Anatomical and biomechanical investigations of the iliotibial tract

Abstract

Divergent descriptions of the anatomic location and biomechanical function of the iliotibial tract (IT) can be found in the literature. This study attempted to obtain exact data regarding the anatomic course and material characteristics including the biomechanical properties of this structure. The following were its aims: (1) anatomical investigations of the IT; (2) mechanical properties of the IT; (3) femoral head centralizing force of the IT and subligamentous forces in the height of the greater trochanter in different joint positions by using a custom-made measuring prosthesis and a subligamentous positioned sensor; (4) construction of a finite element model of the proximal femur including the IT and measuring the femoral neck angle under variation. The hip joints and IT in a total of 18 unfixed corpses were evaluated. We studied the anatomic relationship to surrounding structures, as well as the material properties with the help of tensile strength testing utilizing an uniaxial apparatus. During the test, a load-displacement curve was registered, documenting the maximum load and deformation of the IT. To measure the subligamentous pressure at the height of the greater trochanter, a custom-made sensor with a power-recording instrument was constructed. Furthermore, an altered hip prosthesis with a pressure gauge at the height of the femoral neck was used to measure the forces which are directed at the acetabulum. The investigations were done in neutral-0 position and ab/adduction of the hip joint of the unfixed corpse. In addition, we varied the femoral neck angle between 115 degrees and 155 degrees in 5 degrees steps. To confirm the subligamentous forces, we did the same measurements intraoperatively at the height of the greater trochanter before and after hip joint replacement in 12 patients. We constructed a finite element model of the proximal femur and considering the IT. The acquisition of the data was done at physiological (128 degrees), varus (115 degrees), and valgus (155 degrees) femoral neck angles. The influencing forces of the IT at the height of the greater trochanter and the forces at the femoral head or the acetabulum could be measured. Our anatomical investigations revealed a splitting of the IT into a superficial and a deep portion, which covers the tensor fasciae latae. The tensor fasciae latae has an insertion on the IT. The IT continues down the femur, passing over the greater trochanter without developing an actual fixation to the bone. Part of the insertion of the gluteus maximus radiates into the IT. The IT passes over the vastus lateralis and inserts at the infracondylar tubercle of the tibia or Gerdy's tubercle, at the head of the fibula, as well as at the lateral intermuscular septum. Portions also insert on the transverse and longitudinal retinaculum of the patella. Concerning the material properties of the IT, we found a structural stiffness of 17 N/mm extension on average (D = 17 N/mm). The subligamentous measurements at the height of the greater trochanter in the unfixed corpse an...

Competitive Female Runners With a History of Iliotibial Band Syndrome Demonstrate Atypical Hip and Knee Kinematics

“…This finding provides further evidence that knee flexion, by itself, does not play a significant role in the aetiology of ITBS as has been historically believed. 1,21,23 However, the increased peak knee internal rotation angle in the ITBS group measured in the current study is likely an important factor in the development of ITBS. A number of authors have suggested that, due to its insertion on the tibia, increased knee rotation increases torsional loads to the tissues of the knee joint such as the iliotibial band.…”

“…21,26 Anecdotally, this syndrome has been associated with repetitive flexion and extension on a loaded knee, in combination with a tight iliotibial band. 1,16,[21][22][23] Orchard et al 23 suggested that frictional forces between the iliotibial band and the lateral femoral condyle are greatest at 20° to 30° of knee flexion, which occur during the first half of the stance phase of running. However, despite this well-accepted sagittal-plane theory, 1,21,23 no differences have been found in the few biomechanical investi-…”

“…8,17 The iliotibial band originates from the fibers of the gluteus maximus, gluteus medius, and tensor fascia latae muscles, and attaches proximal to the knee joint into the lateral femoral condyle and distal to the knee joint into the infracondylar tubercle of the tibia. 1,17 As a result of the femoral and tibial attachments, it is possible that atypical hip and foot mechanics, which both influence the knee, could play a role in the development of ITBS.…”

Kinematics and kinetics during stair ascent in individuals with Gluteal Tendinopathy

“…Modelling studies suggest that: (1) ITB tension increases with HADM and hip adduction angle (Tateuchi et al, 2015) and (2) ITB tension and subsequent compressive forces between the ITB and greater trochanter (gluteal tendon insertion) increase with hip adduction angle (Birnbaum et al, 2004). The impact of greater HADM on gluteal tendon loading is likely to be greater during stair ascent than level walking for several reasons.…”

“…The gluteal tendons are vulnerable to compression against the greater trochanter and iliotibial band (ITB) (Dwek et al, 2005) as the hip moves into adduction and ITB tension increases (Birnbaum and Pandorf, 2011;Birnbaum et al, 2004). Contraction of the muscles that insert into the ITB (i.e.…”