Iliotibial Band Syndrome- Around the Knee

Iliotibial band syndrome is the inflammation and thickening of the iliotibial band, which results from excessive friction as the iliotibial band slides over the lateral femoral condyle. The iliotibial band is a thick band of fascia that extends along the lateral thigh from the iliac crest to the knee. It inserts into the Gerdy’s tubercle of the tibia (Figure 1).

The iliotibial band is a continuation of the Tensor Fasciae Latae muscle. The Tensor Fasciae Latae muscle arises from the outer surface of the anterior iliac crest, between the tubercle of the iliac spine and inserts into the iliotibial tract (Figure 2). The gluteus maximus also inserts into the iliotibial band.

The IT band extends, abducts, and laterally rotates the hip. It also contributes to lateral knee stabilization. The IT band is repeatedly shifted forward and backwards across the lateral femoral condyle. Impingement usually occurs around 30° of knee flexion. There may be swelling, tenderness, and crepitus over the lateral femoral condyle.

The condition of ITBS around the knee most commonly occurs in runners, cyclists, and other athletes undergoing exercise with repetitive knee flexion and extension. The IT band inserts into Gerdy’s tubercle. The pain is proximal to the Gerdy’s tubercle. The pain may be reproduced by doing a single-leg squat.

Predisposing factors include:

· Foot and knee malalignment (foot pronation & varus knee)

· Prominent lateral condyle

· Tight IT band

· Leg length discrepancy

· Weak abductors of the hip

· Poor shoe wear

· Training errors

Two tests are helpful in diagnosing Iliotibial Band Syndrome of the Knee. The Ober’s test (Figure 3) is a clinical examination test used to access tightness of the iliotibial band. The patient should lay on their side with the affected leg up. The examiner will slowly abduct the leg with the knee in flexion and the hip in full extension. When the IT band is tight, adduction of the leg will be limited as the leg will not touch the other knee and the test is considered positive.

The Noble Test (Figure 4) is performed by the examiner placing the knee into flexion and putting the thumb over the iliotibial band prior to its insertion into the Gerdy’s tubercle of the lateral tibia. With pressure placed onto the IT band, then extend the leg. If pain is felt at the lateral femoral condyle with extension of the leg, then this is a positive Noble test.

X-rays may not be helpful. An MRI may show edema in the area of the ITB.

Nonoperative treatment typically consists of rest, ice, and physical therapy—which is very important. Stretching, proprioception, and improvement in neuromuscular coordination. Training modification, better shoe wear, and possible injections are some additional treatment options. A majority of patients will get better in about 4-8 weeks using conservative treatments. Surgery is the last resort. Typically, it involves excision of the scarred, inflamed part of the iliotibial band or an excision of a cyst or bursa is performed. A Z-plasty is rarely done.

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