Iliotibial Bands Research Articles

Effectiveness of dry needling on pain & disability in athletes with iliotibial band tightness- a clinical trial

IntroductionDry needling (DN) for Myofascial trigger points (MTrP's) can be done on superficial or deep tissue levels for the management of a range of neuromusculoskeletal pain disorders. There is still much to learn about dry needling, despite the fact that it has been demonstrated to be useful for a variety of illnesses. The aim of the current study was to determine the effectiveness of DN with stretching on pain and disability in the treatment of athletes with iliotibial band (ITB) tightness. DesignA Clinical Trial. MethodsFor this study, 38 athletes both male and female, aged between 18 to 28 years, with tight iliotibial bands were divided into two groups: DN (n = 19) [Mean age (Years) 21.11 ± 2.96, Height (Cm) 171.16 ± 8.97, Weight (Kg) 63.73 ± 14.12, BMI (Kg/m2) 21.68 ± 3.53] and control group (n = 19) [Mean age 20.26 ± 2.37 (Years), Height (Cm) 166.31 ± 7.97, Weight (Kg) 56.02 ± 9.49, BMI (Kg/m2) 20.17 ± 2.39] who received ITB stretching. As outcome measures both before and after the treatment, the Visual Analogue Scale (VAS) and the Lower Extremity Functional Scale (LEFS) were used. ResultsThe difference in pain and functional scale was assessed using paired and unpaired t-tests. Post-treatment, individuals who received DN showed statistically greater improvements in pain (p = 0.000) and disability (p = 0.001) than those who received stretching. ConclusionAccording to this trial's findings, three sessions of DN with stretching are more effective at reducing pain and enhancing iliotibial band functionality.

The relationship between the pH value of a hydration solution and the biomechanical properties of Crosado-embalmed human iliotibial bands

Determining the biomechanical properties of human tissues commonly involves the immersion or spraying of the tissues to maintain them in a hydrated state. However, the influence of the pH value of these solutions on the biomechanical properties of the tissues is not well understood. This study investigated the effects of the pH value on the biomechanical properties of the collagen-rich human iliotibial band (ITB). A total of 124 samples were allocated to polyethylene glycol (PEG) solutions of pH values between 3 and 13 for 24 h, which is a frequently used immersion time prior to biomechanical tests. After this, the samples were biomechanically tested in a uniaxial tensile testing setup using an established testing routine. Similarly, 69 samples were allocated to pH groups of 6, 7 and 8 and biomechanically tested after 1, 2 and 3 weeks. The cross-sectional area of all samples was determined after immersion into the PEG solutions for the specified time frames. In the 24-h experiment, the elastic modulus (pH 12: p ≤ 0.045; pH 13: p ≤ 0.020) and the ultimate tensile strength (pH 12: p ≤ 0.031; pH 13: p ≤ 0.026) of the pH groups 12 and 13 were significantly lower and their cross-sectional areas were higher (pH 12: p ≤ 0.005; pH 13: p ≤ 0.003) compared to several groups of acidic to alkaline pH values. There was no difference in the maximum forces between the different groups within a 24-h immersion time (p > 0.999). In the 3-week-test, a decrease of the ultimate tensile strength was noted between the 24-h and 3 week values for the pH groups 7 (p = 0.034) and 8 (p = 0.029). It is concluded that pH-dependent tissue swelling influences the cross-sectional area-dependent biomechanical properties of the human ITB. Therefore, the pH value of storage and hydration solutions for the preparation of biomechanical tests should be recorded. From a biomechanical perspective, the collagen stability of the human ITB is largely unaltered in PEG solutions with pH values between 3 and 13 over 24 h.

Extensive Heterotopic Ossification of Bilateral Hip and Knee Joints in a Patient with Recurrent Traumatic Injuries

Background: Heterotopic ossification (HO) refers to the growth of lamellar bone in soft tissues. Extensive heterotopic ossification is rarely seen. In this case, we illustrate a 35-year-old civilian patient with extensive HO due to recurrent traumatic injuries with no neurological deficit. Case Presentation: A 35-year-old man, with a history of recurrent trauma episodes in the past year, presented with pain and swellings in bilateral lower limbs. Physical examination showed stiffness and deformities of bilateral hip and knee joints. Plain x-ray showed patchy ossification extending from hip joints to knee joints bilaterally. 3-dimensional Computer Tomography (3D-CT) showed extensive heterotopic ossifications along gluteal muscles, quadratus muscles and the deep fascia beneath, confirming the diagnosis of extensive heterotopic ossifications of bilateral hip and knee joints. Excision of ossified tissues and re-mobilization of iliotibial bands were performed. Early recovery after surgery (ERAS) strategy was used to speed up recovery. Conclusion: i) Extensive heterotopic ossification in civilian patients is possible. Clinical history should be reviewed to rule out recurrent traumatic injury. Surgery should be considered. ii) Three-dimensional Computer Tomography (3D-CT) is a viable tool for surgical planning to show the extent, site, and anatomical relationship with adjacent tissues. iii) Post-op early recovery after surgery (ERAS) should be considered for better clinical outcomes.

Less iatrogenic soft-tissue damage utilizing robotic-assisted total knee arthroplasty when compared with a manual approach: A blinded assessment.

ObjectivesThe use of the haptically bounded saw blades in robotic-assisted total knee arthroplasty (RTKA) can potentially help to limit surrounding soft-tissue injuries. However, there are limited data characterizing these injuries for cruciate-retaining (CR) TKA with the use of this technique. The objective of this cadaver study was to compare the extent of soft-tissue damage sustained through a robotic-assisted, haptically guided TKA (RATKA) versus a manual TKA (MTKA) approach.MethodsA total of 12 fresh-frozen pelvis-to-toe cadaver specimens were included. Four surgeons each prepared three RATKA and three MTKA specimens for cruciate-retaining TKAs. A RATKA was performed on one knee and a MTKA on the other. Postoperatively, two additional surgeons assessed and graded damage to 14 key anatomical structures in a blinded manner. Kruskal–Wallis hypothesis tests were performed to assess statistical differences in soft-tissue damage between RATKA and MTKA cases.ResultsSignificantly less damage occurred to the PCLs in the RATKA versus the MTKA specimens (p < 0.001). RATKA specimens had non-significantly less damage to the deep medial collateral ligaments (p = 0.149), iliotibial bands (p = 0.580), poplitei (p = 0.248), and patellar ligaments (p = 0.317). The remaining anatomical structures had minimal soft-tissue damage in all MTKA and RATKA specimens.ConclusionThe results of this study indicate that less soft-tissue damage may occur when utilizing RATKA compared with MTKA. These findings are likely due to the enhanced preoperative planning with the robotic software, the real-time intraoperative feedback, and the haptically bounded saw blade, all of which may help protect the surrounding soft tissues and ligaments.Cite this article: Bone Joint Res 2019;8:495–501.

Mechanical and Microstructural Properties of Pediatric Anterior Cruciate Ligaments and Autograft Tendons Used for Reconstruction.

Background:Over the past several decades, there has been a steady increase in pediatric anterior cruciate ligament (ACL) tears, particularly in young female basketball and soccer players. Because allograft tissue for pediatric ACL reconstruction (ACLR) has shown high rates of failure, autograft tissue may be the best option for ACLR in this population. However, differences in the structure and mechanical behavior of these tissues are not clear.Purpose:To characterize the mechanical and microstructural properties in pediatric ACLs and autograft tissues using a rare cadaveric cohort (mean age, 9.2 years).Study Design:Descriptive laboratory study.Methods:ACLs, patellar tendons, quadriceps tendons, semitendinosus tendons, and iliotibial bands (ITBs) were harvested from 5 fresh-frozen pediatric knee specimens (3 male, 2 female) and subjected to a tensile loading protocol. A subset of contralateral tissues was analyzed using bright-field, polarized light, and transmission electron microscopy.Results:Patellar tendons exhibited values for ultimate stress (5.2 ± 3.1 MPa), ultimate strain (35.3% ± 12.5%), and the Young modulus (27.0 ± 8.8 MPa) that were most similar to the ACLs (5.2 ± 2.2 MPa, 31.4% ± 9.9%, and 23.6 ± 15.5 MPa, respectively). Semitendinosus tendons and ITBs were stronger but less compliant than the quadriceps or patellar tendons. ITBs exhibited crimp wavelengths (27.0 ± 2.9 μm) and collagen fibril diameters (67.5 ± 19.5 nm) that were most similar to the ACLs (24.4 ± 3.2 μm and 65.3 ± 19.9 nm, respectively).Conclusion:The mechanical properties of the patellar tendon were almost identical to those of the ACL. The ITB exhibited increased strength and a similar microstructure to the native ACL. These findings are not entirely congruent with studies examining adult tissues.Clinical Relevance:These results can be used to inform further clinical research. In particular, they justify a further examination of the biomechanical and microstructural properties of the ITB in the context of its role as an autograft tissue in pediatric ACL reconstruction.

The immediate and long-term effects of negative pressure soft tissue mobilization on the iliotibial bands of runners using magnetic resonance imaging

Introduction: Myofascial decompression (MFD) is a soft tissue mobilization technique in which negative pressure is applied to soft tissues through active range of motion (ROM). Overuse injuries, such as iliotibial band syndrome (ITBS), result in compression and irritation of lateral knee structures commonly seen in runners (Nemeth & Sanders 1996). The purpose of this study is to quantify the effects of MFD using MR imaging (MRI) to compare tissue changes with clinical measures for addressing ITBS. We hypothesize that immediately and 72 hours after application the space between the tissue layers will increase with MFD. Clinically, subjective pain, hip adduction ROM, and functional single leg squat (SLS) will be improved.

An anatomic study of trifurcate iliotibial bands for correcting valgus knee deformity

BackgroundThe iliotibial band (ITB) trifurcates into the anterior, central and posterior branches at the knee level, and sometimes the branches must be selectively released to correct the valgus knee deformity during total knee arthroplasty. However, the anatomical morphology of the trifurcate ITBs has not been investigated. MethodsFifty-two knees from 26 embalmed cadavers were dissected to observe and record the relationship of the three branches given off from the ITB trifurcation. Fourteen parameters with regard to the length, width, thickness, and trifurcate angle of each branch were measured. These parameters were compared between sex and sides (left or right). Meanwhile, the correlations between parameters and subject age, weight and height were assessed. ResultsThe longest, widest and thickest branches of the ITB were the posterior band (59.82±5.14mm), anterior band (39.56±4.17mm) and central band (2.61±0.36mm), respectively. The length and thickness of ITB were significantly larger in males than in females (P<0.05). No significant differences were found between sides (P>0.05). The ITB thickness showed a negative correlation with subject age, while the length and width of the ITB were positively correlated with subject height and weight, respectively. ConclusionsThis study provided an anatomical reference of trifurcate ITBs to help the release of ITB in valgus knees. The anatomical variations regarding the subject's sex, age, height and weight should be considered in the selective release of ITB.

Muscle Disease

On the basis of strong research evidence, Duchenne muscular dystrophy (DMD), the most common severe childhood form of muscular dystrophy, is an X-linked recessive disorder caused by out-of-frame mutations of the dystrophin gene. Thus, it is classified asa dystrophinopathy. The disease onset is before age 5 years. Patients with DMD present with progressive symmetrical limb-girdle muscle weakness and become wheelchair dependent after age 12 years. (2)(3). On the basis of some research evidence,cardiomyopathy and congestive heart failure are usually seen in the late teens in patients with DMD. Progressive scoliosis and respiratory in sufficiency often develop once wheelchair dependency occurs. Respiratory failure and cardiomyopathy are common causes of death, and few survive beyond the third decade of life. (2)(3)(4)(5)(6)(7). On the basis of some research evidence, prednisone at 0.75 mg/kg daily (maximum dose, 40 mg/d) or deflazacort at 0.9 mg/kg daily (maximum dose, 39 mg/d), a derivative of prednisolone (not available in the United States), as a single morning dose is recommended for DMD patients older than 5 years, which may prolong independent walking from a few months to 2 years. (2)(3)(16)(17). Based on some research evidence, treatment with angiotensin-converting enzyme inhibitors, b-blockers, and diuretics has been reported to be beneficial in DMD patients with cardiac abnormalities. (2)(3)(5)(18). Based on expert opinion, children with muscle weakness and increased serum creatine kinase levels may be associated with either genetic or acquired muscle disorders (Tables 1 and 3). (14)(15)

The anatomical characteristics and clinical application of the lateral superior genicular artery perforator iliotibial band flap

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. Key words: Iliotibial band; Perforator flap; Lateral superior genicular artery; Microsurgery

Biomechanics of iliotibial band friction syndrome in runners.

We propose a biomechanical model to explain the pathogenesis of iliotibial band friction syndrome in distance runners. The model is based on a kinematic study of nine runners with iliotibial band friction syndrome, a cadaveric study of 11 normal knees, and a literature review. Friction (or impingement) occurs near footstrike, predominantly in the foot contact phase, between the posterior edge of the iliotibial band and the underlying lateral femoral epicondyle. The study subjects had an average knee flexion angle of 21.4 degrees +/- 4.3 degrees at footstrike, with friction occurring at, or slightly below, the 30 degrees of flexion traditionally described in the literature. In the cadavers we examined, there was substantial variation in the width of the iliotibial bands. This variation may affect individual predisposition to iliotibial band friction syndrome. Downhill running predisposes the runner to iliotibial band friction syndrome because the knee flexion angle at footstrike is reduced. Sprinting and faster running on level ground are less likely to cause or aggravate iliotibial band friction syndrome because, at footstrike, the knee is flexed beyond the angles at which friction occurs.

A randomized controlled trial of early surgery in duchenne muscular dystrophy

We performed a randomized controlled trial of early surgical treatment of contractures in 20 boys with Duchenne muscular dystrophy, age 4–6 yr. Surgery consisted of release of hip flexors, removal of iliotibial bands, and lengthening of tendo Achilles bilaterally. All patients were monitored for at least 12 months post-randomization, and assessed quantitatively for muscle strength and function. Surgery corrected the deformities, but had no beneficial effect on strength or function. Indeed, data in the second year showed more rapid deterioration of function in some of the operated boys. There appeared to be continued evolution of pathology following surgery, as assessed by sequential muscle ultrasound and muscle biopsy. We cannot recommend this type of surgery as a routine treatment.

Progression of scoliosis in Duchenne muscular dystrophy.

We reviewed the clinical charts and spinal radiographs of fifty-one boys who had Duchenne muscular dystrophy, had not had surgical treatment of the spine, and had been followed until death. All had scoliosis. None of the following variables was useful in predicting which curves would become severe: age when the patient initially walked, age when he ceased walking, age at onset of spinal collapse, surgical release of the iliotibial bands, or age at the time of death. Radiographs were made within eighteen months before death for thirty-three patients; in thirty-one of them, the final curve exceeded 40 degrees and in seventeen, 90 degrees. For the remaining eighteen patients, final radiographs were made more than eighteen months before death; at that time, eight of them already had a curve of more than 90 degrees. Although there was a relationship between extension of the lumbar spine and severity of scoliosis at the time of final follow-up, early maintenance of the lumbar spine in extension rarely prevented the development of a severe curve. For most of the patients who had a severe curve, sitting was difficult and was accompanied by breakdown of the skin and pain. When a patient's curve exceeded 35 degrees, the vital capacity usually was less than 40 per cent of the predicted normal value. Therefore, when walking becomes impossible for boys who have Duchenne muscular dystrophy, routine spinal arthrodesis should be considered.

Lower extremity flexibility patterns in classical ballet dancers and their correlation to lateral hip and knee injuries.

Knee and hip problems account for up to 40% of injuries in classical ballet. Despite apparent flexibility, many dancers appeared to have tight iliotibial bands that contributed to lower limb problems. Thirty senior female ballet dancers were contrasted with thirty age-matched active volunteers for hip and knee range of motion, and the information derived was correlated with their orthopaedic medical histories. Dancers spent a reasonable period of time warming up, but it was usually with an unbalanced routine that emphasized hip abduction and external rotation to the exclusion of adduction work. This was reflected in the significantly lower range of passive hip adduction and internal rotation compared to the controls. Furthermore, the older and more experienced the dancer, the more this trend was exaggerated. This unbalanced flexibility may play a role in the production of lateral knee pain (30% of the dancers) and anterior hip pain (33% of the dancers). It is suggested that more attention should be given to a balanced stretching regimen as part of the dancers' warmup in an effort to reduce the frequency of some of the chronic hip and knee complaints.

BILATERAL CONGENITAL CONTRACTURE OF THE ILIO-TIBIAL TRACT

1. A case is described of bilateral congenital contracture of the ilio-tibial bands in a healthy girl of ten months. 2. With the hips extended each lower limb was held in about 25 degrees of fixed abduction. 3. Division of the ilio-tibial bands abolished the abduction contractures.