How iliotibial tract injuries of the knee combine with acute anterior cruciate ligament tears to influence abnormal anterior tibial displacement

Abstract

A knowledge of the patterns of injury to the components of the iliotibial tract allows a clearer interpretation of motion limits testing in patients with abnormal anterior tibial translation of the knee (anterior cruciate ligament-deficient knees). Eighty-two consecutive patients with acute knee injuries were classified as anteromedial-anterolateral rotatory instability (anterior cruciate ligament-deficient) based on the abnormal motion demonstrated by clinical examination tests for instability. At surgery, injuries to the intraarticular and extraarticular anatomic structures were identified and correlated to the abnormal grades of motion demonstrated by the knee motion limits examination. Tears of the anterior cruciate ligament occurred in 80 (98%) of the knees. However, the grade of abnormal motion demonstrated by the Lachman and pivot shift tests was quite variable. This variation did not correlate statistically with anterior cruciate ligament tears. Injuries to the anatomic components of the iliotibial tract were confirmed in 76 (93%) of the knees. These injuries correlated highly with variations in grades of abnormal motion detected by the following tests: lateral joint line opening at 30 degrees (r2 = 0.05); Lachman test (r2 = 0.08); pivot shift (r2 = 0.16); and anterior translation at 90 degrees of flexion (r2 = 0.34). Thus, injuries to the components of the iliotibial tract are thought to contribute to the variation in grades of abnormal motion observed in this complex subgroup of anterior tibial translation instabilities.

Percutaneous Reconstruction of the Anterolateral Ligament of the Knee With a Polyester Tape

“…Terry et al, 23 in 1993, concluded that injuries to the components of the iliotibial tract contributed to the variation in anterior tibial translation and rotation. Samuelson et al, 24 in 1996, also showed that adding an extra-articular reconstruction to intra-articular ACL reconstruction would improve results if the patient had anterolateral ligamentous injuries.…”

Effect of the iliotibial band on knee biomechanics during a simulated pivot shift test

“…5,17 The pivot shift test is best done in a controlled setting with the patient relaxed or under anesthesia because the amount of tibial subluxation can be significantly reduced due to pain, effusion, and hamstrings muscle contraction, yielding false-negative results. 27 Further, quadriceps contraction would increase tibial subluxation, causing patient discomfort and making the examination difficult to perform.…”

“…5,6 In addition, Terry et al demonstrated that injury to the anatomic components of the ITB is highly correlated with levels of pivot shift for ACL deficient knees. 17 Thus, the ITB is necessary to provide reduction of ACL deficient knees during the pivot shift test at high flexion angles. 2,6,7,18 However, a similar role of the ITB forces with the knee near extension may prevent tibial subluxation of ACL deficient knees and result in false negative findings.…”

Comparative study of autograft or allograft in primary anterior cruciate ligament reconstruction

“…Several normal structures in and around the knee have the ability to compensate for the injury, and this may account for the fact that some patients have nearly normal knee function in the absence of an intact ACL. In other patients who have symptoms of a torn ACL, either the compensatory structures are damaged themselves or they are mechanically inadequate to compensate for the loss [21].…”