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Iliotibial band friction syndrome: An original technique of digastric release of the iliotibial band from Gerdy's tubercle
G Model
ARTICLE IN PRESS
OTSR-2134; No. of Pages 5
Orthopaedics & Traumatology: Surgery & Research xxx (2018) xxx–xxx
Contents lists available at ScienceDirect
Orthopaedics & Traumatology: Surgery & Research journal homepage: www.elsevier.com
Technical note
Iliotibial band friction syndrome: An original technique of digastric release of the iliotibial band from Gerdy’s tubercle Paul Walbron ∗ , Adrien Jacquot , Jean-Marc Geoffroy , Franc¸ois Sirveaux , Daniel Molé Centre chirurgical Emile-Gallé, 49, rue Hermite, 54000 Nancy, France
a r t i c l e
i n f o
Article history: Received 10 May 2018 Accepted 23 August 2018 Available online xxx Keywords: Iliotibial band friction syndrome Gerdy’s tubercle
a b s t r a c t The various surgical techniques to treat iliotibial band friction syndrome consist in releasing the iliotibial band by means of plasties that partially interrupt its continuity or by release of the deep aspect. We describe an original technique of digastric distal iliotibial band release from Gerdy’s tubercle. Via a 2 cm approach above Gerdy’s tubercle, the iliotibial band is incised longitudinally and partially released from the tubercle. Fourteen knees underwent the procedure. With a mean 27 ± 20.6 months’ follow-up (range, 12–69 months), return to sport at previous level was possible at a mean 4 ± 2.18 months (range, 1–8 months). Eight patients were very satisfied, 3 satisfied and 2 (15%) dissatisfied. Respect of continuity is a key-point in this technique to control internal rotation of the knee. © 2018 Elsevier Masson SAS. All rights reserved.
1. Introduction Iliotibial band friction syndrome is a sports pathology inducing recurrent lateral pain, first described by Renne [1] in young military recruits. Most patients are relieved by non-operative treatment [2], with surgery reserved for resistant cases. Two theories are proposed to account for symptomatology. According to Renne and Noble, iliotibial band friction against the lateral epicondyle eminence in passing from extension to flexion causes mechanical pain [1,3]. Later, cadaver studies by Nemeth and Sanders demonstrated invagination of the lateral joint capsule [4], to which the iliotibial band has fibrous attachments [5] previously described by Kaplan. This account of inflammatory enthesopathy gave rise to new surgical, and notably arthroscopic techniques. Many studies have shown the involvement of the anterolateral ligament (ALL) in rotational stability of the knee [6–8], but involvement of the iliotibial band and its deep attachments remains to be clarified. To the best of our knowledge, no open surgical techniques have been described concerning the most distal part of the band.
along the iliotibial band axis, above the tubercle. The underlying aponeurosis is incised along the axis, revealing the distal end of the band. A medial incision by electrocautery separates the band into 2 longitudinal parts, without releasing the tubercle insertion (Fig. 1). Anteroposterior dissection by electrocautery releases the deep aspect of the band against the tubercle (Fig. 2), respecting the continuity of the band and its prolongation in the tibial aponeurosis. Release should be checked intraoperatively in comparison with the situation at the beginning of the procedure, by direct palpation of the fascia lata above the lateral epicondyle. The band is released from its deep femoral attachments, using Mayo scissors. The tourniquet is released, hemostasis is performed, and the two edges of the superficial aponeurosis are approximated, without drainage. Compressive dressing is applied for 24 hours. Immediate full weight-bearing is authorized, with forearm crutches. One week’s antithrombotic prophylaxis is recommended. At 2 weeks, the patient is encouraged to resume cycling and line swimming, then running at 6 weeks. 2.1. Study series
2. Surgical technique The patient is positioned supine, with a tourniquet at the root of the limb, in full extension. Gerdy’s tubercle is located by direct palpation. The surgical approach is created by a 2 cm incision
∗ Corresponding author. E-mail address: [email protected] (P. Walbron).
14 knees, with a mean age of 36 ± 11 years (range, 19–51 years) were operated on. The satisfaction rate was 85.7% at a mean 21 ± 17 months’ follow-up (range, 5–61 months). Return to sport at preoperative level was possible at a mean 4 ± 2 months (range, 1–8 months). Mean postoperative Tegner score was 6 ± 2 (range, 4–9) and mean Lysholm score 93 ± 7 (range, 80–100). There were 2 deep venous thromboses, in patients without systematic thromboprophylaxis.
https://doi.org/10.1016/j.otsr.2018.08.013 1877-0568/© 2018 Elsevier Masson SAS. All rights reserved.
Please cite this article in press as: Walbron P, et al. Iliotibial band friction syndrome: An original technique of digastric release of the iliotibial band from Gerdy’s tubercle. Orthop Traumatol Surg Res (2018), https://doi.org/10.1016/j.otsr.2018.08.013
G Model OTSR-2134; No. of Pages 5 2
ARTICLE IN PRESS P. Walbron et al. / Orthopaedics & Traumatology: Surgery & Research xxx (2018) xxx–xxx
Fig. 1. Anterior view of digastric iliotibial band release; right knee. Medial incision shown by Farabeuf distractors.
Fig. 2. Surgical steps of digastric release from Gerdy’s tubercle; left knee. A. 2 cm skin incision perpendicular to Gerdy’s tubercle, in the iliotibial band axis. B. Longitudinal medial incision of superficial aponeurosis and band. C. Posterior half of band. D. Posterior half release and mobilization. E. Anterior half release and mobilization. F. Closure of superficial aponeurosis by 3 loose sutures.
Please cite this article in press as: Walbron P, et al. Iliotibial band friction syndrome: An original technique of digastric release of the iliotibial band from Gerdy’s tubercle. Orthop Traumatol Surg Res (2018), https://doi.org/10.1016/j.otsr.2018.08.013
G Model OTSR-2134; No. of Pages 5
ARTICLE IN PRESS P. Walbron et al. / Orthopaedics & Traumatology: Surgery & Research xxx (2018) xxx–xxx
3
Fig. 3. The various reported surgical techniques to treat iliotibial band friction syndrome, with authors.
3. Discussion The first reported techniques (Fig. 3) consisted in resection of a posterior triangle in the band adjacent to the lateral epicondyle, described by Noble [3], and later by Martens et al. [9], or transverse sectioning of the posterior half, described by Drogset et al. [10]. Holmes et al. [11] described resection of an ellipse adjacent to the lateral epicondyle. Sangkaew [12] reported a single case with band lengthening by multiple puncture of the distal part, validated by prior cadaver study [13]. Another lengthening technique, by Z-plasty, was described by Barber et al. [14]. Techniques interrupting direct fascia lata continuity incur a theoretic risk for knee stability, especially in internal rotation. The present technique conserves band continuity. The proximal transverse and distal oblique Kaplan fibers are accessible via the approach over Gerdy’s tubercle, using dissection scissors. Godin et al. [7] confirmed their role in controlling internal rotation, especially in case of isolated anterior cruciate ligament (ACL) tear. According to Lutz et al., however, control of internal rotation is multifactorial: sectioning the ALL, iliotibial band or ACL each increases internal rotation separately, and potentially synergically. In the literature, a causal relation between Kaplan fiber sectioning and risk of ACL tear has yet to be demonstrated.
Isolated resection of the underlying bursa from the band was reported by Hariri et al. [15], with 81% satisfaction, but a bursa is not always observed [3,9,10,16,17]: according to Muhle et al. [18], the correlation between tissue inflammation beneath the band and a presence of a primary bursa is unclear. Fairclough et al. [16] even suggested possible confusion between the lateral synovial recess and the bursa, and implicated inflammation rather than a mechanical effect, with imbalance between tensor fasciae latae and iliotibial band, as described by Falvey et al. [17]. Technical progress enables arthroscopy to be included, either for initial exploration [15,19], or for the main procedure [20–22] by lateral synovial recess release (Table 1). However, this may induce postoperative hematoma [22], as the superolateral geniculate artery runs just proximally to the synovial recess [7], making 24 hours’ Redon drainage mandatory; the risk is especially great if resection is considered sufficient once the shaver comes in direct contact with the bony part of the epicondyle. Hematoma risk is also associated with other techniques in which iliotibial band plasty is adjacent to the superolateral geniculate artery [9,11]. In the present technique, digastric incision above Gerdy’s tubercle avoids this risk of hematoma. The present technique incurred no more complications than others previously described.
Please cite this article in press as: Walbron P, et al. Iliotibial band friction syndrome: An original technique of digastric release of the iliotibial band from Gerdy’s tubercle. Orthop Traumatol Surg Res (2018), https://doi.org/10.1016/j.otsr.2018.08.013
Postoperative Lysholm
Postoperative IKDC postoperative
Mean FU, (months)
Return to sport
Excellent and good results
Complications
9
Case series
/
/
/
(2–16)
89%
“All satisfied”
Recurrent pain (1)
1989
19
Case series
/
/
/
45 (24–132)
100% (same level) mean 7 weeks
84.50%
Hematoma with surgical revision (1)
Drogset
1999
45
Case series
Resection of posterior-base band triangle Resection of posterior-base band triangle Posterior demi-sectioning with or without bursectomy
/
/
/
25
?
25%
Residual surgery site pain (20); quadriceps amyotrophy (2); effusion (1)
Holmes
1993
4 21
Case series
Percutaneous release Ellipse resection
/
/
/
(6–24)
25% 81% (same level) 6–8 weeks
71% /
Cadaver study Technical note
Multiple puncture cadaver study Arthroscopic exploration + Z-plasty lengthening Multiple puncture adjacent to epicondyle Z-plasty lengthening
/
/
/
/
/
/
Hematoma (2); serous effusion (9); surgical revision of ellipse (1) /
/
/
/
/
/
/
None
/
/
/
75.6
?
None
4,4 (2–7)
2.6
38
81%
None
5 (3–8)
88.6 (57–100) /
88 (66–100)
28 (6–/)
Same level (2 yrs’ FU) 100% (same level) (6 yrs’ FU) ?
87.10%
None
/
/
/
1
100% running (3 months’ FU)
?
Hematoma with surgical revision (1)
/
/
/
21 (5–61)
(Same level) in 4 weeks
85.70%
None
6 (4–9)
93 (80–100)
/
Noble
1979
Martens
Zenz
2002
14
Richards
2003
1
Sangkaew
2006
1
Barber
2007
8
Technical note Case series
Hariri
2009
11
Case series
Michels
2009
35
Case series
Cowden
2014
1
Case report
Walbron
2018
14
Technical note
Arthroscopic exploration + open bursectomy Arthroscopic lateral synovial recess resection Arthroscopic Kaplan fiber and lateral synovial recess resection Release from Gerdy’s tubercle
(Same level) 4 months (1–8)
2 cases of phlebitis (no preventive heparin)
ARTICLE IN PRESS
Postoperative Tegner
Number of cases
G Model
Surgical technique
Date
P. Walbron et al. / Orthopaedics & Traumatology: Surgery & Research xxx (2018) xxx–xxx
Type of study
Author
OTSR-2134; No. of Pages 5
4
Please cite this article in press as: Walbron P, et al. Iliotibial band friction syndrome: An original technique of digastric release of the iliotibial band from Gerdy’s tubercle. Orthop Traumatol Surg Res (2018), https://doi.org/10.1016/j.otsr.2018.08.013
Table 1 Published techniques, results and complications.
G Model
ARTICLE IN PRESS
OTSR-2134; No. of Pages 5
P. Walbron et al. / Orthopaedics & Traumatology: Surgery & Research xxx (2018) xxx–xxx
4. Conclusion The present technique of digastric resection provided good clinical results, enabling both release of Kaplan fibers and relaxation of the iliotibial band, with low bleeding risk thanks to the distal approach to the band. Disclosure of interest A. Jacquot, F. Sirveaux and D. Molé are consultants for Tornier Wright Medical. A. Jacquot is a consultant for Smith & Nephew. F. Sirveaux and D. Molé receive royalties from Tornier Wright Medical. The other authors declare that they have no competing interest. Funding No funding was received by the authors for the study. Contribution P. Walbron: first author/illustrator. A. Jacquot: article review. J.-M. Geoffroy: article review. F. Sirveaux: article review. D. Molé: article review/senior surgeon. References [1] Renne JW. The iliotibial band friction syndrome. J Bone Joint Surg Am 1975;57:1110–1. [2] Baker RL, Fredericson M. Iliotibial band syndrome in runners: biomechanical implications and exercise interventions. Phys Med Rehabil Clin N Am 2016;27:53–77. [3] Noble CA. The treatment of iliotibial band friction syndrome. Br J Sports Med 1979;13:51–4.
5
[4] Nemeth WC, Sanders BL. The lateral synovial recess of the knee: anatomy and role in chronic Iliotibial band friction syndrome. Arthrosc J Arthrosc Relat Surg 1996;12:574–80. [5] Kaplan EB. The iliotibial tract: clinical and morphological significance. J Bone Joint Surg Am 1958;40:817–32. [6] Lutz C, Sonnery-Cottet B, Niglis L, et al. Behavior of the anterolateral structures of the knee during internal rotation. Orthop Traumatol Surg Res 2015;101:523–8. [7] Godin JA, Chahla J, Moatshe G, et al. A comprehensive reanalysis of the distal iliotibial band: quantitative anatomy, radiographic markers, and biomechanical properties. Am J Sports Med 2017;45:2595–603. [8] Chahla J, Geeslin AG, Cinque ME, et al. Biomechanical proof for the existence of the anterolateral ligament. Clin Sports Med 2018;37:33–40. [9] Martens M, Libbrecht P, Burssens A. Surgical treatment of the iliotibial band friction syndrome. Am J Sports Med 1989;17:651–4. [10] Drogset JO, Rossvoll I, Grøntvedt T. Surgical treatment of iliotibial band friction syndrome. A retrospective study of 45 patients. Scand J Med Sci Sports 1999;9:296–8. [11] Holmes JC, Pruitt AL, Whalen NJ. Iliotibial band syndrome in cyclists. Am J Sports Med 1993;21:419–24. [12] Sangkaew C. Surgical treatment of iliotibial band friction syndrome with the mesh technique. Arch Orthop Trauma Surg 2007;127:303–6. [13] Zenz P, Huber M, Obenaus CH, et al. Lengthening of the iliotibial band by femoral detachment and multiple puncture. A cadaver study. Arch Orthop Trauma Surg 2002;122:429–31. [14] Barber FA, Boothby MH, Troop RL. Z-plasty lengthening for iliotibial band friction syndrome. J Knee Surg 2007;20:281–4. [15] Hariri S, Savidge ET, Reinold MM, et al. Treatment of recalcitrant iliotibial band friction syndrome with open iliotibial band bursectomy indications, technique, and clinical outcomes. Am J Sports Med 2009;37:1417–24. [16] Fairclough J, Hayashi K, Toumi H, et al. Is iliotibial band syndrome really a friction syndrome? J Sci Med Sport 2007;10:74–6. [17] Falvey EC, Clark RA, Franklyn-Miller A, et al. Iliotibial band syndrome: an examination of the evidence behind a number of treatment options. Scand J Med Sci Sports 2010;20:580–7. [18] Muhle C, Ahn JM, Yeh L, et al. Iliotibial band friction syndrome: MR imaging findings in 16 patients and MR arthrographic study of six cadaveric knees. Radiology 1999;212:103–10. [19] Richards DP, Alan Barber F, Troop RL. Iliotibial band Z-lengthening. Arthrosc J Arthrosc Relat Surg 2003;19:326–9. [20] Fayard J-M, Carnesecchi O, Sonnery-Cottet B, et al. Pathologies tendineuses autour du genou. In: L’arthroscopie. Elsevier Masson; 2015. p. 1181–3. [21] Cowden CH, Barber FA. Arthroscopic treatment of iliotibial band syndrome. Arthrosc Tech 2014;3:e57–60. [22] Michels F, Jambou S, Allard M, et al. An arthroscopic technique to treat the iliotibial band syndrome. Knee Surg Sports Traumatol Arthrosc 2009;17:233–6.
Please cite this article in press as: Walbron P, et al. Iliotibial band friction syndrome: An original technique of digastric release of the iliotibial band from Gerdy’s tubercle. Orthop Traumatol Surg Res (2018), https://doi.org/10.1016/j.otsr.2018.08.013
ARTICLE IN PRESS
OTSR-2134; No. of Pages 5
Orthopaedics & Traumatology: Surgery & Research xxx (2018) xxx–xxx
Contents lists available at ScienceDirect
Orthopaedics & Traumatology: Surgery & Research journal homepage: www.elsevier.com
Technical note
Iliotibial band friction syndrome: An original technique of digastric release of the iliotibial band from Gerdy’s tubercle Paul Walbron ∗ , Adrien Jacquot , Jean-Marc Geoffroy , Franc¸ois Sirveaux , Daniel Molé Centre chirurgical Emile-Gallé, 49, rue Hermite, 54000 Nancy, France
a r t i c l e
i n f o
Article history: Received 10 May 2018 Accepted 23 August 2018 Available online xxx Keywords: Iliotibial band friction syndrome Gerdy’s tubercle
a b s t r a c t The various surgical techniques to treat iliotibial band friction syndrome consist in releasing the iliotibial band by means of plasties that partially interrupt its continuity or by release of the deep aspect. We describe an original technique of digastric distal iliotibial band release from Gerdy’s tubercle. Via a 2 cm approach above Gerdy’s tubercle, the iliotibial band is incised longitudinally and partially released from the tubercle. Fourteen knees underwent the procedure. With a mean 27 ± 20.6 months’ follow-up (range, 12–69 months), return to sport at previous level was possible at a mean 4 ± 2.18 months (range, 1–8 months). Eight patients were very satisfied, 3 satisfied and 2 (15%) dissatisfied. Respect of continuity is a key-point in this technique to control internal rotation of the knee. © 2018 Elsevier Masson SAS. All rights reserved.
1. Introduction Iliotibial band friction syndrome is a sports pathology inducing recurrent lateral pain, first described by Renne [1] in young military recruits. Most patients are relieved by non-operative treatment [2], with surgery reserved for resistant cases. Two theories are proposed to account for symptomatology. According to Renne and Noble, iliotibial band friction against the lateral epicondyle eminence in passing from extension to flexion causes mechanical pain [1,3]. Later, cadaver studies by Nemeth and Sanders demonstrated invagination of the lateral joint capsule [4], to which the iliotibial band has fibrous attachments [5] previously described by Kaplan. This account of inflammatory enthesopathy gave rise to new surgical, and notably arthroscopic techniques. Many studies have shown the involvement of the anterolateral ligament (ALL) in rotational stability of the knee [6–8], but involvement of the iliotibial band and its deep attachments remains to be clarified. To the best of our knowledge, no open surgical techniques have been described concerning the most distal part of the band.
along the iliotibial band axis, above the tubercle. The underlying aponeurosis is incised along the axis, revealing the distal end of the band. A medial incision by electrocautery separates the band into 2 longitudinal parts, without releasing the tubercle insertion (Fig. 1). Anteroposterior dissection by electrocautery releases the deep aspect of the band against the tubercle (Fig. 2), respecting the continuity of the band and its prolongation in the tibial aponeurosis. Release should be checked intraoperatively in comparison with the situation at the beginning of the procedure, by direct palpation of the fascia lata above the lateral epicondyle. The band is released from its deep femoral attachments, using Mayo scissors. The tourniquet is released, hemostasis is performed, and the two edges of the superficial aponeurosis are approximated, without drainage. Compressive dressing is applied for 24 hours. Immediate full weight-bearing is authorized, with forearm crutches. One week’s antithrombotic prophylaxis is recommended. At 2 weeks, the patient is encouraged to resume cycling and line swimming, then running at 6 weeks. 2.1. Study series
2. Surgical technique The patient is positioned supine, with a tourniquet at the root of the limb, in full extension. Gerdy’s tubercle is located by direct palpation. The surgical approach is created by a 2 cm incision
∗ Corresponding author. E-mail address: [email protected] (P. Walbron).
14 knees, with a mean age of 36 ± 11 years (range, 19–51 years) were operated on. The satisfaction rate was 85.7% at a mean 21 ± 17 months’ follow-up (range, 5–61 months). Return to sport at preoperative level was possible at a mean 4 ± 2 months (range, 1–8 months). Mean postoperative Tegner score was 6 ± 2 (range, 4–9) and mean Lysholm score 93 ± 7 (range, 80–100). There were 2 deep venous thromboses, in patients without systematic thromboprophylaxis.
https://doi.org/10.1016/j.otsr.2018.08.013 1877-0568/© 2018 Elsevier Masson SAS. All rights reserved.
Please cite this article in press as: Walbron P, et al. Iliotibial band friction syndrome: An original technique of digastric release of the iliotibial band from Gerdy’s tubercle. Orthop Traumatol Surg Res (2018), https://doi.org/10.1016/j.otsr.2018.08.013
G Model OTSR-2134; No. of Pages 5 2
ARTICLE IN PRESS P. Walbron et al. / Orthopaedics & Traumatology: Surgery & Research xxx (2018) xxx–xxx
Fig. 1. Anterior view of digastric iliotibial band release; right knee. Medial incision shown by Farabeuf distractors.
Fig. 2. Surgical steps of digastric release from Gerdy’s tubercle; left knee. A. 2 cm skin incision perpendicular to Gerdy’s tubercle, in the iliotibial band axis. B. Longitudinal medial incision of superficial aponeurosis and band. C. Posterior half of band. D. Posterior half release and mobilization. E. Anterior half release and mobilization. F. Closure of superficial aponeurosis by 3 loose sutures.
Please cite this article in press as: Walbron P, et al. Iliotibial band friction syndrome: An original technique of digastric release of the iliotibial band from Gerdy’s tubercle. Orthop Traumatol Surg Res (2018), https://doi.org/10.1016/j.otsr.2018.08.013
G Model OTSR-2134; No. of Pages 5
ARTICLE IN PRESS P. Walbron et al. / Orthopaedics & Traumatology: Surgery & Research xxx (2018) xxx–xxx
3
Fig. 3. The various reported surgical techniques to treat iliotibial band friction syndrome, with authors.
3. Discussion The first reported techniques (Fig. 3) consisted in resection of a posterior triangle in the band adjacent to the lateral epicondyle, described by Noble [3], and later by Martens et al. [9], or transverse sectioning of the posterior half, described by Drogset et al. [10]. Holmes et al. [11] described resection of an ellipse adjacent to the lateral epicondyle. Sangkaew [12] reported a single case with band lengthening by multiple puncture of the distal part, validated by prior cadaver study [13]. Another lengthening technique, by Z-plasty, was described by Barber et al. [14]. Techniques interrupting direct fascia lata continuity incur a theoretic risk for knee stability, especially in internal rotation. The present technique conserves band continuity. The proximal transverse and distal oblique Kaplan fibers are accessible via the approach over Gerdy’s tubercle, using dissection scissors. Godin et al. [7] confirmed their role in controlling internal rotation, especially in case of isolated anterior cruciate ligament (ACL) tear. According to Lutz et al., however, control of internal rotation is multifactorial: sectioning the ALL, iliotibial band or ACL each increases internal rotation separately, and potentially synergically. In the literature, a causal relation between Kaplan fiber sectioning and risk of ACL tear has yet to be demonstrated.
Isolated resection of the underlying bursa from the band was reported by Hariri et al. [15], with 81% satisfaction, but a bursa is not always observed [3,9,10,16,17]: according to Muhle et al. [18], the correlation between tissue inflammation beneath the band and a presence of a primary bursa is unclear. Fairclough et al. [16] even suggested possible confusion between the lateral synovial recess and the bursa, and implicated inflammation rather than a mechanical effect, with imbalance between tensor fasciae latae and iliotibial band, as described by Falvey et al. [17]. Technical progress enables arthroscopy to be included, either for initial exploration [15,19], or for the main procedure [20–22] by lateral synovial recess release (Table 1). However, this may induce postoperative hematoma [22], as the superolateral geniculate artery runs just proximally to the synovial recess [7], making 24 hours’ Redon drainage mandatory; the risk is especially great if resection is considered sufficient once the shaver comes in direct contact with the bony part of the epicondyle. Hematoma risk is also associated with other techniques in which iliotibial band plasty is adjacent to the superolateral geniculate artery [9,11]. In the present technique, digastric incision above Gerdy’s tubercle avoids this risk of hematoma. The present technique incurred no more complications than others previously described.
Please cite this article in press as: Walbron P, et al. Iliotibial band friction syndrome: An original technique of digastric release of the iliotibial band from Gerdy’s tubercle. Orthop Traumatol Surg Res (2018), https://doi.org/10.1016/j.otsr.2018.08.013
Postoperative Lysholm
Postoperative IKDC postoperative
Mean FU, (months)
Return to sport
Excellent and good results
Complications
9
Case series
/
/
/
(2–16)
89%
“All satisfied”
Recurrent pain (1)
1989
19
Case series
/
/
/
45 (24–132)
100% (same level) mean 7 weeks
84.50%
Hematoma with surgical revision (1)
Drogset
1999
45
Case series
Resection of posterior-base band triangle Resection of posterior-base band triangle Posterior demi-sectioning with or without bursectomy
/
/
/
25
?
25%
Residual surgery site pain (20); quadriceps amyotrophy (2); effusion (1)
Holmes
1993
4 21
Case series
Percutaneous release Ellipse resection
/
/
/
(6–24)
25% 81% (same level) 6–8 weeks
71% /
Cadaver study Technical note
Multiple puncture cadaver study Arthroscopic exploration + Z-plasty lengthening Multiple puncture adjacent to epicondyle Z-plasty lengthening
/
/
/
/
/
/
Hematoma (2); serous effusion (9); surgical revision of ellipse (1) /
/
/
/
/
/
/
None
/
/
/
75.6
?
None
4,4 (2–7)
2.6
38
81%
None
5 (3–8)
88.6 (57–100) /
88 (66–100)
28 (6–/)
Same level (2 yrs’ FU) 100% (same level) (6 yrs’ FU) ?
87.10%
None
/
/
/
1
100% running (3 months’ FU)
?
Hematoma with surgical revision (1)
/
/
/
21 (5–61)
(Same level) in 4 weeks
85.70%
None
6 (4–9)
93 (80–100)
/
Noble
1979
Martens
Zenz
2002
14
Richards
2003
1
Sangkaew
2006
1
Barber
2007
8
Technical note Case series
Hariri
2009
11
Case series
Michels
2009
35
Case series
Cowden
2014
1
Case report
Walbron
2018
14
Technical note
Arthroscopic exploration + open bursectomy Arthroscopic lateral synovial recess resection Arthroscopic Kaplan fiber and lateral synovial recess resection Release from Gerdy’s tubercle
(Same level) 4 months (1–8)
2 cases of phlebitis (no preventive heparin)
ARTICLE IN PRESS
Postoperative Tegner
Number of cases
G Model
Surgical technique
Date
P. Walbron et al. / Orthopaedics & Traumatology: Surgery & Research xxx (2018) xxx–xxx
Type of study
Author
OTSR-2134; No. of Pages 5
4
Please cite this article in press as: Walbron P, et al. Iliotibial band friction syndrome: An original technique of digastric release of the iliotibial band from Gerdy’s tubercle. Orthop Traumatol Surg Res (2018), https://doi.org/10.1016/j.otsr.2018.08.013
Table 1 Published techniques, results and complications.
G Model
ARTICLE IN PRESS
OTSR-2134; No. of Pages 5
P. Walbron et al. / Orthopaedics & Traumatology: Surgery & Research xxx (2018) xxx–xxx
4. Conclusion The present technique of digastric resection provided good clinical results, enabling both release of Kaplan fibers and relaxation of the iliotibial band, with low bleeding risk thanks to the distal approach to the band. Disclosure of interest A. Jacquot, F. Sirveaux and D. Molé are consultants for Tornier Wright Medical. A. Jacquot is a consultant for Smith & Nephew. F. Sirveaux and D. Molé receive royalties from Tornier Wright Medical. The other authors declare that they have no competing interest. Funding No funding was received by the authors for the study. Contribution P. Walbron: first author/illustrator. A. Jacquot: article review. J.-M. Geoffroy: article review. F. Sirveaux: article review. D. Molé: article review/senior surgeon. References [1] Renne JW. The iliotibial band friction syndrome. J Bone Joint Surg Am 1975;57:1110–1. [2] Baker RL, Fredericson M. Iliotibial band syndrome in runners: biomechanical implications and exercise interventions. Phys Med Rehabil Clin N Am 2016;27:53–77. [3] Noble CA. The treatment of iliotibial band friction syndrome. Br J Sports Med 1979;13:51–4.
5
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Please cite this article in press as: Walbron P, et al. Iliotibial band friction syndrome: An original technique of digastric release of the iliotibial band from Gerdy’s tubercle. Orthop Traumatol Surg Res (2018), https://doi.org/10.1016/j.otsr.2018.08.013