Search Results (25)

Background/Objectives: The aim was to provide a comprehensive, systematic review on the Lateral Extra-articular Tenodesis (LET) methods used in anterior cruciate ligament (ACL) reconstruction in the light of recent data. Methods: To identify all of the essential studies that reported relevant data concerning primary outcomes: indications for surgery, surgical technique, graft type, fixation method, and tibial fixation location, an extensive search of the major and significant electronic databases (PubMed, Cochrane Central, ScienceDirect, Web of Science, Embase) was performed by three independent authors. A systematic investigation was conducted in November 2023, with no limits regarding the year of publication. After the database search, three independent reviewers screened all the papers, which followed strictly the inclusion and exclusion criteria, identifying a title, abstract, and full text concerning LET, surgical technique, femoral attachment, tibial attachment, graft type, fixation method, knee angle during fixation, and graft tension at fixation in ACL reconstruction. A systematic review of the collected literature was carried out according to the guidelines of Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Study quality was assessed using the Cochrane Risk of Bias Tool. Results: Of the 35 papers reviewed, seven surgical techniques of LET differing in the way the procedure was performed were separated. The majority of papers were from Italy (n = 11), USA (n = 3), France (n = 3), and Canada (n = 3). The number of total participants across all studies was 6253. The majority of studies (17 papers) used the Lemaire modified procedure, and 10 papers used the MacIntosh technique modified by the Coker–Arnold approach. Most of the papers mentioned fixation location on the lateral distal part of the femur including six articles referring directly to lateral femoral epicondyle. Most authors (25 papers) defined tibial attachment as Gerdy’s tubercle. The most common graft was the iliotibial band and fixation method was sutures. The types of fixation in the surgical techniques of the collected papers were Sutures, Staples, Anchor, Interference screw, K-wire, Bioabsorbable Screw and Titanium Screw with a serrated polyethylene washer. Conclusions: Despite variability in technique, the Lemaire-modified procedure emerged as the preferred approach for Lateral Extra-articular Tenodesis, suggesting a general consensus around its reliability and reproducibility in clinical practice. The frequent use of the iliotibial band as graft material reflects its accessibility and suitability for reinforcing anterolateral stability. Similarly, the consistent use of sutures and fixation at Gerdy’s tubercle may indicate a favorable balance between technical ease and biomechanical strength. The variability in femoral fixation points—either at the lateral femoral condyle or epicondyle—highlights the ongoing debate or surgeon preference, underscoring the need for further comparative studies to establish optimal fixation strategy. Collectively, these patterns may help guide surgical decision-making, particularly when tailoring procedures to individual patient anatomy or surgical expertise. Full article

Background: The iliotibial band (ITB) is an anatomically complex structure with multiple proximal and distal attachments, making its mechanical behavior difficult to interpret. In the study of iliotibial band syndrome (ITBS), prior research has often considered the underlying lateral femoral epicondyle (LFE) as a fixed reference to describe ITB movement during knee flexion, potentially misrepresenting true tissue dynamics. This proof-of-concept study introduces the musculoskeletal advanced transillumination technique (MATT) to visualize and measure LFE displacement relative to the ITB and the tubercule of the ITB (tITB) on the tibia during passive knee flexion. Methods: Un-embalmed donor knees (n = 8) were dissected to expose the ITB and positioned on a device allowing standardized passive motion from 0° to 30°. A trocar was inserted between the femoral epicondyles, and a 300-watt xenon light source illuminated the LFE. Video was recorded with an iPhone 15, and key frames were analyzed using ImageJ Version 1.54i, and a custom Python (Version 3.12.5) script to quantify LFE displacement relative to the ITB and to the tITB. Results: Median absolute LFE displacement from 0° to 30° was 9.18 mm (IQR 7.23–10.95). Between 0° and 30°, the LFE shifted anteriorly by −1.76 mm (IQR −10.28 to −8.72) relative to the anterior border of the ITB, and by 11.26 mm (IQR 8.27 to 26.33) relative to its posterior border. The LFE-tITB distance increased from 51.98 mm (IQR 49.13–52.36) at 0° to 53.66 mm (IQR 50.08–60.11) at 30°, with a median displacement of 3.92 mm (IQR: 2.48–5.73). Conclusions: Musculoskeletal Advance Transillumination Technique (MATT) is a straightforward and reproducible technique that offers direct visualization of the dynamic relationship between a skeletal landmark and myofascial structures, such as the LFE and the ITB. By challenging the assumption that the LFE is a fixed reference point, MATT opens new perspectives for investigating the biomechanical mechanisms underlying conditions like iliotibial band syndrome. Full article

Background/Objectives: Additive manufacturing (AM) enables the production of cementless acetabular cups with porous surfaces that facilitate early osseointegration. Directed energy deposition (DED), a form of AM, allows the direct welding of porous structures onto metal substrates without requiring a vacuum environment, offering advantages over conventional powder bed fusion methods. Despite growing interest in DED, no prospective clinical studies evaluating DED-based acetabular components have been published to date. This study assessed short-term outcomes of a DED-based 3D-printed acetabular cup in total hip arthroplasty (THA). Methods: A total of 120 patients who underwent primary cementless THA using the Corentec Mirabo Z^® acetabular cup were prospectively enrolled. Among them, 124 hips from 100 patients who had completed a minimum of 24 months of follow-up were included in the analysis. Clinical outcomes were assessed using the Harris hip score (HHS), WOMAC, EQ-5D-5L, and pain NRS. Radiographic evaluation included measurements of cup position, osseointegration, and detection of interfacial or polar gaps on CT and plain radiographs. Implant-related complications were also recorded. Results: At a mean follow-up of 34.6 months, the implant survival rate was 99.3%, with one revision due to suspected osseointegration failure. The HHS improved from 56.6 to 91.4 at 24 months, and the NRS decreased from 6.2 to 1.1 (both p < 0.001). Interfacial gaps were observed in 58.1% of cases on CT, though most were <1 mm and not clinically significant. Common postoperative issues included greater trochanteric pain syndrome, squeaking, and iliotibial band tightness, all of which were resolved with conservative treatment. Conclusions: DED-based 3D-printed acetabular cups demonstrated favorable short-term clinical and radiographic outcomes, with high survivorship and reliable early osseointegration in cementless THA. Full article

Background: Iliotibial band syndrome (ITBS) through the tensor fascia latae (TFL) is a well-known pathology among runners whose etiology is not completely clear, nor is the effectiveness of plantar insoles for different types of feet known well enough for them to be considered a possible approach for this issue. Objective: to understand how foot type and foot orthotics may influence the electromyographic (EMG) activity of the TFL. Methods: A total of 41 healthy recreational runners (mean age 32.66 ± 3.51) were recruited for the present cross-sectional study, categorizing them as neutral (NEUg = 15), supinators (SUPg = 15), and pronators (PROg = 11) according to the foot postural index, over a period of 11 months. The EMG of the TFL was measured using a surface electromyograph device while they ran on a treadmill at a constant speed of 9 km/h for 3 min, randomly using supinating (SUP), pronating (PRO), or heel lift (TAL) insoles of 5 mm each one, compared to the baseline condition (SIN). The intraclass correlation coefficient (ICC) was performed to check the reproducibility of the tests, pairwise comparisons with Bonferroni adjustment were made, and to test the differences between measurements, the Friedman test was performed. Results: The Shapiro–Wilk test indicated a normal distribution of the sample (p > 0.05). Almost all obtained results showed a “perfect reproducibility” close to one; a significant statistical increase was observed in the mean EMG values from NEUg (87.58 ± 4.81 mV) to SUPg (97.17 ± 4.3 mV) (p < 0.05) during SIN+ basal condition. Additionally, there was a statistical reduction from SIN (87.58 ± 4.81 mV) vs. PRO (74.69 ± 3.77 mV) (p < 0.001) in NEUg and from SIN (97.17 ± 4.3 mV) vs. PRO (90.96 ± 4 mV) (p < 0.001) in SUPg. Conclusions: The SUPg exhibited increased activation of TFL fibers compared to the NEUg, likely due to the biomechanical demands associated with a supinated foot type. In contrast, the use of PRO appeared to promote relaxation of the TFL fibers by inducing internal rotation of the lower limb. Based on these preliminary results from a cross-sectional study in a healthy population, it is recommended to assess foot type when addressing ITBS and to consider the use of PRO as a complementary therapeutic strategy alongside conventional treatments. Full article

Anterior cruciate ligament reconstruction with concurrent lateral extra-articular tenodesis enhances rotational stability. However, not many studies describe radiological features following the abovementioned procedure. The purpose of this study was to evaluate the visibility and describe the sonographic morphology of the iliotibial band strip harvested during the modified Lemaire technique and to establish a correlation between these findings and clinical outcomes. Thirty-two consecutive patients underwent primary or revision anterior cruciate ligament reconstruction with the addition of lateral extra-articular tenodesis by the mini-open modified Lemaire technique. All individuals completed the following preoperative and postoperative questionnaires: the KOOS-pain, KOOS-symptoms, KOOS-ADL, KOOS-sport, KOOS-quality, IKDC, Lysholm, and WOMAC. Each patient underwent a postoperative ultrasound examination to evaluate the lateral extra-articular procedure, especially the harvested iliotibial band strip. The most common ultrasound findings of the iliotibial band strip were its hyperechoic appearance (87.1%), location at the level of the femur (58.1%), no surrounding effusion (83.9%), and no power Doppler signal (100%). Effusion seen in sonographic images was correlated with KOOS-symptoms postoperative scores (p = 0.0115). However, there were no correlations between other iliotibial band strip sonographic features and clinical outcomes. The functional score value increased in each patient compared to preoperative measurements. This is the first study that evaluated the sonographic features of the iliotibial band strip after the lateral extra-articular procedure by the mini-open modified Lemaire technique. Our study indicates that ultrasonography is a useful tool in identifying the iliotibial band strip after the mentioned procedure. Effusion observed around the strip on ultrasound was significantly associated with worse KOOS-symptoms scores, suggesting potential clinical relevance. Full article

The objective of this study was to find out the effect of the myofascial release technique combined with valgus correction exercise on the pain, range of motion, balance, and quality of life in participants with grade II knee osteoarthritis. Forty participants with grade II knee osteoarthritis were randomly assigned into two treatment groups in the present clinical trial; group A was the myofascial release group, and group B was the myofascial release with valgus correction exercises group. Measurement included pain, balance, range of motion, and quality of life, as measured through the visual analog scale (VAS), Berg balance scale (BBS), goniometer, and knee injury and osteoarthritis outcome score (KOOS), respectively. The data were collected at the baseline and 3rd and 6th weeks. The between-groups comparison at the end of the 6th week showed significant results in the iliotibial band myofascial release with the valgus correction exercise group (p < 0.001). The within-group difference showed improvement in both groups individually, with more significant values in group B. The current study showed that the myofascial release combined with valgus correction exercises can effectively improve the pain, range of motion, balance, and quality of life in participants with grade II knee osteoarthritis. Trial Registration: IRCT20230216057434N3. Full article

Traditional lateral extra-articular tenodesis (LET) using fixation elements constrains medial knee rotation laxity after anterior cruciate ligament reconstruction (ACLr). However, the mechanical behavior of an LET made with an iliotibial band–intermuscular septum is unknown using different anterior cruciate ligament (ACL) reconstruction drillings and would be crucial for constraining the rotatory components of direction change movements. Thus, this study aimed to explore the maximum principal stresses and their distribution in grafts during medial knee rotation with and without iliotibial band–intermuscular septum lateral extra-articular tenodesis for the transtibial technique (TT), hybrid transtibial technique (HTT), and anteromedial portal technique (AM) in single-bundle ACLr. The maximum von Mises principal stresses and their distribution under medial knee rotation were described using a finite element model generated from a healthy knee. LET with HTT, TT, and AM decreases stress by 97%, 93%, and 86% during medial rotation compared to each technique without LET, respectively. The stress concentration for the AM portal and TT techniques was located at the femoral tunnel, and for HTT with LET, it was located across the distal thirds of the anterior aspect of the graft. In conclusion, the HTT with LET diminishes graft stress more than the HTT, TT, and AM without LET, and the TT and AM with LET during medial knee rotation. The AM portal, HTT, and TT techniques without LET show higher stress concentration patterns at the femoral tunnel, establishing a biomechanical risk of femoral tunnel enlargement when LET is not performed. Full article

Background: The lateral extra-articular tenodesis (LET) procedure associated with anterior cruciate ligament (ACL) reconstruction can be considered in selected patients to diminish the risk of persistent rotatory instability and achieve a protective effect on the graft. Several techniques have been described in the literature to treat rotatory instability. Usually, a strip of the iliotibial band (ITB) is harvested from its middle while leaving the distal insertion, then passed underneath the lateral collateral ligament and fixed on the lateral aspect of the distal femur with various fixation methods such as staples, screws, anchors or extracortical suspensory devices. Despite their effectiveness, these fixation methods may be associated with complications such as lateral pain, over-constraint and tunnel convergence. Methods: This study presents a detailed surgical description of a new technique to perform an LET during ACL reconstruction with any type of graft fixing the ITB strip with the sutures of the ACL femoral button, comparing its pros and cons in relation to similar techniques found in the literature. Conclusions: This technique represents a reproducible, easy to learn and inexpensive solution to perform a lateral extra-articular tenodesis associated with an ACL reconstruction using the high-resistance sutures of the femoral button. Full article

Iliotibial band syndrome (ITBS) is one of the most common overuse syndromes causing knee pain; it is especially prevalent in runners and also common in cyclists, rowers, and field athletes, with occasional cases occurring in non-athletes too. ITBS symptoms can negatively affect not only knee function, but also mental and physical aspects of health-related quality of life. Although various conservative treatment options have been investigated and discussed, there is still no consensus on a standard of care for ITBS. Moreover, the literature on the etiology and risk factors of ITBS, which could help in selecting appropriate treatment methods, is conflicting and inconclusive. The role of individual treatment modalities such as stretching and releasing techniques has not been extensively studied and remains unclear. In this article, we will critically review the available evidence for the benefits of ITB stretching and “release” methods in the treatment of ITBS. In addition to the direct evidence (clinical studies examining the effects of ITB stretching and other methods that purportedly stretch or “release” the ITB), we present several additional lines of reasoning that discuss the rationale for ITB stretching/releasing in terms of the etiology of ITBS, the mechanical properties and behavior of the ITB, and the risk factors for ITBS development. We conclude that the current literature provides some evidence for the inclusion of stretching or other “release” methods in the early rehabilitation of ITBS. Long-term interventions typically include ITB stretching; however, it remains unclear to what extent stretching within a multimodal treatment actually contributes to resolving the symptoms. At the same time, there is no direct evidence to suggest that stretching and “release” methods have any negative effects. Full article

Background: Iliotibial band syndrome (ITBS) is one of the most prevalent overuse injuries in runners. The strain rate in the iliotibial band (ITB) has been theorized to be the primary causative factor in the development of ITBS. Running speed and exhaustion might lead to an alteration in the biomechanics that influence the strain rate in the iliotibial band. Objectives: To identify how exhaustion states and running speeds affect the ITB strain and strain rate. Methods: A total of 26 healthy runners (including 16 males and 10 females) ran at a normal preferred speed and a fast speed. Then, participants performed a 30 min exhaustive treadmill run at a self-selected speed. Afterward, participants were required to run at similar speeds to those of the pre-exhaustion state. Results: Both the exhaustion and running speeds were revealed to have significant influences on the ITB strain rate. After exhaustion, an increase of approximately 3% in the ITB strain rate was observed for both the normal speed (p = 0.001) and the fast speed (p = 0.008). Additionally, a rapid increase in the running speed could lead to an increase in the ITB strain rate for both the pre- (9.71%, p = 0.000) and post-exhaustion (9.87%, p = 0.000) states. Conclusions: It should be noted that an exhaustion state could lead to an increase in the ITB strain rate. In addition, a rapid increase in running speed might cause a higher ITB strain rate, which is proposed to be the primary cause of ITBS. The risk of injury should also be considered due to the rapid increase in the training load involved. Running at a normal speed in a non-exhaustive state might be beneficial for the prevention and treatment of ITBS. Full article

Iliotibial band syndrome (ITBS) is a common running related injury. While previous studies have evaluated the relationship between biomechanical variables and ITBS, most have found limited evidence, particularly with measures related to ground reaction force (GRF). The purpose of this study was to use a classification and regression tree (CART) analysis to determine whether the combination of GRF measures would be strongly associated in runners with ITBS. A cross-sectional study was performed at an outpatient center focused on running injuries. A convenience sample of 52 runners with ITBS, assessed between September 2012 and July 2022, were evaluated for eligibility, from which, 30 rearfoot strike runners with ITBS and no secondary running-related injuries were selected. Injured runners were matched to 30 healthy controls from a normative database. Each ran on an instrumented treadmill at a self-selected speed. GRF variables were calculated, including peak GRFs, loading rates, and impulses. CART analysis was performed to identify interactions between GRF data and runners with ITBS. An ROC curve was executed, to determine the accuracy of the model. Posterior GRF impulse (PGRFI), anterior GRF (AGRFI), peak anterior GRF (PAGRF), and vertical stiffness at initial loading (VSIL) all emerged as variables associated with ITBS in the CART analysis. The model was able to correctly identify 25 (83.3%) runners with ITBS and 25 (83.3%) controls. The area under the ROC curve (accuracy) was 0.87 (95% CI, 0.77–0.96; SE, 0.04; p < 0.001). In conclusion, interactions between GRF variables were associated with ITBS in runners. The best classification included interactions between PGRFI, AGRFI, AGRFP, and VSIL, using specific cut-off values. Loading rates were not independently associated with ITBS. Full article

The ideal surgical treatment of femoral neck fractures remains controversial. When treating these fractures with internal fixation, many fixation constructs exist. The primary aim of this study was to evaluate the incidence and specific risk factors associated with complication and re-operation following fixation of intracapsular proximal femoral fractures using the Targon-FN system (B.Braun Melsungen AG). A secondary aim was to identify if lateral prominence of the implant relative to the lateral border of the vastus ridge was a specific risk factor for elective plate removal. Methodically, a retrospective case series was conducted of all consecutive adult patients treated at a single level 1 trauma center in Switzerland for an intracapsular proximal femoral fracture with the Targon-FN. Demographic data were collected. Patients with a follow-up of less than three months were excluded. Complications as well as plate position were recorded. Statistical analysis to identify specific risk factors for re-operation and complications was performed. In result, a total of 72 cases with intracapsular femoral neck fractures were treated with the Targon-FN locking plate system between 2010 and 2017. Thirty-four patients (47.2%) experienced one or more complications. The most common complication was mechanical irritation of the iliotibial band (ITB) (23.6%, n = 17). Complications included intraarticular screw perforation (6.9%, n = 5), avascular necrosis (5.6%, n = 4), non-union (5.6%, n = 4) among others. In total, 46 re-operations were required. Younger age, fracture displacement and time to postoperative weight bearing were identified as risk factors for re-operation. In conclusion, intracapsular femoral neck fractures treated with the Targon-FN system resulted in a high rate of post-operative complication and re-operation. Statistical analysis revealed patient age, fracture displacement, time to postoperative full weight bearing were risk factors for re-operation. The main limitation is the limited number of cases and a short follow-up of less than 12 months in a subgroup of our patients. Full article

Patellofemoral joint pain and iliotibial band syndrome are very common running−related injuries. Excessive contralateral pelvic drop, hip adduction, and hip internal rotation have been suggested to be associated with the two injuries. The purpose of this repeated measures and the cross−sectional study was to investigate the effect of flat running shoes on these kinematic variables compared with that of conventional running shoes with a 10 mm drop. Eighteen male recreational runners were recruited to run in flat shoes and conventional shoes with a 10 mm drop, in random order. Impact force data and lower extremity kinematics were synchronously obtained using two Kistler force plates and eight motion infrared cameras, whereas differences in the impact force and hip kinematics were compared using statistical parametric mapping. Regarding hip kinematics, the hip flexion (p = 0.004) and adduction angles (p = 0.004) decreased significantly at 30–70% and 62–85% of the stance phase, respectively, while wearing flat running shoes; the contralateral pelvic drop angle (p = 0.001) decreased significantly at 31–75% of the stance phase while wearing flat running shoes. The knee internal rotation angle (p = 0.035) decreased significantly at 8–17% of the stance phase while wearing flat running shoes compared with conventional running shoes. Given that these kinematic variables are associated with patellofemoral joint pain and iliotibial band syndrome, flat running shoes may have potential benefits for the prevention or treatment of knee injuries. Full article

Cycling is a popular sport, and the cycling population and prevalence of related injuries and diseases increase simultaneously. Iliotibial band friction syndrome is a common chronic overuse injury caused by repetitive knee use in cycling. Self-myofascial release using foam rollers is an effective intervention for this syndrome; however, studies reporting positive results on self-myofascial release in cycling are limited. Therefore, this study investigated the effect of self-myofascial release on pain and iliotibial band flexibility, heart rate, and exercise performance (cadence, power, and record) in adult male cyclists with iliotibial band friction syndrome. We evaluated the pain and exercise ability of the control (n = 11) and self-myofascial release (n = 11) groups before and after cycling twice. Significant differences were observed in the pain scale, the iliotibial band flexibility, and cycling pain and power. The posterior cadence of the self-myofascial release group was 3.2% higher than that of the control group. The control group’s record time increased by 74.64 s in the second cycling session compared to the first cycling session, while that of the self-myofascial release group decreased by 30.91 s in the second cycling session compared to the first cycling session. Self-myofascial release is effective in relieving pain and may improve cycling performance by increasing the iliotibial band flexibility. Full article

Ultrasound (US) therapy in sports and medical pathologies is widely used by many physiotherapists and sports medicine clinicians; however, data regarding their potential side effects remain rare. We report a case of a 21-year-old woman with iliotibial band (ITB) syndrome treated with a physiotherapy session combined with US therapy. She had twenty 7 min US sessions on the knee, for 3 months (US at 1 Mhz with an intensity between 1 and 2 W/cm²). Due to persistence of the ITB syndrome’s symptomatology after the 3 months of physiotherapy sessions, an MRI (magnetic resonance imaging) was carried out and revealed osteonecrosis-like bone abnormalities on the external femoral condyle, the external tibial plateau, and the proximal fibula. In view of these lesions, the ultrasonic therapy was stopped, and a repeat MRI demonstrated the progressive disappearance of these imaging abnormalities one year after the last US (ultrasound) treatment. In light of this case, we propose here a short review of reported osseous “osteonecrosis” abnormalities associated with US therapies. Full article