Iliotibial Band Research Articles

Midterm Outcomes After Total Knee Arthroplasty With Lateral Approach for Valgus Knee Deformity in Patients With Rheumatoid Arthritis.

Background Valgus knee deformity is often seen in rheumatoid arthritis (RA) cases. Usually, the medial approach has been often utilized for total knee arthroplasty (TKA), even in valgus deformity cases; however, the medial approach is feared to induce further instability in the medial side because it could further break the soft tissue structure, including medial collateral ligament (MCL) and medial patellofemoral ligament (MPFL). Consequently, loosening of the implant, recurrence of valgus knee deformity, and pain due to instability might be induced in the early period after surgery. In this study, a lateral approach for TKA against valgus deformity in RA cases was utilized to avoid further damage on the medial side. Methods Eleven valgus knees in 10 patients with RA (mean age, 61.1 years; mean follow-up, 33.1 months) underwent primary TKA with the lateral approach. Iliotibial band (ITB) dissection and/or peroneal nerve release were performed if necessary. Radiological and clinical investigations were evaluated pre- and postoperatively. Results The average operating time was 106 minutes, which was no longer compared with the time after the medial approach described previously. The extension angle was significantly improved from -15.0 ± 10.2 to -5.5 ± 4.2 degrees (P = 0.03), while the flexion angle showed no significant change (from 111.8 ± 15.9 to 115.0 ± 13.2 degrees). The hip-knee-ankle angle (HKA) was also significantly corrected from -9 ± 4.9 to 0.4 ± 1.7 degrees (P < 0.001). The 2011 Knee Score System (KSS) scores were significantly improved from 6.9 ± 3.4 to 21.5 ± 2.9 (P < 0.001) in symptoms, from 15.6 ± 2.7 to 31.1 ± 4.1 (P < 0.001) in satisfaction, and from 31.5 to 59.5 (P < 0.01) in activity. Conclusion Midterm outcomes after lateral approach TKA were good, and knee alignment was significantly improved. The lateral approach TKA for valgus deformity in patients with RA was not complicated and difficult because it required no additional operating time compared with the medial approach. From the perspective of preventing further damage to the soft tissue structure on the medial side, the lateral approach was meaningful for valgus deformity in patients with RA.

A portable system to measure knee extensor spasticity after spinal cord injury

BackgroundThe pendulum test is a quantitative method used to assess knee extensor spasticity in humans with spinal cord injury (SCI). Yet, the clinical implementation of this method remains limited. The goal of our study was to develop an objective and portable system to assess knee extensor spasticity during the pendulum test using inertial measurement units (IMU).MethodsSpasticity was quantified by measuring the first swing angle (FSA) using a 3-dimensional optical tracking system (with external markers over the iliotibial band, lateral knee epicondyle, and lateral malleolus) and two wireless IMUs (positioned over the iliotibial band and mid-part of the lower leg) as well as a clinical exam (Modified Ashworth Scale, MAS).ResultsMeasurements were taken on separate days to assess test–retest reliability and device agreement in humans with and without SCI. We found no differences between FSA values obtained with the optical tracking system and the IMU-based system in control subjects and individuals with SCI. FSA values from the IMU-based system showed excellent agreement with the optical tracking system in individuals with SCI (ICC > 0.98) and good agreement in controls (ICC > 0.82), excellent test–retest reliability across days in SCI (ICC = 0.93) and good in controls (ICC = 0.87). Notably, FSA values measured by both systems showed a strong association with MAS scores (ρ\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$$\\uprho$$\\end{document} ~ −0.8) being decreased in individuals with SCI with higher MAS scores, reflecting the presence of spasticity.ConclusionsThese findings suggest that our new portable IMU-based system provides a robust and flexible alternative to a camera-based optical tracking system to quantify knee extensor spasticity following SCI.

A Study on Efficacy of Dry Needling with Deep Friction Massage in Iliotibial Band Syndrome

Iliotibial band syndrome (ITBS) was first specifically described by Renne as a chronic condition with pain felt on the lateral aspect of the thigh and knee with lower limb activities involving repetitive knee flexion and extension such as running or cycling. The study aims to find out the effectiveness of Dry needling with Deep friction Massage on the reduction of pain &amp; restoration of the functional ability of an individual with ITBS. 30 subjects with lateral thigh &amp; knee pain are taken through proper screening and fulfilling the inclusive and exclusive criteria. The subjects will receive Dry needling with Deep friction Massage for a session of 2 weeks. Pre &amp; Post-test will be analyzed based on the outcome measure i.e., Lower Extremity functional scale (LEFS) and Visual Analogue Scale (VAS). The statistical analysis shows the effectiveness that Dry Needling with deep Friction Massage In IT Band Syndrome. That Study concludes that Dry Needling with Deep Friction Massage is more effective in reduction on of pain and restoring functional ability in IT Band Syndrome.

Dual Plating of Distal Femoral Fractures.

Dual plating of the distal femur is indicated for the treatment of complex intra-articular fractures, supracondylar femoral fractures, low periprosthetic fractures, and nonunions. The aim of this procedure is anatomical alignment of the articular surface, restoration of the articular block, and prevention of varus collapse. Following preoperative planning, the patient is positioned supine with the knee flexed at 30°. The lateral incision is made first, with a mid-lateral incision that is in line with the femoral shaft. If intra-articular work is needed this incision can be extended by curving anteriorly over the lateral femoral condyle. Next, the iliotibial band is transected in line with its fibers. The vastus lateralis fascia is incised and elevated off the septum, working distal to proximal. Care should be taken to maintain hemostasis when encountering femoral artery perforating vessels. Once there is adequate exposure, several reduction aids can be utilized, including a bump under the knee, Schanz pins, Kirschner wires, and reduction clamps. A lateral precontoured plate is placed submuscularly, and the most proximal holes are filled percutaneously. The medial incision begins distally at the adductor tubercle and is a straight incision made proximally in line with the femoral shaft. The underlying fascia is transected in line with the skin incision, and the vastus medialis is elevated. Care should be taken to avoid the descending geniculate artery, as well as its articular branch and the muscular branch to the vastus medialis. A lateral tibial plateau plate is contoured and placed. Nonoperative treatment of distal femoral fractures is rare, but relative indications for nonoperative treatment include frailty of the patient, lack of ambulatory status, a non-reconstructible fracture, or a stable fracture. These patients are placed in a long-leg cast followed by a hinged knee brace1. There are several other surgical fixation options, including lateral plating, retrograde intramedullary nailing, distal femoral replacement, and augmentation of a retrograde nail with a plate. Dual plating has several benefits, depending on the clinical scenario. Biomechanical studies have found that dual plating results in increased stiffness and construct strength2,3. Additional construct stability can be offered through the use of locking plates, particularly in osteoporotic bone. Taken together, this increased stability and construct strength can allow for earlier weight-bearing, which is particularly important for fractures in the geriatric population. Furthermore, the increased stiffness and construct strength make this procedure a favorable treatment option for nonunion, and it has been shown to result in lower rates of postoperative nonunion compared with lateral plating alone4-7. Adjunctive use of a medial plate also has been suggested to prevent varus collapse, particularly with metaphyseal comminution and poor bone quality2,3,8. Finally, in the periprosthetic fracture population, dual plating also removes the concern of incompatibility with a retrograde nail. The outcomes of dual plating are promising, given the severity of the injury. When comparing operative to nonoperative treatment outcomes, nonoperatively managed patients had worse functional outcomes and higher rates of complications related to immobility1. Dual plating of supracondylar fractures and intra-articular distal femoral fractures yields nonunion rates ranging from 0% to 12.5%, lower than the 18% to 20% reported with lateral locking plates4-7,9-12. This reduction in nonunions has been shown to lead to fewer revisions when compared with single-plating techniques7. In prior studies, 95% of nonunions treated with the dual-plating technique achieved union postoperatively11. One concern when utilizing the medial approach is critical damage to medial vascularity; however, this result has not been reported in the literature, and there is a safe operating window13. Despite the benefits of dual plating, there are relatively high rates of infection following dual plating (0% to 16.7%) compared with lateral plating alone (3.6% to 8.5%)5,14-17. However, many of these studies are small case series, highlighting that a surgeon's comfort and skill with these procedures is paramount to patient outcomes. Meticulous placement and contouring of lateral and medial plates are required to prevent malreduction of the articular block that creates a "golf-club deformity."18,19During the medial approach, be aware of descending geniculate artery-particularly its muscular branch, which is ∼5 cm from the adductor tubercle/medial epicondyle, and its root, which enters the compartment at the adductor hiatus at ∼16 cm13.

Injuries to both anterolateral ligament and Kaplan fiber of the iliotibial band do not increase preoperative pivot-shift phenomenon in ACL injury

BackgroundTo assess the incidence of anterolateral ligament (ALL) and Kaplan fiber of the iliotibial band (KF) injuries in patients with acute anterior cruciate ligament (ACL) injury on magnetic resonance imaging (MRI), and to investigate the association between these injuries and the magnitude of preoperative pivot-shift test. MethodOne-hundred and five patients with primary ACL injury were retrospectively reviewed. ALL injury and KF injury were assessed by preoperative MRI, and subjects were allocated into four groups: Group A, neither injury; Group B, only ALL injury; Group C, only KF injury; Group D, simultaneous ALL and KF injuries. Before ACL reconstruction, tibial acceleration during the pivot-shift test was measured by an electromagnetic measurement system, and manual grading was recorded according to the International Knee Documentation Committee (IKDC) guideline. ResultsIn MRI, the ALL was identified in 104 patients (99.1%) and KF in 99 patients (94.3%). ALL and KF injuries were observed in 43 patients (43.9%) and 23 patients (23.5%), respectively. Patient distribution to each group was as follows; Group A: 43 patients (43.9%), Group B: 32 patients (32.7%), Group C: 12 patients (12.2%), Group D: 11 patients (11.2%). No significant differences were observed in tibial acceleration, and manual grading among the four groups. ConclusionSimultaneous injury to both ALL and KF was uncommon, and preoperative pivot-shift phenomenon did not increase even in those patients. The finding suggests that the role of ALL and KF in controlling anterolateral rotatory knee laxity may be less evident in the clinical setting compared to a biomechanical test setting.

Clinical Outcomes Following Incomplete Arthroscopic Iliotibial Band Release for External Snapping Hip Syndrome: An Observational Study.

Arthroscopic treatment is indicated for external snapping hip (ESH) syndrome in patients refractory to conservative treatment, but snapping does not disappear completely in some case. No previous studies have described the clinical course of ESH syndrome in patients who presented with persistent snapping after an arthroscopic procedure. We demonstrated the clinical outcomes following an incomplete arthroscopic iliotibial band (ITB) release for ESH syndrome. This retrospective observational study was performed at two teaching hospitals between October 2015 and December 2021. We reviewed the data of 33 patients (34 hips) aged ≥18 years, diagnosed with ESH syndrome, who were treated with arthroscopic ITB release. Patients who presented with persistent snapping despite sufficient arthroscopic ITB release following systematic order were defined as having an incomplete release. We collected the data for recurrent symptomatic snapping hip as the primary outcome after a minimum 2-year follow-up. The visual analogue scale (VAS) and modified Harris hip (mHHS) scores were measured as secondary outcome. "Incomplete release" was identified in three of the 34 hips (8.9%). Cases of recurrent symptomatic snapping or conversion to open surgery were not observed. The symptoms of residual snapping spontaneously disappeared in all cases following routine postoperative rehabilitation within a 3-month follow-up period. The VAS (4 ± 1) and mHHS (17 ± 6) scores of all the patients improved. When refractory ESH syndrome is identified during arthroscopic surgery, appropriate ITB release and removal of the major lesion causing snapping are expected to lead to resolution of residual symptoms without conversion to open surgery.

Isolated lateral-sided knee pain in total knee arthroplasty. A review.

Isolated lateral-sided knee pain is a unique problem following total knee arthroplasty (TKA). Reported causes include soft tissue impingement against extruded cement, an overhanging tibial tray, remnant osteophytes rubbing against the iliotibial band (ITB), popliteal tendon impingement, fabella syndrome, and synovial tissue impingement in the lateral gutter. In addition, iliotibial band traction syndrome secondary to guided motion Bi-cruciate stabilizing knee arthroplasty has been recognized as a new clinical entity. Initial work up should include ruling out the most common causes of painful TKA including infection, aseptic loosening, and instability. Radiographs and CT scan are utilized to identify potential source of pain. Ultrasound evaluation (with elicited probe tenderness) can increase diagnostic accuracy. Ultrasound guided local anesthetic injections can confirm the source of pain. Anti-inflammatory medications, physical therapy with ITB stretches, and therapeutic local steroid injections are initial treatment modalities. Satisfactory resolution of symptoms may require surgical intervention directed at the specific cause and may avoid the morbidity associated with revision TKA.

Isometry of anteromedial reconstructions mimicking the deep medial collateral ligament depends on the femoral insertion.

This study aimed to investigate the length change patterns of the native deep medial collateral ligament (dMCL) and potential anteromedial reconstructions (AMs) that might be added to a reconstruction of the superficial MCL (sMCL)to better understand the control of anteromedial rotatory instability (AMRI). Insertion points of the dMCL and potential AM reconstructions were marked with pins (tibial) and eyelets (femoral) in 11 cadaveric knee specimens. Length changes between the pins and eyelets were then tested using threads in a validated kinematics rig with muscle loading of the quadriceps and iliotibial tract. Between 0° and 100° knee flexion, length change pattern of the anterior, middle and posterior part of the dMCL and simulated AM reconstructions were analysed using a rotary encoder. Isometry was tested using the total strain range (TSR). The tibiofemoral distance of the anterior dMCL part lengthened with flexion (+12.7% at 100°), whereas the posterior part slackened with flexion (-12.9% at 100°). The middle part behaved almost isometrically (maximum length: +2.8% at 100°). Depending on the femoral position within the sMCL footprint, AM reconstructions resulted in an increase in length as the knee flexed when a more centred position was used, irrespective of the tibial attachment position. Femoral positioning in the posterior aspect of the sMCL footprint exhibited <4% length change and was slightly less tight in flexion (min TSR = 3.6 ± 1.5%), irrespective of the tibial attachment position. The length change behaviour of potential AM reconstructions in a functionally intact knee is mainly influenced by the position of the femoral attachment, with different tibial attachments having a minimal effect on length change. Surgeons performing AM reconstructions to control AMRI would be advised to choose a femoral graft position in the posterior part of the native sMCL attachment to optimise graft length change behaviour. Given the high frequency of MCL injuries, sufficient restoration of AMRI is essential in isolated and combined ligamentous knee injuries. There is no level of evidence as thisstudy was an experimental laboratory study.

Anterior Cruciate Ligament Reconstruction: 3-Incision Technique With Allograft Quad Tendon ACL Reconstruction

Background: Anterior cruciate ligament (ACL) ruptures are becoming more common in younger and older athletes. Approximately 250,000 ACL injuries occur each year, requiring the need for an effective and reproducible surgical technique. Indications: The 3-incision outside-in technique utilizes the donor quadriceps tendon, an extraordinarily strong graft, without damage from autogenous harvesting of patellar tendon or hamstrings. While some data suggest higher re-rupture risk with donor tissue, this is counterbalanced by avoiding secondary surgical site damage. Technique Description: The ruptured ACL is removed and the intercondylar notch is cleaned to visualize the anatomical ACL insertion site. Using the 3-tunnel technique a gaff is passed through the intercondylar notch, through a puncture hole (incision 1) and a rear entry guide hooked to its tip. The guide point is pulled into the knee and placed in posterior aspect of the anatomic footprint of the native ACL. Through incision 2, a guide pin is drilled to this point and overdrilled with a 10-mm drill. The edges of the hole in the intercodylar notch are smoothed with a currette. The tibial footprint is cleared, a tibial aiming guide placed. Through incision 3, a guide pin is placed and over drilled with a 10-mm drill followed by a Gore-Tex reamer to ensure no impingement would inhibit graft passage. The proximal bone of a quadriceps tendon graft is sized through a 10-mm sizer and compacted. Two holes are drilled to hold sutures for the proximal aspect of the femoral graft. The quadriceps tendon graft is sized to fit through a 9-mm tunnel and the free end whipped with a stitch before being passed from outside-in through the smoothed tunnels. The femoral bone block is tapped to have a press fit initially and then is fixed with a Milagro screw. The knee is cycled ten times to remove slack and the interference fit guide pin is placed on the anterior aspect of the graft, and fixed with the knee at 15° to 30° of flexion. Stability is tested with confirmation of no impingement, and then an extra-articular reconstruction with a semitendinosus allograft is performed. The extra articular reconstruction is placed at the point between Gerdy's tubercle and the fibular head, passed under the skin and the iliotibial band, and then inserted just anterior and superior to the ACL femoral drill hole. Results: Patient outcomes in our initial experience are comparable to our autogenous bone-tendon-bone (BTB) procedures without anterior knee pain. Return to sport is similar with autogenous procedures, with a delay of 6 to 12 months. In addition, there is a possibility for acceleration of healing with the addition of platelet-rich plasma and hyaluronic acid between 1 and 3 months postsurgery. We have insufficient data so far to determine if the re-rupture rate will decline compared with reported outcomes. Conclusion: The 3-incision technique with allograft quadriceps tendon for ACL reconstruction is a reproducible surgical technique that avoids harvest from the patient's own body. 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.

Hip abductor strengthening vs iliotibial band stretching exercises in conventional knee osteoarthritis rehabilitation: a comparative trial

Abstract The aim of this study is to compare the effect of hip abductor and iliotibial band (ITB) exercises for patients of knee osteoarthritis (OA). 60 patients with knee OA were randomly divided into three groups. Group A received hip abductor strengthening along with quadriceps strengthening exercises, Group B received iliotibial band stretching along with quadriceps strengthening exercises and Group C received conventional knee exercises. The treatment duration was three sessions per week in alternate days for 3 weeks. The outcome measures were pain, physical performance and quality of life, which were evaluated at the baseline and after 3 week of intervention with the visual analogue scale, chair sit to stand test and knee injuries and osteoarthritis outcome score questionnaire. All the three groups showed statistically significant improvement in pain, physical performance and quality of life in patients with knee OA. Hip abductor strengthening exercises group showed more significant improvement in pain, physical performance and quality of life than the Iliotibial band stretching exercises group. The results of the study suggest that the hip abductor strengthening exercises can be more effective than iliotibial band stretching exercises in reducing pain, improving quality of life and physical performance in patients with knee osteoarthritis. But we can also use iliotibial band stretching exercises with other interventions in case of knee OA because iliotibial band stretching exercises also gives result in reduction of pain, symptoms and improvement in physical performance and quality of life. Clinical trial registry of India No. CTRI/2023/06/054225

Traditional Massage-Induced Iliotibial Band Syndrome: A Case Report

Iliotibial Band (ITB) Syndrome is common among athletes, such as runners and cyclists. There are several theories regarding the etiology of ITB Syndrome, including friction, compression, and chronic inflammation. We report a rare case of ITB Syndrome induced by traditional massage after a history of chronic knee pain. A 63-year-old female visited our Pysical Medicine and Rehabilitation Department with the pain of the lateral side of the right knee for four months after traditional massage. The physical examination showed a positive Ober test and Noble compression test. We performed an ultrasonography on the lateral right knee and found fluid effusion beneath the ITB confirming the diagnosis of ITB Syndrome. A pain intervention was performed with ultrasound-guided aspiration and injection of steroid beneath the ITB. After the procedure and rehabilitation program of cryotherapy and ultrasound therapy, the pain was reduced greatly and there was no need for further management.

Labral Augmentation With Either Iliotibial Band Allograft or Dermis Allograft Perform Similarly Regarding Peak Force, Displacement, and Work to Labral Repair in Suction Seal Restoration: A Biomechanical Study

PurposeIn order to investigate if allograft substitutes may be utilized to restore suctional seal properties with labral augmentation, the purpose of the current study was to evaluate the biomechanical properties of the labral suction seal under several scenarios, including: (1)intact labrum, (2)rim preparation, (3)labral repair, (4)labral augmentation with iliotibial band (ITB), (5)labral augmentation with a dermis allograft. MethodsEleven hemi-pelvises were dissected to the level of the labrum and placed in a material testing system (MTS) for biomechanical axial distraction. Each specimen was compressed to 250 newtons (N) and distracted at 10 mm/s while load, crosshead displacement, and time were continuously recorded. For each of the five labral states, three testing repetitions were performed. Peak force (N, newtons), displacement at peak force (mm, millimeter), and work (N-mm, newton, millimeter) were calculated and normalized to the intact state of each specimen. ResultsEleven specimens were tested and eight specimens (age: 58.6±5.4 years, BMI: 28.6±6.8 kg/m2; 4 females; 5 right hips) were included in final analyses. Expressed as a percentage relative to the intact state, the average normalized peak force, displacement at peak force, and work for each labral state were as follows: intact (100.0%±0% for all), rim preparation (89.0%±9.2%, 93.3%±20.6%, 85.1%±9.0%), repair (61.3%±17.9%, 88.4%±36.9%, 58.1%±16.7%), ITB allograft (62.7%±24.9%, 83.9%±21.6%, 59.4%±22.4%), and dermis allograft (57.8%±27.2%, 88.2%±29.5%, 50.0%±20.1%). Regarding peak force, intact state was significantly higher compared to the labral repair, augmentation with ITB, and augmentation with the dermis allograft states (p<0.001). No significant differences were demonstrated between displacement at peak force (p=0.561). Regarding work, both intact state and rim preparation states were significantly higher than the repair, ITB augmentation, and dermis allograft augmentation states (p<0.001). In all outcome measures, the dermis allograft augmentation performed with no statistical difference to the ITB augmentation state. ConclusionLabral repair and labral augmentation with either ITB allograft or the dermis allograft resulted in significantly lower peak force and work to equilibrium compared to the intact and rim prep states. There was no statistical difference between repair and augmentation states as well as no statistical difference between ITB allograft and dermal allograft at time zero. Clinical RelevanceThis study compares biomechanical properties of the suction seal of the hip comparing labral states including intact, rim preparation, repair, and augmentation under which can be used for surgical decision making.

A Lateral Extra-articular Procedure Reduces the Failure Rate of Revision Anterior Cruciate Ligament Reconstruction Surgery Without Increasing Complications: A Systematic Review and Meta-analysis

Background: Lateral extra-articular procedures are becoming increasingly popular in association with anterior cruciate ligament (ACL) reconstruction, especially in patients with persistent rotatory instability and in a high-risk population. However, few studies have investigated the outcomes of the lateral extra-articular procedure as an associated procedure in an ACL revision (R-ACLR) setting and its benefit with respect to isolated intra-articular reconstruction. Hypothesis: Lateral extra-articular procedures reduce the failure rate of revision ACL reconstruction (R-ACLR). Purpose: To compare subjective outcomes, knee stability, and failure and complication rates between patients who underwent ACL revision with and without an associated lateral extra-articular procedure. Study Design: Systematic review and meta-analysis; Level of evidence, 3. Methods: A systematic search of the PubMed, Cochrane, and OVID databases was performed on September 2022 in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Eligible studies were trials directly comparing patients who had isolated ACL revision with patients who had ACL revision associated with lateral extra-articular procedures at a minimum follow-up of 2 years. A meta-analysis was performed, and bias and the quality of the evidence were rated according to the Newcastle-Ottawa Scale. The meta-analysis was conducted according to the PRISMA guidelines. Results: Eight studies were included: a total of 334 patients were treated with isolated revision (isolated (R-ACLR)) and 342 treated with combined revision and a lateral extra-articular procedure (combined (R-ACLR)). For the failure rate, the meta-analysis showed a significantly decreased relative risk reduction of 54% (P = .004) in patients with combined (R-ACLR) with respect to isolated R-ACL, whereas no difference in complication rate was observed. The combined (R-ACLR) group demonstrated a decreased risk ratio of 50% (P = .002) for having a positive pivot-shift test result and a relative risk reduction of 68% (P = .003) for having a grade 2-3 pivot shift when compared with the isolated (R-ACLR) group. Finally, no significant differences were observed among the lateral extra-articular procedures. Conclusion: The addition of a lateral extra-articular procedure to revision ACL significantly reduced the failure rate and postoperative pivot shift without increasing the complication rate. Anterolateral ligament reconstruction and a lateral extra-articular procedure with iliotibial band were effective in improving the outcomes of revision ACL reconstruction. Further high-level studies could help to clarify which subgroup of patients could particularly benefit from an anterolateral procedure in the context of ACL revision.

Hot-pack therapy increased gliding function of the iliotibial band during passive knee motion: An exploratory study

IntroductionQuantifying soft tissue dynamics during joint motion is important for the valid assessment and development of effective therapeutic interventions for the soft tissues. This study aimed to examine the immediate effect of thermotherapy on gliding of the iliotibial band (ITB), including the subcutaneous tissue, and vastus lateralis (VL) muscle during passive knee joint motion. MethodsTen participants (age, 20.4 ± 0.7 years; height, 172.0 ± 8.9 cm; weight, 64.1 ± 9.7 kg; BMI, 21.6 ± 1.7 kg/m2) with no history of lower extremity surgery or neuromuscular disease participated in the study. An electrothermal hot pack with an internal temperature of 65 °C was applied to one of the lateral thighs, followed by measuring its stiffness using a durometer. Movements of both the ITB and VL were recorded using ultrasound imaging during isokinetic knee motion. The Farneback method and optical flow algorithm analysis software were adapted to create the movement velocity from ultrasound imaging. Gliding coefficient was calculated using the coefficient of correlation for each velocity in the proximal-distal direction during knee motion. The mean velocity during knee motion was calculated using absolute values. The differences between the pre-intervention values and between the pre- and post-intervention values were examined. ResultsAfter applying the hot pack, the stiffness significantly decreased (p = 0.01), and the mean velocity of the ITB significantly increased (p = 0.03). The gliding coefficient and VL mean velocity did not significant differ (p = 0.65 and p = 0.80, respectively) between pre- and post-hot-pack applications. ConclusionsHot-pack therapy might increase gliding function of the ITB during passive knee motion.

Traumatic instability in the knee joint due to an anterior cruciate ligament (ACL) injury in a 23-year-old athlete

Introduction&#x0D; In this paper, we aim to present an analysis of the diagnostic, therapeutic, and rehabilitation procedures in a 23-year-old athlete with an anterior cruciate ligament (ACL) injury. The study includes the patient's medical history, circumstances of the injury, diagnostic and therapeutic procedures applied, as well as the course of postoperative rehabilitation.&#x0D; Objective&#x0D; The objective of our study is to present the anatomy of the ACL, the typical mechanism of injury, and diagnostic and therapeutic possibilities.&#x0D; Methods&#x0D; This is a retrospective study. The medical documentation and imaging studies were subjected to analysis. The analysis was complemented by a literature review based on publications in the English-language PubMed database.&#x0D; Results&#x0D; The case involves a 23-year-old soccer player with an isolated ACL injury in the right knee joint. The case analysis highlights the challenges related to diagnosis and decision-making regarding therapeutic procedures. ACL reconstruction using the STG method and lateral tenodesis with the iliotibial band in combination with postoperative rehabilitation resulted in a positive outcome in terms of knee joint stability and return to sports.&#x0D; Conclusions&#x0D; The review of this medical case underscores the importance of a personalized approach to each patient with an ACL injury, taking into account age, level of physical activity, and coexisting injuries within the knee joint. This allows for the correct decision on the best treatment method for the patient, facilitating a return to sports and minimizing the risk of complications.

Three-dimensional Volumetric Visceral and Subcutaneous Fat Analysis on Opportunistic Computed Tomography Imaging of Patients With Greater Trochanteric Pain Syndrome Compared With Those With Predominant Osteoarthritis: A Case-Control Study.

This study aimed to address the gap in knowledge assessing the impact of visceral and subcutaneous body fat on 3-dimensional computed tomography imaging in patients with greater trochanteric pain syndrome (GTPS) in comparison with those primarily diagnosed with osteoarthritis (OA). We evaluated adult patients with a confirmed diagnosis of GTPS from our institutional hip-preservation clinic spanning 2011 to 2022. Selection criteria included their initial clinic visit for hip pain and a concurrent pelvis computed tomography scan. These patients were age- and sex-matched to mild-moderate OA patients selected randomly from the database. Visceral and subcutaneous fat areas were measured volumetrically from the sacroiliac joint to the lesser trochanter using an independent software. Interreader reliability was also calculated. A total of 93 patients met the study criteria, of which 37 belonged to the GTPS group and 56 belonged to the OA group. Both groups were sex and race matched. Average age in GTPS and OA groups was 59.3 years and 56 years, respectively. For GTPS group, average body mass index was 28.9 kg/m 2 , and for the OA group, average body mass index was 29.9 kg/m 2 , with no significant difference ( P > 0.05). Two-sample t test showed no significant differences in the visceral fat, subcutaneous fat, or the visceral fat to total fat volume ratio between the GTPS and OA groups. There was excellent interreader reliability. Our results indicate that there is no significant difference in fat distribution and volumes among GTPS and OA patients. This suggests that being overweight or obese may not be directly linked or contribute to the onset of GTPS. Other factors, such as gluteal tendinopathy, bursitis, or iliotibial band syndrome, might be responsible and need further investigation.

Lateral Extra-Articular Tenodesis with Indirect Femoral Fixation Using an Anterior Cruciate Ligament Reconstruction Suspensory Device.

The lateral extra-articular tenodesis (LET) procedure associated with anterior cruciate ligament (ACL) reconstruction can be considered in selected patients to diminish the risk of persistent rotatory instability and achieve a protective effect on the graft. Several techniques have been described in the literature to treat rotatory instability. Usually, a strip of the iliotibial band (ITB) is harvested from its middle while leaving the distal insertion, then passed underneath the lateral collateral ligament and fixed on the lateral aspect of the distal femur with various fixation methods such as staples, screws, anchors or extracortical suspensory devices. Despite their effectiveness, these fixation methods may be associated with complications such as lateral pain, over-constraint and tunnel convergence. This study presents a detailed surgical description of a new technique to perform an LET during ACL reconstruction with any type of graft fixing the ITB strip with the sutures of the ACL femoral button, comparing its pros and cons in relation to similar techniques found in the literature. This technique represents a reproducible, easy to learn and inexpensive solution to perform a lateral extra-articular tenodesis associated with an ACL reconstruction using the high-resistance sutures of the femoral button.

COMPARISON OF PATELLAR MOBILIZATION AND TAPING IN PATIENT WITH PATELLOFEMORAL PAIN SYNDROME

Background of the Study: To compare patellar taping and mobilization plus conventional therapy for reducing knee pain in patients with patellofemoral pain syndrome (PFPS). Methodology: Controlled trial with 50 participants divided into two groups who received different treatments for 6 weeks: Group A had patellar taping and iliotibial band stretching, while Group B had patellar mobilization and quadriceps strengthening. Participants received three treatment sessions weekly for six weeks. The VAS was used to conduct pre and post-test pain evaluations for groups A and B. Results: Knee pain decreased in PFPS patients receiving patellar taping (Group A) or mobilization (Group B) using VAS (p&lt;0.05). All treatments are effective for PFPS. The VAS scores after 6 weeks of post A and post B treatments assessed. After 6 weeks of taping, mean = 0.76±0.83. After 6 weeks, mean and SD = 1.20±1.12 from patellar mobilization. No significant difference between means (p = 0.12, α ≤ 0.05). Insignificance. Conclusion: The result of the study indicated that after 6 weeks of treatment for both patellar taping and patellar mobilization were effective in decreasing pain in PFPS. Keywords: Syndrome, mobilization, taping, visual analogue scale, pain, rehabilitation.

Development and Content Validation of Iliotibial Band Friction Syndrome Index (IBFS-I)

Introduction: Activity-related lateral knee discomfort is a common symptom of Iliotibial Band Friction Syndrome (ITBFS), a condition characterised by excessive friction between the iliotibial band and the lateral femoral condyle. Literature indicates that ITBFS is highly prevalent in road cyclists, military recruits, and habitual runners respectively. But there is scarcity of readily usable tool to identify the extent of ITBS. This study was designed to develop and validate the content of a scale for ITBFS diagnosis. Aim: To develop and content validate of the developed tool which will help the physiotherapist to asses easier and earlier. Materials and Methods: This study involves expert opinions from seven different physiotherapy experts in an offline mode. Study was done in 3 phases: Phase 1: The extensive literature exploration Phase 2: Development of questionnaire Phase 3: Content validation of the developed questionnaire. The Delphi method was used to validate the content, which involves expert review panel, examining the domain and its items, assigning a score to each item, and computing the scale level content validity index (S-CVI) and item content validity index (I-CVI). It was performed using Delphi method which includes seeking expert opinion from 7 different expert from the field of physiotherapy on an offline mode, selecting expert review panel, reviewing domain and items, providing score to each item and calculating I-CVI (item content validity index) and scale level content validity index (S-CVI). Results: I-CVI was calculated using (I-CVI= agreed item/number of expert) and found to be 0.98 and S-CVI using (S-CVI=sum of I-CVI scores/Number of items) and found to be 0.9. This developed questionnaire is having excellent I-CVI and S-CVI. The physiotherapists may use the IBFS-I scale for the early identification of ITBFS. Conclusion: The IBFS-I scale may help physiotherapists diagnose ITBFS early. This scale may prove to be an effective tool in assisting the therapist in determining the degree of ITBFS in individuals

The Effects of Different Myofascial Release Techniques on Pain, Range of Motion, and Muscle Strength in Athletes With Iliotibial Band Tightness: A Randomized Controlled Study.

We designed this study to investigate the effects of 2 myofascial release techniques, Instrument-Assisted Soft Tissue Mobilization (IASTM) and Foam Roller (FR), on pain, joint range of motion, and muscle strength in athletes suffering from iliotibial band (ITB) tightness. A total of 39 male soccer players were enrolled in this randomized controlled trial, aged between 18 and 23years who were divided into 3 groups: Only Exercise, IASTM, and FR. All participants performed daily strengthening and stretching exercises, while 1 group added IASTM, and the other added FR to the exercise program. We evaluated ITB tightness with the Ober test and an inclinometer, pressure pain threshold, using an algometer, and we evaluated muscle strength with the Cybex Norm Isokinetic device. We found that all 3 groups exhibited an increase in the Ober inclination angle after the interventions (P = .001), but the increase was greater for participants in the IASTM and FR groups, compared with exercise alone. Additionally, both the IASTM and FR groups displayed an increased pressure pain threshold (P = .001), whereas there was no change in the control group. Moreover, while all 3 groups experienced an increase in hip muscle strength (P = .001), the IASTM and FR groups exhibited a greater increase compared with exercise alone (P = .001). Based on these findings, exercise improves pain, range of motion, and muscle strength in athletes with ITB tightness, and IASTM, and FR techniques enhanced exercise effects but did not differ from one another. While our study demonstrated that both IASTM and FR techniques significantly enhance the benefits of exercise for athletes with ITB tightness, further research could delve into the long-term effects of these interventions.