 (63.6%) active-duty members were able to return to full duty. Malpositioning of femoral buttons during ACL reconstruction occurred in 3.5% of patients in this series. The techniques of intraoperative fluoroscopy and direct open visualization are encouraged to prevent malpositioning.

Local Vibration Effects on Iliotibial Band Release in Patients with Knee Osteoarthritis

Local Vibration Effects on Iliotibial Band Release in Patients with Knee Osteoarthritis

Gluteal Complex is important in External Snapping Hip: intraoperative identification of syndrome origin and endoscopic stepwise release–a case series.

PurposeExternal snapping hip syndrome (ESHS) was historically attributed to isolated iliotibial band (ITB) contracture. However, the gluteus maximus complex (GMC) may also be involved. This study aimed to intraoperatively identify the ESHS origin and assess the outcomes of endoscopic treatment based on the identified aetiological type.MethodsFrom 2008-2014, 30 consecutive patients (34 hips) with symptomatic ESHS cases refractory to conservative treatment underwent endoscopic stepwise “fan-like” release, gradually addressing all known reasons of ESHS: from the isolated ITB, through the fascial part of the GMC until a partial release of gluteus maximus femoral attachment occurred. Snapping was assessed intra-operatively after each surgical step and prospectively recorded. Functional outcomes were assessed via the MAHORN Hip Outcome Tool (MHOT-14).ResultsTwenty seven patients (31 hips) were available to follow-up at 24-56 months. In all cases, complete snapping resolution was achieved intra-operatively: in seven cases (22.6%) after isolated ITB release, in 22 cases (70.9%), after release of ITB + fascial part of the GMC, and in two cases (6.5%) after ITB + fascial GMC release + partial release of GM femoral insertion. At follow-up, there were no snapping recurrences and MHOT-14 score significantly increased from a pre-operative average of 46 to 93(p<0.001).ConclusionIntraoperative identification and gradual addressing of all known causes of ESHS allows for maximum preservation of surrounding tissue during surgery while precisely targeting the directly involved structures. Endoscopic stepwise “fan-like” release of the ITB and GMC is an effective, tailor-made treatment option for ESHS regardless of the snapping origin in the patients with possibility to manually reproduce the snapping.

Revision ACL-R With Contralateral BTB Autograft and Iliotibial Band Lateral Extra-Articular Tenodesis With Interference Screw Fixation: A Technique Video

Background: Lateral extra-articular tenodesis (LET) is a reproducible and reliable technique to assist in control of rotational stability of the knee and decrease forces across an anterior cruciate ligament (ACL) graft in the setting of ACL reconstruction. Bone-tendon-bone (BTB) autograft is a common graft choice in revision ACL reconstruction. We present a technique for combining contralateral BTB autograft with LET in revision ACL reconstruction. Indications: This technique is indicated in patients undergoing ACL reconstruction who are at increased risk of graft failure, including revision cases, high-grade rotational instability, return to pivoting/cutting sports, ligamentous laxity, young age, meniscal deficiency, and hyperextension/recurvatum. Technique Description: The contralateral BTB autograft is harvested through standard fashion. We begin with the LET dissection prior to fluid infiltration in the soft tissues. A 1-cm strip of iliotibial (IT) band is harvested and whipstitched. The IT band strip is passed from anterior to posterior deep to the lateral collateral ligament (LCL). The LET socket is aimed 10° proximal and 10° anterior to limit tunnel convergence with the ACL. The LET is fixed with a tenodesis screw with the knee in neutral rotation and 30° of flexion. The ACL femoral socket is then placed, and care is taken to avoid convergence. A 10-mm tibial tunnel is drilled near the level of the posterior margin of the anterior horn of the lateral meniscus. The ACL is subsequently fixed with standard techniques. Results: The addition of LET to revision ACL has been shown to improve failure rate and outcomes. The use of contralateral patella tendon graft reduces morbidity on the operated leg. Notably, the position of the femoral LET tunnel is less important than the ACL tunnel position on the femur. If the LET is passed under the LCL, then the fixation point on femur becomes less relevant. The technique presented is a time-efficient way for combining tenodesis with revision ACL. Discussion/Conclusion: Performing a revision ACL reconstruction utilizing contralateral donor tissue with the addition of LET is a viable and reliable option for competitive athletes. Patient Consent Disclosure Statement: The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form.

Outcome of lateral retinacular nerve transection combined with release for recalcitrant iliotibial band friction syndrome.

In this retrospective study, a technique consisting in neurolysis of the lateral retinacular nerve combined with a partial release through elliptic excision of the iliotibial band (ITB) is evaluated for efficacy in recalcitrant ITB friction syndrome and compared with results from other techniques reported in literature. From April 2014 to December 2017, 21 patients suffering from recalcitrant ITB friction syndrome were surgically treated with the aforementioned technique. 15 patients (15 knees) were available for a written retrospective reassessment after completion of a follow-up period of at least 12 months. Residual pain was scored using the Visual Analogue Scale (VAS). The functional outcome was evaluated by two patient reported outcome measurement scales (PROMs), the Lysholm and the International Knee Documentation Committee (IKDC) score. Return to sport was analysed by duration of the inactivity period as well as by the Tegner score. Overall satisfaction was evaluated using a modified Boyden scale. At final follow-up of one year, the performed intervention resulted in a pain reduction (VAS 4.2 (1-8) to 1.4 (0-6)) and improved knee function (Lysholm 59.53 to 87.73, IKDC 75) with return to sport (Tegner 4.3 to 5.4) after a median of 23.8 weeks (6 to 52). Twelve patients reported good or excellent results (80%) at final follow-up, and 12 patients (80%) would undergo surgery again, if necessary. The treatment of recalcitrant ITB friction syndrome by combining neurectomy of the lateral retinacular nerve with elliptic excision of the ITB resulted in good to excellent results in 80% of treated cases with return to sport in 93%.

Open Reduction of Pediatric Femur Fracture: A Technical Trick

Open Reduction of Pediatric Femur Fracture: A Technical Trick

Lateral Extra-Articular Tenodesis in Skeletally Immature Patients: The Modified Ellison Technique

Background: Anterior cruciate ligament (ACL) rupture is an increasingly common injury in the young population. Unfortunately, reinjury rates in this population following ACL reconstruction (ACLR) are also very high. As such, lateral extra-articular procedures have been proposed to augment ACLR and shown to reduce reinjury rates. Most techniques use a strip of iliotibial band (ITB) fixed proximally on the distal femur in close proximity to the lateral femoral epicondyle, which in the skeletally immature patient may be closely associated with the distal femoral physis. In addition, there is also a risk of convergence with the femoral tunnel for the ACLR. The modified Ellison technique avoids both of these risks given it is a distally based tenodesis with its fixation point on the proximal tibial epiphysis. The purpose of this video is to describe a modified Ellison technique in a skeletally immature patient. Indications: Primary ACLR in skeletally immature patients at high risk of ACL graft rerupture due to their young age, a positive family history of ACL rupture in a first-degree relative, previous contra-lateral ACL rupture, generalized joint hypermobility, high-grade pivot-shift test, and participating in pivoting sports. Technique Description: The modified Ellison technique is a distally based lateral extra-articular procedure. A 1-cm strip of ITB is detached from Gerdy’s tubercle, passed beneath the lateral collateral ligament, and reattached back to from where it was removed. The fixation is within the proximal epiphysis of the tibia. Results: In a high-risk adult population, the modified Ellison technique has been shown to have a low ACL graft reinjury rate at 2 years following an ACLR. Biomechanical studies have demonstrated that a modified Ellison technique closely restores native knee kinematics following simulated anterolateral complex injury. Discussion/Conclusion: The modified Ellison technique is a safe and reproducible lateral extra-articular procedure in skeletally immature patients when performed in combination with an ACLR. Patient Consent Disclosure Statement: The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication.