The functional anatomy of the iliotibial band during flexion and extension of the knee: Implications for understanding iliotibial band syndrome

John Fairclough, Koji Hayashi, Hechmi Toumi, Kathleen Lyons, Graeme Bydder, Nicola Phillips, Thomas Best, Mike Benjamin

Research output: Contribution to journalArticle

109 Citations (Scopus)

Abstract

Iliotibial band (ITB) syndrome is a common overuse injury in runners and cyclists. It is regarded as a friction syndrome where the ITB rubs against (and 'rolls over') the lateral femoral epicondyle. Here, we re-evaluate the clinical anatomy of the region to challenge the view that the ITB moves antero-posteriorly over the epicondyle. Gross anatomical and microscopical studies were conducted on the distal portion of the ITB in 15 cadavers. This was complemented by magnetic resonance (MR) imaging of six asymptomatic volunteers and studies of two athletes with acute ITB syndrome. In all cadavers, the ITB was anchored to the distal femur by fibrous strands, associated with a layer of richly innervated and vascularized fat. In no cadaver, volunteer or patient was a bursa seen. The MR scans showed that the ITB was compressed against the epicondyle at 30° of knee flexion as a consequence of tibial internal rotation, but moved laterally in extension. MR signal changes in the patients with ITB syndrome were present in the region occupied by fat, deep to the ITB. The ITB is prevented from rolling over the epicondyle by its femoral anchorage and because it is a part of the fascia lata. We suggest that it creates the illusion of movement, because of changing tension in its anterior and posterior fibres during knee flexion. Thus, on anatomical grounds, ITB overuse injuries may be more likely to be associated with fat compression beneath the tract, rather than with repetitive friction as the knee flexes and extends.

Original languageEnglish (US)
Pages (from-to)309-316
Number of pages8
JournalJournal of Anatomy
Volume208
Issue number3
DOIs
StatePublished - Mar 1 2006
Externally publishedYes

Fingerprint

Iliotibial Band Syndrome
knees
anatomy
fat
Knee
Anatomy
Cadaver
thighs
Cumulative Trauma Disorders
friction
volunteers
Friction
Fats
lipids
Thigh
fascia
Volunteers
Magnetic Resonance Spectroscopy
athletes
Fascia Lata

Keywords

  • Bursa
  • Enthesis
  • Enthesopathy
  • Fat
  • Iliotibial tract

ASJC Scopus subject areas

  • Anatomy
  • Histology
  • Ecology, Evolution, Behavior and Systematics
  • Molecular Biology
  • Developmental Biology
  • Cell Biology

Cite this

The functional anatomy of the iliotibial band during flexion and extension of the knee : Implications for understanding iliotibial band syndrome. / Fairclough, John; Hayashi, Koji; Toumi, Hechmi; Lyons, Kathleen; Bydder, Graeme; Phillips, Nicola; Best, Thomas; Benjamin, Mike.

In: Journal of Anatomy, Vol. 208, No. 3, 01.03.2006, p. 309-316.

Research output: Contribution to journalArticle

Fairclough, John ; Hayashi, Koji ; Toumi, Hechmi ; Lyons, Kathleen ; Bydder, Graeme ; Phillips, Nicola ; Best, Thomas ; Benjamin, Mike. / The functional anatomy of the iliotibial band during flexion and extension of the knee : Implications for understanding iliotibial band syndrome. In: Journal of Anatomy. 2006 ; Vol. 208, No. 3. pp. 309-316.
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