1
|
Unuvar BS, Demirdel E, Gercek H. The Effects of Different Myofascial Release Techniques on Pain, Range of Motion, and Muscle Strength in Athletes With Iliotibial Band Tightness: A Randomized Controlled Study. J Sport Rehabil 2024; 33:531-541. [PMID: 39159925 DOI: 10.1123/jsr.2023-0375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Revised: 03/21/2024] [Accepted: 06/15/2024] [Indexed: 08/21/2024]
Abstract
CONTEXT We designed this study to investigate the effects of 2 myofascial release techniques, Instrument-Assisted Soft Tissue Mobilization (IASTM) and Foam Roller (FR), on pain, joint range of motion, and muscle strength in athletes suffering from iliotibial band (ITB) tightness. DESIGN A total of 39 male soccer players were enrolled in this randomized controlled trial, aged between 18 and 23 years who were divided into 3 groups: Only Exercise, IASTM, and FR. METHODS All participants performed daily strengthening and stretching exercises, while 1 group added IASTM, and the other added FR to the exercise program. We evaluated ITB tightness with the Ober test and an inclinometer, pressure pain threshold, using an algometer, and we evaluated muscle strength with the Cybex Norm Isokinetic device. RESULTS We found that all 3 groups exhibited an increase in the Ober inclination angle after the interventions (P = .001), but the increase was greater for participants in the IASTM and FR groups, compared with exercise alone. Additionally, both the IASTM and FR groups displayed an increased pressure pain threshold (P = .001), whereas there was no change in the control group. Moreover, while all 3 groups experienced an increase in hip muscle strength (P = .001), the IASTM and FR groups exhibited a greater increase compared with exercise alone (P = .001). CONCLUSIONS Based on these findings, exercise improves pain, range of motion, and muscle strength in athletes with ITB tightness, and IASTM, and FR techniques enhanced exercise effects but did not differ from one another. While our study demonstrated that both IASTM and FR techniques significantly enhance the benefits of exercise for athletes with ITB tightness, further research could delve into the long-term effects of these interventions.
Collapse
Affiliation(s)
- Bayram Sonmez Unuvar
- Department of Audiology, Faculty of Health Sciences, KTO Karatay University, Konya, Turkey
| | - Ertugrul Demirdel
- Physiotherapy and Rehabilitation Department, Faculty of Health Sciences, Ankara Yıldırım Beyazıt University, Ankara, Turkey
| | - Hasan Gercek
- Vocational School of Health Services, Department of Therapy and Rehabilitation, KTO Karatay University, Konya, Turkey
| |
Collapse
|
2
|
Sanchez-Alvarado A, Bokil C, Cassel M, Engel T. Effects of conservative treatment strategies for iliotibial band syndrome on pain and function in runners: a systematic review. Front Sports Act Living 2024; 6:1386456. [PMID: 39247485 PMCID: PMC11377285 DOI: 10.3389/fspor.2024.1386456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Accepted: 08/08/2024] [Indexed: 09/10/2024] Open
Abstract
Introduction This systematic review summarizes the efficacy of conservative treatment strategies on pain and function in runners with iliotibial band syndrome (ITBS), a prevalent running injury constituting about 10% of all running-related injuries. The multifactorial nature of ITBS necessitates diverse treatment approaches; yet, a consensus on an optimal conservative regimen remains unreported. This review seeks to update and expand upon existing literature with recent rehabilitative approaches. Methods A systematic search was conducted in Medline, Web of Science, and CINHAL databases, from inception to June 31, 2024. Inclusion criteria were: (1) reporting of conservative treatments for ITBS in adult runners and (2) pain and function defined as main outcome parameters. The methodological quality was evaluated using the NIH Quality Assessment Tool. Results Thirteen out of 616 records met the inclusion criteria (201 participants), including five randomized controlled trials, one case-control study, one pre-test post-test study, and six case studies. Different active and passive treatment strategies were applied as single (five studies) or combined (eight studies) treatments. The average methodological quality was deemed good. Large between-study heterogeneity was present, impeding a meta-analysis to be performed. Hip abductor strengthening (HAS) exercise emerged as a common strategy. The intervention effects on pain reduction ranged from 27% to 100%, and functional improvement from 10% to 57%, over 2 to 8 weeks. Conclusion A conservative treatment approach incorporating HAS exercises, possibly augmented by shockwave or manual therapy, is effective for mitigating pain and enhancing function in ITBS-afflicted runners. Finally, the potential of emerging strategies like gait retraining requires further exploration through rigorous trials and comprehensive evidence. Addressing these gaps could refine ITBS management, enhancing treatment outcomes and facilitating runners' return to sport.
Collapse
Affiliation(s)
- Alberto Sanchez-Alvarado
- Sports Medicine and Sports Orthopaedics, University Outpatient Clinic, University of Potsdam, Potsdam, Germany
- Institute of Interdisciplinary Exercise Science and Sports Medicine, MSH Medical School Hamburg, Hamburg, Germany
| | - Chaitrali Bokil
- Sports Medicine and Sports Orthopaedics, University Outpatient Clinic, University of Potsdam, Potsdam, Germany
| | - Michael Cassel
- Sports Medicine and Sports Orthopaedics, University Outpatient Clinic, University of Potsdam, Potsdam, Germany
| | - Tilman Engel
- Sports Medicine and Sports Orthopaedics, University Outpatient Clinic, University of Potsdam, Potsdam, Germany
| |
Collapse
|
3
|
Golubjatnikov M, Walker A. Endurance Sporting Events. Emerg Med Clin North Am 2024; 42:581-596. [PMID: 38925776 DOI: 10.1016/j.emc.2024.02.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/28/2024]
Abstract
Endurance sports encompass a broad range of events from marathons and triathlons to ultramarathons, long-distance cycling, skiing, and swimming. As these events have experienced a surge in popularity, we have a greater need to understand the associated medical risks. This article reviews the history of endurance races, reviews the most critical and common causes of cardiovascular, heat, electrolyte, and musculoskeletal injuries/illnesses, and discusses considerations for medical directors/personnel associated with such events.
Collapse
Affiliation(s)
- Matt Golubjatnikov
- St Joseph's Medical Center, 1800 N California Street, Stockton, CA 95204, USA
| | - Anne Walker
- St Joseph's Medical Center, 1800 N California Street, Stockton, CA 95204, USA.
| |
Collapse
|
4
|
Cheung YYB, Lui TH. Endoscopic Resection of Distal Femoral Exostosis That Causes Distal Iliotibial Band Syndrome. Arthrosc Tech 2024; 13:103001. [PMID: 39100257 PMCID: PMC11293314 DOI: 10.1016/j.eats.2024.103001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2024] [Accepted: 03/08/2024] [Indexed: 08/06/2024] Open
Abstract
Distal iliotibial band (ITB) syndrome is the most common cause of lateral knee pain in runners. If the ITB is too tight, the repetitive knee flexion associated with sports may lead to compression of the vascularized fat pad in the sub-ITB space or development of sub-ITB adventitious bursitis as the band crosses over the lateral femoral epicondyle and the ITB itself is normal. Distal ITB syndrome usually responds to conservative treatment. The presence of any underlying causes, for example, exostosis at the sub-ITB space, should be explored in recalcitrant cases of distal ITB syndrome. Although open surgical excision is the treatment of choice for extra-articular exostosis, the surgical risk and complication rates have been reported as high as 13%. Endoscopic resection of extra-articular exostosis has been proposed to reduce the complication rates. The purpose of this technical note is to describe the details of arthroscopic management of endoscopic resection of distal femoral exostosis that causes distal ITB syndrome.
Collapse
Affiliation(s)
| | - Tun Hing Lui
- Department of Orthopaedics and Traumatology, North District Hospital, Sheung Shui, Hong Kong
| |
Collapse
|
5
|
Marais JV, Jansen van Rensburg A, Schwellnus MP, Jordaan E, Boer P. Risk factors associated with a history of iliotibial band syndrome (hITBS) in distance runners: a cross-sectional study in 76 654 race entrants - a SAFER XXXIII study. PHYSICIAN SPORTSMED 2024:1-11. [PMID: 38618688 DOI: 10.1080/00913847.2024.2341607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Accepted: 04/08/2024] [Indexed: 04/16/2024]
Abstract
BACKGROUND Despite the numerous health benefits of distance running, it is also associated with the development of 'gradual onset running-related injuries' (GORRIs) one of which is Iliotibial Band Syndrome (ITBS). Novel risk factors associated with a history of ITBS (hITBS) have not been described in a large cohort of distance runners. OBJECTIVE To identify risk factors associated with hITBS in distance runners. DESIGN Descriptive cross-sectional study. SETTING 21.1 km and 56 km Two Oceans Marathon races (2012-2015). PARTICIPANTS 106 743 race entrants completed the online pre-race medical screening questionnaire. A total of 1 314 runners confirmed an accurate hITBS diagnosis. METHODS Selected risk factors associated with hITBS explored included: demographics (race distance, sex, age groups), training/running variables, history of existing chronic diseases (including a composite chronic disease score) and history of any allergy. Prevalence (%) and prevalence ratios (PR; 95% CI) are reported (uni- & multiple regression analyzes). RESULTS 1.63% entrants reported hITBS in a 12-month period. There was a higher (p < 0.0001) prevalence of hITBS in the longer race distance entrants (56 km), females, younger entrants, fewer years of recreational running (PR = 1.07; p = 0.0009) and faster average running speed (PR = 1.02; p = 0.0066). When adjusted for race distance, sex, age groups, a higher chronic disease composite score (PR = 2.38 times increased risk for every two additional chronic diseases; p < 0.0001) and a history of allergies (PR = 1.9; p < 0.0001) were independent risk factors associated with hITBS. CONCLUSION Apart from female sex, younger age, fewer years of running and slower running speed, two novel independent risk factors associated with hITBS in distance runners are an increased number of chronic diseases and a history of allergies. Identifying athletes at higher risk for ITBS can guide healthcare professionals in their prevention and rehabilitation efforts.
Collapse
Affiliation(s)
- Jandre V Marais
- Section Sports Medicine, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
- Sport, Exercise Medicine and Lifestyle Institute (SEMLI), Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
| | | | - Martin P Schwellnus
- Sport, Exercise Medicine and Lifestyle Institute (SEMLI), Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
- Emeritus Professor of Sport and Exercise Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
- International Olympic Committee (IOC) Research Centre, Pretoria, South Africa
| | - Esme Jordaan
- Biostatistics Research Unit, Medical Research Council, Cape Town, South Africa
- Statistics and Population Studies Department, University of the Western Cape, Cape Town, South Africa
| | - Pieter Boer
- Section Sports Medicine, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
- Department of Human Movement Science, Cape Peninsula University of Technology, Wellington, South Africa
| |
Collapse
|
6
|
Cheppalli NS, Purudappa PP, Price R, Kolwadkar Y, Metikala S. Isolated lateral-sided knee pain in total knee arthroplasty. A review. Orthop Rev (Pavia) 2024; 16:93014. [PMID: 38505137 PMCID: PMC10950199 DOI: 10.52965/001c.93014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 01/08/2024] [Indexed: 03/21/2024] Open
Abstract
Isolated lateral-sided knee pain is a unique problem following total knee arthroplasty (TKA). Reported causes include soft tissue impingement against extruded cement, an overhanging tibial tray, remnant osteophytes rubbing against the iliotibial band (ITB), popliteal tendon impingement, fabella syndrome, and synovial tissue impingement in the lateral gutter. In addition, iliotibial band traction syndrome secondary to guided motion Bi-cruciate stabilizing knee arthroplasty has been recognized as a new clinical entity. Initial work up should include ruling out the most common causes of painful TKA including infection, aseptic loosening, and instability. Radiographs and CT scan are utilized to identify potential source of pain. Ultrasound evaluation (with elicited probe tenderness) can increase diagnostic accuracy. Ultrasound guided local anesthetic injections can confirm the source of pain. Anti-inflammatory medications, physical therapy with ITB stretches, and therapeutic local steroid injections are initial treatment modalities. Satisfactory resolution of symptoms may require surgical intervention directed at the specific cause and may avoid the morbidity associated with revision TKA.
Collapse
Affiliation(s)
| | | | - Ryan Price
- Orthopedic Surgery University of New Mexico School of Medicine
| | | | | |
Collapse
|
7
|
Arnal-Burró J, Vidal-Fernández C, Igualada-Blazquez C, Cuervas-Mons M, Martínez-Ayora Á, Santos-Vaquinhas AD. PLAR: a combined percutaneous and arthroscopic treatment for iliotibial band syndrome description of surgical technique and short-term results: description of surgical technique and short-term results. BMC Sports Sci Med Rehabil 2023; 15:151. [PMID: 37950302 PMCID: PMC10636855 DOI: 10.1186/s13102-023-00723-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 09/05/2023] [Indexed: 11/12/2023]
Abstract
INTRODUCTION Description of a new surgical procedure (percutaneous lengthening and arthroscopic release, PLAR) that combines all the possible interventions on the iliotibial band (ITB), and evaluates its outcomes in a group of distance runners diagnosed with ITBS. METHODS A prospective observational study was made of distance runners diagnosed with ITBS and operated upon using the PLAR technique between 1 and 2018 and 31 June 2020. The surgical technique is described in detail, and the demographic data and functional outcomes measured by the sports performance scales Activity Rating Scale (ARS) and International Knee Documentation Committee (IKDC) are presented. RESULTS A total of 14 patients were included, with a mean follow-up of 16 months (range 12-42 months). All the patients resumed their previous sporting activity after an average of 4 (range 2.5-6) months, and no complications were recorded. In all cases, statistically significant improvement was evidenced by the ARS and IKDC scales following PLAR (p < 0.001), with excellent outcomes in 71% of the cases according to the ARS scale and in 86% according to the IKDC scale (mean difference between preoperative and final follow-up scores of 12.1/16 and 34.2/100 points, respectively). CONCLUSION The PLAR technique is effective in allowing a return to previous sports performance levels in a short period of time among patients with ITBS refractory to conservative management, with a high satisfaction rate and the absence of complications.
Collapse
Affiliation(s)
- Juan Arnal-Burró
- Department of Orthopaedic Surgery, University Hospital Gregorio Marañón, C/ Doctor Esquerdo 46, Madrid, 28007, Spain.
| | - Carlos Vidal-Fernández
- Department of Orthopaedic Surgery, University Hospital Gregorio Marañón, C/ Doctor Esquerdo 46, Madrid, 28007, Spain
| | - Cristina Igualada-Blazquez
- Department of Orthopaedic Surgery, University Hospital Gregorio Marañón, C/ Doctor Esquerdo 46, Madrid, 28007, Spain
| | - Manuel Cuervas-Mons
- Department of Orthopaedic Surgery, University Hospital Gregorio Marañón, C/ Doctor Esquerdo 46, Madrid, 28007, Spain
| | - Álvaro Martínez-Ayora
- Department of Orthopaedic Surgery, Torrejón University Hospital. C/ Mateo Inurria, Torrejón de Ardoz, Madrid, 28850, Spain
| | - Alex Dos Santos-Vaquinhas
- Department of Orthopaedic Surgery, University Hospital Gregorio Marañón, C/ Doctor Esquerdo 46, Madrid, 28007, Spain
| |
Collapse
|
8
|
Munday CE, Patel SU, Jain N, Hikmat D, Armstrong T. A rare cause of Hoffa's fat pad impingement: the crossed-doubled patellar tendon. BJR Case Rep 2023; 9:20220049. [PMID: 37928710 PMCID: PMC10621588 DOI: 10.1259/bjrcr.20220049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 05/11/2023] [Accepted: 05/22/2023] [Indexed: 11/07/2023] Open
Abstract
We present an unusual case of Hoffa's fat pad impingement syndrome and chondromalacia patellae in the presence of a rare congenital crossed doubled patellar tendon. The crossed-doubled patellar tendon is exceedingly rare. It's relationship to other conditions involved in anterior knee pain is unclear; however, this case highlights potential pathological associations.
Collapse
Affiliation(s)
- Charlotte E Munday
- Barnet Hospital Radiology Department, Royal Free London NHS Foundation Trust, London, UK
| | - Shreena U Patel
- Barnet Hospital Radiology Department, Royal Free London NHS Foundation Trust, London, UK
| | - Neel Jain
- Barnet Hospital Radiology Department, Royal Free London NHS Foundation Trust, London, UK
| | - Dina Hikmat
- Barnet Hospital Radiology Department, Royal Free London NHS Foundation Trust, London, UK
| | - Thomas Armstrong
- Barnet Hospital Radiology Department, Royal Free London NHS Foundation Trust, London, UK
| |
Collapse
|
9
|
Kloos J, Bellemans J. Outcome of lateral retinacular nerve transection combined with release for recalcitrant iliotibial band friction syndrome. Acta Orthop Belg 2023; 89:417-422. [PMID: 37935223 DOI: 10.52628/89.3.9251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2023]
Abstract
In this retrospective study, a technique consisting in neurolysis of the lateral retinacular nerve combined with a partial release through elliptic excision of the iliotibial band (ITB) is evaluated for efficacy in recalcitrant ITB friction syndrome and compared with results from other techniques reported in literature. From April 2014 to December 2017, 21 patients suffering from recalcitrant ITB friction syndrome were surgically treated with the aforementioned technique. 15 patients (15 knees) were available for a written retrospective reassessment after completion of a follow-up period of at least 12 months. Residual pain was scored using the Visual Analogue Scale (VAS). The functional outcome was evaluated by two patient reported outcome measurement scales (PROMs), the Lysholm and the International Knee Documentation Committee (IKDC) score. Return to sport was analysed by duration of the inactivity period as well as by the Tegner score. Overall satisfaction was evaluated using a modified Boyden scale. At final follow-up of one year, the performed intervention resulted in a pain reduction (VAS 4.2 (1-8) to 1.4 (0-6)) and improved knee function (Lysholm 59.53 to 87.73, IKDC 75) with return to sport (Tegner 4.3 to 5.4) after a median of 23.8 weeks (6 to 52). Twelve patients reported good or excellent results (80%) at final follow-up, and 12 patients (80%) would undergo surgery again, if necessary. The treatment of recalcitrant ITB friction syndrome by combining neurectomy of the lateral retinacular nerve with elliptic excision of the ITB resulted in good to excellent results in 80% of treated cases with return to sport in 93%.
Collapse
|
10
|
Opara M, Kozinc Ž. Stretching and Releasing of Iliotibial Band Complex in Patients with Iliotibial Band Syndrome: A Narrative Review. J Funct Morphol Kinesiol 2023; 8:74. [PMID: 37367238 DOI: 10.3390/jfmk8020074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 06/01/2023] [Accepted: 06/01/2023] [Indexed: 06/28/2023] Open
Abstract
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.
Collapse
Affiliation(s)
- Manca Opara
- Faculty of Health Sciences, University of Primorska, Polje 42, SI-6310 Izola, Slovenia
| | - Žiga Kozinc
- Faculty of Health Sciences, University of Primorska, Polje 42, SI-6310 Izola, Slovenia
- Andrej Marušič Institute, University of Primorska, Muzejski trg 2, SI-6000 Koper, Slovenia
| |
Collapse
|
11
|
Pirri C, Stecco C, Güvener O, Mezian K, Ricci V, Jačisko J, Novotný T, Kara M, Chang KV, Dughbaj M, Jain NB, Özçakar L. EURO-MUSCULUS/USPRM Dynamic Ultrasound Protocols for Knee. Am J Phys Med Rehabil 2023; 102:e67-e72. [PMID: 36729007 DOI: 10.1097/phm.0000000000002173] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
ABSTRACT In this dynamic scanning protocol, ultrasound examination of the knee is described using various maneuvers to assess different conditions. Real-time patient examination and scanning videos are used for better simulation of the daily clinical practice. The protocol is prepared by several/international experts in the field of musculoskeletal ultrasound and within the umbrella of European Musculoskeletal Ultrasound Study Group in Physical and Rehabilitation Medicine/Ultrasound Study Group of the International Society of Physical and Rehabilitation Medicine.
Collapse
Affiliation(s)
- Carmelo Pirri
- From the Department of Neurosciences, Institute of Human Anatomy, University of Padova, Padova, Italy (CP, CS); Mersin University Medical School, Department of Physical and Rehabilitation Medicine, Mersin, Turkey (OG); Department of Rehabilitation Medicine, Charles University, First Faculty of Medicine, Prague, Czech Republic (KM); Physical and Rehabilitation Medicine Unit, Luigi Sacco University Hospital, ASST Fatebenefratelli-Sacco, Milan, Italy (VR); Department of Rehabilitation and Sports Medicine, Second Faculty of Medicine, Charles University and University Hospital Motol, Prague, Czech Republic (JJ); Department of Orthopaedics, University J.E. Purkinje, Masaryk Hospital, Usti nad Labem, Czech Republic (TN); Hacettepe University Medical School, Department of Physical and Rehabilitation Medicine, Ankara, Turkey (MK, LÖ); Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Bei-Hu Branch, Taipei, Taiwan (K-VC); National Taiwan University College of Medicine, Taipei, Taiwan (K-VC); Physical Medicine and Rehabilitation Hospital, Ministry of Health, Kuwait (MD); and Departments of Physical Medicine and Rehabilitation, Orthopaedics, and Population and Data Sciences, University of Texas Southwestern, Dallas, Texas (NBJ)
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
12
|
Park JJ, Lee HS, Kim JH. Effect of Acute Self-Myofascial Release on Pain and Exercise Performance for Cycling Club Members with Iliotibial Band Friction Syndrome. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph192315993. [PMID: 36498062 PMCID: PMC9740901 DOI: 10.3390/ijerph192315993] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Revised: 11/23/2022] [Accepted: 11/25/2022] [Indexed: 05/13/2023]
Abstract
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.
Collapse
Affiliation(s)
- Jong Jin Park
- GYMNOW Fitness, Seoul 04417, Republic of Korea
- Department of Physical Education, College of Performing Arts and Sport, Hanyang University, Seoul 04763, Republic of Korea
| | - Hae Sung Lee
- Department of Physical Education, College of Performing Arts and Sport, Hanyang University, Seoul 04763, Republic of Korea
- BK21 FOUR Human-Tech Convergence Program, Hanyang University, Seoul 04763, Republic of Korea
| | - Jong-Hee Kim
- Department of Physical Education, College of Performing Arts and Sport, Hanyang University, Seoul 04763, Republic of Korea
- BK21 FOUR Human-Tech Convergence Program, Hanyang University, Seoul 04763, Republic of Korea
- Correspondence: ; Tel.: +82-2-2220-1325
| |
Collapse
|
13
|
Moussadikine I, Nguyễn MV, Nich C, Arrigoni PP, Quinette Y, Crenn V. MRI Bone Abnormality of the Knee following Ultrasound Therapy: Case Report and Short Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:14202. [PMID: 36361081 PMCID: PMC9654887 DOI: 10.3390/ijerph192114202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 10/27/2022] [Accepted: 10/28/2022] [Indexed: 06/16/2023]
Abstract
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.
Collapse
Affiliation(s)
- Ismaël Moussadikine
- Orthopedic and Traumatology Unit, Nantes University Hospital, 1 Place Alexis Ricordeau, 44000 Nantes, France
| | - Mỹ-Vân Nguyễn
- Orthopedic and Traumatology Unit, Nantes University Hospital, 1 Place Alexis Ricordeau, 44000 Nantes, France
| | - Christophe Nich
- Orthopedic and Traumatology Unit, Nantes University Hospital, 1 Place Alexis Ricordeau, 44000 Nantes, France
- INSERM, UMRS 1229, Regenerative Medicine and Skeleton (RMeS), Nantes Université, ONIRIS, 44042 Nantes, France
| | - Pierre-Paul Arrigoni
- Radiology Department, Nantes University Hospital, 1 Place Alexis Ricordeau, 44000 Nantes, France
| | - Yonis Quinette
- Orthopedic and Traumatology Unit, Nantes University Hospital, 1 Place Alexis Ricordeau, 44000 Nantes, France
| | - Vincent Crenn
- Orthopedic and Traumatology Unit, Nantes University Hospital, 1 Place Alexis Ricordeau, 44000 Nantes, France
- CRCI2NA (Centre de Recherche en Cancérologie et Immunologie Nantes-Angers), INSERM UMR 1307, CNRS UMR 6075-Team 9 CHILD (Chromatin and Transcriptional Deregulation in Pediatric Bone Sarcoma), Nantes Université, 1 rue Gaston Veil, 44035 Nantes, France
| |
Collapse
|
14
|
GÜNEY B, ÖZDEMİR MY, DOĞAN E. Evaluation of iliotibial band volume with 3T MRI. JOURNAL OF HEALTH SCIENCES AND MEDICINE 2022. [DOI: 10.32322/jhsm.1132039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Aim: The aim of our study is to evaluate the iliotibial band thickness (ITBT) and volume (ITBV) according to age and gender with 3 T MRI in a healthy Turkish population.
Material and Method: In the current study, 150 patients who had knee MRI were retrospectively evaluated. They were divided into the following groups to examine the effects of age: group 1: 18–30 years old; group 2: 31–40 years old; group 3: 41–50 years old; and group 4: 51–60 years old. ITBV measurements were performed on axial T2-weighted knee MR images.
Results: The mean age was 42.2±29.6 (range 18-60) years. The mean ITBT was 1.76±0.22 mm and the mean ITBV was 20,24±1,44 mm3 in all patients. There was statistically significant difference in mean iliotibial band thickness and volume between genders (p=0.001; p=0.001). There were no statistically significant differences in mean iliotibial band thickness and volume values between the groups in the one-way ANOVA test (p >0.05).
Conclusion: Radiological studies on iliotibial band thickness and band area in healthy individuals are new in the literature. This study is the first radiological study in which the volume of the iliotibial band was measured in healthy individuals and was performed on a 3 tesla MR device. Also, it is the first study that is used artificial intelligence for iliotibial band evaluation and the technic is effective and more rapid according to our experience. ITBV and ITBT are statistically significantly higher in males than females. Most thick ITB was detected between the ages of 31-40. The values of our study, especially ITBT, differ from previous studies and the values are altered in a wide range. Therefore, standardization in the calculation is necessary. This topic is open to future research.
Collapse
Affiliation(s)
| | | | - Emrah DOĞAN
- Muğla Sıtkı Koçman Üniversitesi,Tıp Fakültesi
| |
Collapse
|
15
|
Okamura H, Ishikawa H, Ohno T, Fujita S, Yamakami S, Inagaki K. Arthroscopic Osteophyte Resection for Osteophyte-Induced Popliteal Impingement. Arthrosc Tech 2022; 11:e1883-e1887. [PMID: 36457389 PMCID: PMC9705398 DOI: 10.1016/j.eats.2022.06.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Accepted: 06/30/2022] [Indexed: 11/23/2022] Open
Abstract
Popliteal tendinitis causes lateral knee pain. A cause is impingement of the popliteal tendon by lateral femoral condylar osteophytes. Conservative and surgical treatments have been reported; however, popliteal impingement is a relatively rare disease, and no treatment has been established. Reduction of mechanical stress is important in the treatment of impingement syndromes. The popliteal tendon is an important tissue that contributes to knee stability and, therefore, usually cannot be transected. On the other hand, osteophyte resection may allow the reduction of mechanical stress. Therefore, we describe an arthroscopic osteophyte resection technique for the treatment of osteophyte-induced popliteal impingement. In brief, this technique involves confirmation of popliteal impingement, osteophyte resection using an osteotome, smoothening of the resected area, and confirmation of the resolution of popliteal impingement.
Collapse
Affiliation(s)
- Hiroki Okamura
- Department of Orthopaedic Surgery, Nippon Koukan Hospital, Kanagawa, Japan,Address correspondence to Hiroki Ishikawa, M.D., Ph.D., Department of Orthopaedic Surgery, Nippon Koukan Hospital, 1-2-1 Koukandori, Kawasaki-ku, Kanagawa, 210-0852, Japan.
| | - Hiroki Ishikawa
- Department of Orthopaedic Surgery, Nippon Koukan Hospital, Kanagawa, Japan
| | - Takuya Ohno
- Department of Orthopaedic Surgery, Nippon Koukan Hospital, Kanagawa, Japan
| | - Shogo Fujita
- Department of Orthopaedic Surgery, Nippon Koukan Hospital, Kanagawa, Japan
| | - Shigeo Yamakami
- Department of Orthopaedic Surgery, Nippon Koukan Hospital, Kanagawa, Japan
| | - Katsunori Inagaki
- Department of Orthopaedic Surgery, Showa University School of Medicine, Tokyo, Japan
| |
Collapse
|
16
|
Narducci DM, Taylor WC, Montero DP, Maynard JR, Nguyen CQ, Cudahy R, Pujalte G. Is There a Correlation Between Reported Knee Pain and Fluid at the Distal Insertion of the Iliotibial Band in Runners? Cureus 2022; 14:e28116. [PMID: 36134044 PMCID: PMC9481265 DOI: 10.7759/cureus.28116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/17/2022] [Indexed: 11/05/2022] Open
Abstract
Objective To determine whether there is a correlation between pain and the amount of fluid present at the distal insertion of the iliotibial band (ITB) in runners, as measured by USG. Method Our retrospective cross-sectional study evaluated 100 male and female runners prior to the start of a race. A valid and reliable questionnaire collected demographic, pain, and training data. If a runner reported knee pain, a numeric pain rating scale was used to record the degree of pain. Participants then underwent USG on both knees to determine the presence or absence of fluid at the distal insertion of the ITB. Result We found no statistically significant correlations of fluid measurements with pain score, running experience in years, or age. In addition, we found no other differences in fluid measurements between those with and without knee pain or between the sexes. Conclusions Our findings indicate that the presence or absence of fluid at the distal insertion of the ITB does not correlate with knee pain in runners, regardless of age, running experience, or sex.
Collapse
|
17
|
Intraobserver Assessment of Shear Wave Elastography in Tensor Fasciae Latae and Gluteus Maximus Muscle: The Importance of the Hip Abductor Muscles in Runners Knee Compared to Healthy Controls. J Clin Med 2022; 11:jcm11133605. [PMID: 35806887 PMCID: PMC9267262 DOI: 10.3390/jcm11133605] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Revised: 05/31/2022] [Accepted: 06/20/2022] [Indexed: 02/05/2023] Open
Abstract
Background: Iliotibial band syndrome (ITBS) represents one of the most common running related injuries. The pathophysiology is postulated to be caused by excessive ITB tension, impingement and irritation of soft tissues at the lateral femoral epicondyle. However, direct evidence has yet to be found and the multifactorial etiology is under discussion. The purpose was to evaluate stiffness of ITB, gluteus maximus (GM) and tensor fasciae latae (TFL) muscles using shear wave elastography (SWE). Methods: In 14 patients with clinically verified ITBS and 14 healthy controls, three SWE measurements each of ITB, GM and TFL in both legs was performed to determine measurement reliability and between-group and -leg differences. Results: The mean value of ITB was 12.8 m/s with ICC of 0.76, whereas the values measured in the GM were 3.02 m/s with an ICC of 0.87. No statistically significant difference in controls compared to patients were found (p = 0.62). The mean value of TFL was 5.42 m/s in healthy participants, compared to 3.89 m/s patients with an ICC of 0.98 (p = 0.002). Conclusion: Although SWE showed no difference in ITB stiffness, significant differences for TFL muscle stiffness in runner’s knee was found, suggesting that the hip abductor muscles might play a bigger role in the pathophysiology of ITBS. We aimed to implement baseline values for stiffness assessments and prove reliability for further prospective studies of SWE in runner’s knee.
Collapse
|
18
|
Pharis H, Kong A, Robbins M, Waranch C, Wissman R. Friction Syndromes of the Knee. J Knee Surg 2022; 35:491-497. [PMID: 35189665 DOI: 10.1055/s-0042-1743222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The knee is a complex joint with many fascial and ligamentous interactions. The movement in multiple planes makes the knee a prime site for friction syndromes, especially in active individuals. The most common friction syndrome is the iliotibial band friction syndrome. This occurs commonly in runners and cyclists and can be diagnosed clinically in a patient with lateral knee pain during activity. The anterior fat pads of the knee can also be the site of friction syndromes, most often in the Hoffa fat pad. Edema here can be located in the superolateral aspect of the fat pad when associated with patellar abnormalities, or diffusely when impingement is due to other causes. Edema of the quadriceps or prefemoral fat pad may also cause anterior knee pain and may be diagnosed with magnetic resonance imaging. The posteromedial friction syndrome and medial tibial crest syndrome are rare causes of medial knee pain highly active individuals.
Collapse
Affiliation(s)
- Hunter Pharis
- Department of Medical Education, Heritage College of Osteopathic Medicine, Ohio University, Dublin, Ohio
| | - Andrew Kong
- Department of Radiology, University of Missouri System, Columbia, Missouri
| | - Mike Robbins
- Department of Radiology, University of Missouri System, Columbia, Missouri
| | - Christy Waranch
- Department of Radiology, University of Missouri System, Columbia, Missouri
| | - Robert Wissman
- Department of Radiology, University of Missouri System, Columbia, Missouri
| |
Collapse
|
19
|
Friede MC, Innerhofer G, Fink C, Alegre LM, Csapo R. Conservative treatment of iliotibial band syndrome in runners: Are we targeting the right goals? Phys Ther Sport 2021; 54:44-52. [PMID: 35007886 DOI: 10.1016/j.ptsp.2021.12.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 12/23/2021] [Accepted: 12/23/2021] [Indexed: 10/19/2022]
Abstract
OBJECTIVE Iliotibial band syndrome (ITBS) is presumably caused by excessive tension in the iliotibial band (ITB) leading to compression and inflammation of tissues lying beneath it. Usually managed conservatively, there is a lack of scientific evidence supporting the treatment recommendations, and high symptom recurrence rates cast doubt on their causal effectiveness. This review discusses the influence of common physiotherapeutic measures on risk factors contributing to tissue compression beneath the ITB. METHODS The potential pathogenic factors are presented on the basis of a simple biomechanical model showing the forces acting on the lateral aspect of the knee. Existent literature on the most commonly prescribed physiotherapeutic interventions is critically discussed against the background of this model. Practical recommendations for the optimization of physiotherapy are derived. RESULTS According to biomechanical considerations, ITBS may be promoted by anatomical predisposition, joint malalignments, aberrant activation of inserting muscles as well as excessive ITB stiffness. Hip abductor strengthening may correct excessive hip adduction but also increase ITB strain. Intermittent stretching interventions are unlikely to change the ITB's length or mechanical properties. Running retraining is a promising yet understudied intervention. CONCLUSIONS High-quality research directly testing different physiotherapeutic treatment approaches in randomized controlled trials is needed.
Collapse
Affiliation(s)
- Miriam C Friede
- Carinthia University of Applied Sciences, Department of Physiotherapy, Klagenfurt, Austria.
| | - Gunnar Innerhofer
- University of Innsbruck, Department of Sport Science, Innsbruck, Austria
| | - Christian Fink
- Gelenkpunkt Sports and Joint Surgery, Innsbruck, Austria; University for Health Sciences, Medical Informatics and Technology, Research Unit for Orthopaedic Sports Medicine and Injury Prevention, Hall, Austria
| | - Luis M Alegre
- University of Castilla-La Mancha, GENUD Toledo Research Group, Toledo, Spain; CIBER of Frailty and Healthy Aging (CIBERFES), Madrid, Spain
| | - Robert Csapo
- University of Vienna, Department of Sport Science, Vienna, Austria
| |
Collapse
|
20
|
Li J, Sheng B, Qiu L, Yu F, Lv FJ, Lv FR, Yang H. A quantitative MRI investigation of the association between iliotibial band syndrome and patellofemoral malalignment. Quant Imaging Med Surg 2021; 11:3209-3218. [PMID: 34249647 DOI: 10.21037/qims-20-1101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2020] [Accepted: 03/10/2021] [Indexed: 11/06/2022]
Abstract
Background The iliotibial band (ITB) has a wide patellar insertion that provides lateral restraint to the patella and maintains the patellofemoral joint's stability. There has been limited investigation into the relationship between patellofemoral malalignment and iliotibial band syndrome (ITBS). Methods We retrospectively analyzed 47 knees with ITBS by retrieving magnetic resonance imaging (MRI) data collected over an approximately 6-year period from our database. The Insall-Salvati ratio, lateral patellofemoral angle (LPA), lateral patellar tilt (LPT), lateral trochlear length (LTL), angle of the non-weight-bearing facet of the lateral femoral condyle (nwb-LFCA), and the ITB-lateral femoral condyle (IT-LFC) distance were measured on MR images. The knees of 47 age- and gender-matched subjects were enrolled as the normal group. Results In the ITBS group, over one third (34%, 16/47) of knees had abnormal patellofemoral measurements, including 8 (17%, 8/47) knees with patellar alta, 11 (23.4%, 11/47) knees with an abnormally decreased LPA, and 5 (10.6%, 5/47) knees with an abnormally increased LPT indicating lateral patellar tilt. Moreover, 8 knees had simultaneous combinations of two or three abnormality parameters, and 8 (17%, 8/47) knees presented with superolateral Hoffa's fat pad edema. The Insall-Salvati ratio, LPT, and nwb-LFCA in the ITBS group were significantly higher than those in the normal group (P=0.001, P<0.001, and P<0.001, respectively); the LPA and IT-LFC distances in the ITBS group were significantly lower (P=0.003, P<0.001, respectively) than those in the normal group. There were mild to moderate correlations between the MRI parameters and ITBS (P=0.006, P<0.001, respectively). Conclusions This study confirmed that a higher position or lateral tilt of the patella and a steeper morphology of the anterior part of the lateral femoral condyle were associated with the development of ITBS, which is helpful in understanding and further exploring the mechanism of ITBS.
Collapse
Affiliation(s)
- Jia Li
- Department of Radiology, the First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Bo Sheng
- Department of Radiology, the First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Lanyu Qiu
- Department of Radiology, the First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Fan Yu
- Department of Radiology, the First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Fa-Jin Lv
- Department of Radiology, the First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Fu-Rong Lv
- Department of Radiology, the First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Haitao Yang
- Department of Radiology, the First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| |
Collapse
|
21
|
Ultrasound-guided release for iliotibial band syndrome: A novel ultraminimally invasive surgical procedure. Knee 2021; 30:9-17. [PMID: 33784536 DOI: 10.1016/j.knee.2021.02.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Revised: 02/01/2021] [Accepted: 02/15/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND Iliotibial band (ITB) syndrome is the most common cause of lateral knee pain in runners (affecting 7-14%) and in persons taking part in other sports. The aim of this study was to show how to perform a distal release of the ITB guided by ultrasound and present our initial results with this new technique. METHODS The surgical technique - either Z-plasty or transverse section of the ITB - was first validated on 14 cadaver specimens and then applied in clinical practice. We operated on 32 patients (27 males and five females, 34 cases) from 2013 to 2018. Mean age was 40 years (25-60). The patients comprised 21 recreational middle- or long-distance runners (23 cases), five cyclists, two basketball players, two military personnel, one fireman, and one boxer. RESULTS All patients were satisfied after 3 months and returned to their sporting activities without restrictions. The visual analog scale score for the practice of sports activities improved from 7 (6-9) before surgery to 0 (0-1) after. The average Lysholm score was 68 points before surgery and 97 (91-100) after, with five good results and 29 excellent results. No patients complained of instability or muscle weakness after 3 months. CONCLUSION Ultrasound-guided release of the ITB is a novel minimally aggressive surgical approach that potentially enables faster recovery. It is relatively easy, quick, and painless, with a small incision, and can be performed under local anaesthesia in an outpatient setting. It does not require limb exsanguination or stitches, and complications are minimal.
Collapse
|
22
|
Pepper TM, Brismée JM, Sizer PS, Kapila J, Seeber GH, Huggins CA, Hooper TL. The Immediate Effects of Foam Rolling and Stretching on Iliotibial Band Stiffness: A Randomized Controlled Trial. Int J Sports Phys Ther 2021; 16:651-661. [PMID: 34123517 PMCID: PMC8169023 DOI: 10.26603/001c.23606] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Accepted: 10/10/2020] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Iliotibial Band Syndrome (ITBS) is a common clinical condition likely caused by abnormal compressive forces to the iliotibial band (ITB). Stretching interventions are common in ITBS treatment and may predominantly affect tensor fascia latae (TFL). Another ITBS treatment is foam rolling, which may more directly affect the ITB. Shear wave ultrasound elastography (SWUE) measures real-time soft tissue stiffness, allowing tissue changes to be measured and compared. PURPOSE To examine effects of foam rolling and iliotibial complex stretching on ITB stiffness at 0˚ and 10˚ of hip adduction and hip adduction passive range of motion (PROM). STUDY DESIGN Randomized controlled trial. METHODS Data from 11 males (age = 30.5 ± 9.0 years, Body Mass Index (BMI) = 27.8 ± 4.0) and 19 females (age = 23.5 ± 4.9, BMI = 23.2 ± 2.1) were analyzed for this study. Subjects were randomly assigned to one of three groups: control, stretching, and foam rolling. Shear wave ultrasound elastography measurements included ITB Young's modulus at the mid-thigh, the distal femur and the TFL muscle belly. ITB-to-femur depth was measured at mid-thigh level. Hip adduction PROM was measured from digital images taken during the movement. RESULTS No significant interactions or main effects were found for group or time differences in ITB Young's modulus at the three measured locations. The ITB stiffness at the mid-thigh and distal femur increased with 10° adduction, but TFL stiffness did not increase. A main effect for adduction PROM was observed, where PROM increased 0.8˚ post-treatment (p = 0.02). CONCLUSION A single episode of stretching and foam rolling does not affect short-term ITB stiffness. The lack of ITB stiffness changes may be from an inadequate intervention stimulus or indicate that the interventions have no impact on ITB stiffness. LEVELS OF EVIDENCE 1b.
Collapse
Affiliation(s)
- Talin M Pepper
- Texas Tech University Health Sciences Center, Lubbock, TX
| | | | | | | | - Gesine H Seeber
- Center for Rehabilitation Research, School of Health Professions, Texas Tech University Health Sciences Center, Lubbock, TX; University Hospital for Orthopaedics and Trauma Surgery Pius-Hospital, Medical Campus University of Oldenburg, Oldenburg, Germany; Department of Orthopedics, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Christopher A Huggins
- Texas Tech University Health Sciences Center, Lubbock, TX; Lubbock Christian University, Lubbock, TX
| | - Troy L Hooper
- Texas Tech University Health Sciences Center, Lubbock, TX
| |
Collapse
|
23
|
Scheer V, Krabak BJ. Musculoskeletal Injuries in Ultra-Endurance Running: A Scoping Review. Front Physiol 2021; 12:664071. [PMID: 33868030 PMCID: PMC8044296 DOI: 10.3389/fphys.2021.664071] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Accepted: 03/12/2021] [Indexed: 02/05/2023] Open
Abstract
Ultra-endurance running (UER) has seen an important increase in participation over the last few decades. Long hours of UER can lead to excessive stress on the body, resulting in musculoskeletal injuries (MSKI). UER is not a uniform sport and events can differ considerably in distance (over 42.195 km), time (e.g., events over 6 h) and multi-day or multi-stage events on various surfaces (e.g., track, on-road, off-road). The aims of this scoping review were therefore: (1) to examine the current evidence of MSKI, providing a synthesis of the most common MSKI by anatomical region and specific diagnosis; (2) categorize MSKI by type of UER activity (competition: time-limited; multi-stage; continuous UER events and training); (3) describe knowledge gaps in the literature and provide advice on potential further research. Our electronic literature search (PubMed, SPORTDiscus, Web of Science) identified a total of 13 studies (9 in competition, and 4 in training). Anatomical site, diagnosis and rate of injuries differ between competition and training as well as between different UER types. MSKI are observed in 18% of multi-stage events (0.7-1.8 injuries/runner and 7.2 injuries/1000 h). Most MSKI involve the lower leg (35.0%), ankle (16.8%), knee (13.1%) and foot (12.6%), with main diagnosis of medial tibial stress syndrome (30.1%) and patella femoral pain syndrome (PFPS; 7.2%). Single, continuous UER events differ between a 1005 km road race with almost all of the injuries due to overuse, with the main anatomical site of the knee (31%), ankle (28%) and lower leg (14%) and main diagnosis of PFPS (15.6%), compared to a 65 km trail race, with 32.8% of MSKI, mainly on the foot [plantar fasciitis (28.6%)], ankle [sprain (28.6%)] and knee. Timed-UER events (injury rate of 2.1 injuries/athlete) observed most injuries on the ankle (36%) and knee (19%), with the main diagnosis of tendinitis of the foot dorsiflexors (30%). Injuries during training most commonly affect, the back (42%), and knee (40%) and bone stress injuries (22%). Main diagnoses include ankle sprain (18%), iliotibial band injury (16%) and Achilles tendinopathy (11%). Future considerations include examining MSKI in different UER events, environments and surfaces, and on larger study populations. Establishing risk factors, examining sex differences and using a standard reporting system of MSKI in UER are also important.
Collapse
Affiliation(s)
- Volker Scheer
- Ultra Sports Science Foundation, Pierre-Bénite, France
| | - Brian J Krabak
- University of Washington and Seattle Children's Sports Medicine, Seattle, WA, United States
| |
Collapse
|
24
|
D'Amico A, Silva K, Gallo J. Time Course of Acute Hip Adduction Range of Motion Changes Following Foam Rolling. Int J Sports Phys Ther 2021; 16:431-437. [PMID: 33842038 PMCID: PMC8016434 DOI: 10.26603/001c.21417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Accepted: 10/10/2020] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND With the increased popularity of foam rolling (FR), it is important to establish the exact manner in which the practice is useful. PURPOSE The purpose of this study was to examine the impact of FR the iliotibial (IT) band on hip adduction range of motion (ROM) and the short-term time course of any ROM changes that may occur. METHOD In a within-subject design, 34 subjects (21 female, 13 male) (female mean age 24.67 ± 8.6 yrs, height 161.4 ± 9.8 cm, mass 67.3 ± 12.3 kg; male mean age 22 ± 2.5 yrs, height 170.2 ± 8.2 cm, mass 76.3 ± 21.9 kg) underwent a baseline Ober's test to measure hip adduction ROM prior to the FR and control conditions. Subjects rolled the lateral portion of each thigh for 3 bouts of 20 seconds. A tempo of 3 seconds down and 3 seconds up the leg was maintained across FR bouts. A 5-minute walk served as the control condition. The Ober's test was repeated at less than 1 minute, 3 minutes, 10 minutes, 15 minutes, and 20 minutes following the FR bouts and the control to assess changes in hip adduction ROM over time. A blinded clinician conducted the Ober's test. A two-way analysis of variance was used to assess differences by condition and time. RESULTS No differences in hip adduction ROM were found at baseline between FR and CON within subjects (27.9 cm ± 7.5 vs. 27.7 cm ± 6.6, p > .05). Ober's test ROM was significantly greater in FR compared to CON immediately post-treatment (24.2 cm ± 6.3 vs. 28.2 cm ± 6.3, p = .00, d = .59), and 3 minutes post (24.6 cm ± 7.6 vs. 28.3 cm ± 5.9, p = .00, d = .56). No differences were observed 10 minutes post, 15 minutes post, or 20 minutes post FR or CON (p > .05). DISCUSSION Compared to walking, FR the IT band significantly increased hip adduction ROM as measured by the Ober's test. These increases appear to dissipate between 3 and 10 minutes post-FR. CONCLUSION An acute bout of 3 sets of 20 seconds of FR may be effective for transiently increasing ROM. Whether these short-term increases have implications for chronic flexibility changes is unclear. LEVEL OF EVIDENCE 2.
Collapse
|
25
|
Park J, Cho HR, Kang KN, Choi KW, Choi YS, Jeong HW, Yi J, Kim YU. The role of the iliotibial band cross-sectional area as a morphological parameter of the iliotibial band friction syndrome: a retrospective pilot study. Korean J Pain 2021; 34:229-233. [PMID: 33785675 PMCID: PMC8019960 DOI: 10.3344/kjp.2021.34.2.229] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 12/16/2020] [Accepted: 01/07/2021] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Iliotibial band friction syndrome (ITBFS) is a common disorder of the lateral knee. Previous research has reported that the iliotibial band (ITB) thickness (ITBT) is correlated with ITBFS, and ITBT has been considered to be a key morphologic parameter of ITBFS. However, the thickness is different from inflammatory hypertrophy. Thus, we made the ITB cross-sectional area (ITBCSA) a new morphological parameter to assess ITBFS. METHODS Forty-three patients with ITBFS group and from 43 normal group who underwent T1W magnetic resonance imaging were enrolled. The ITBCSA was measured as the cross-sectional area of the ITB that was most hypertrophied in the magnetic resonance axial images. The ITBT was measured as the thickest site of ITB. RESULTS The mean ITBCSA was 25.24 ± 6.59 mm2 in the normal group and 38.75 ± 9.11 mm2 in the ITBFS group. The mean ITBT was 1.94 ± 0.41 mm in the normal group and 2.62 ± 0.46 mm in the ITBFS group. Patients in ITBFS group had significantly higher ITBCSA (P < 0.001) and ITBT (P < 0.001) than the normal group. A receiver operator characteristic curve analysis demonstrated that the best cut-off value of the ITBT was 2.29 mm, with 76.7% sensitivity, 79.1% specificity, and area under the curve (AUC) 0.88. The optimal cut-off score of the ITBCSA was 30.66 mm2, with 79.1% sensitivity, 79.1% specificity, and AUC 0.87. CONCLUSIONS ITBCSA is a new and sensitive morphological parameter for diagnosing ITBFS, and may even be more accurate than ITBT.
Collapse
Affiliation(s)
- Jiyeon Park
- Department of Anesthesiology and Pain Medicine, International St. Mary’s Hospital, Catholic Kwandong University College of Medicine, Incheon, Korea
| | - Hyung Rae Cho
- Department of Anesthesiology and Pain Medicine, Myongji Hospital, Hanyang University College of Medicine, Goyang, Korea
| | - Keum Nae Kang
- Department of Anesthesiology and Pain Medicine, National Police Hospital, Seoul, Korea
| | - Kun Woong Choi
- Department of Anesthesiology and Pain Medicine, National Police Hospital, Seoul, Korea
| | - Young Soon Choi
- Department of Anesthesiology and Pain Medicine, International St. Mary’s Hospital, Catholic Kwandong University College of Medicine, Incheon, Korea
| | - Hye-Won Jeong
- Department of Anesthesiology and Pain Medicine, International St. Mary’s Hospital, Catholic Kwandong University College of Medicine, Incheon, Korea
| | - Jungmin Yi
- Department of Anesthesiology and Pain Medicine, International St. Mary’s Hospital, Catholic Kwandong University College of Medicine, Incheon, Korea
| | - Young Uk Kim
- Department of Anesthesiology and Pain Medicine, International St. Mary’s Hospital, Catholic Kwandong University College of Medicine, Incheon, Korea
| |
Collapse
|
26
|
Martinez-Velez A, Suwan P, Dua A. Iliotibial band syndrome in non-athletes. Minerva Anestesiol 2020; 86:1111-1112. [DOI: 10.23736/s0375-9393.20.14194-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
|
27
|
Jiménez Díaz F, Gitto S, Sconfienza LM, Draghi F. Ultrasound of iliotibial band syndrome. J Ultrasound 2020; 23:379-385. [PMID: 32514741 DOI: 10.1007/s40477-020-00478-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Accepted: 05/09/2020] [Indexed: 12/29/2022] Open
Abstract
Iliotibial band syndrome or friction syndrome is an overuse disorder of the lateral knee. It is commonly reported in athletes, such as runners and cyclists, and refers to pain related to physical activity. The diagnosis is based on clinical history and physical assessment. Imaging, including ultrasound, is mainly performed in recurrent or refractory cases. The purpose of this paper is to review the etiology, diagnosis, and therapy of iliotibial band syndrome with a focus on ultrasound imaging and ultrasound-guided treatment. Ultrasound findings include soft-tissue edematous swelling or discrete fluid collection, suggestive of bursitis, between the iliotibial band and the lateral femoral epicondyle. The thickening of the iliotibial band has been inconsistently reported. Treatment varies according to the disease phase and, in the acute phase, consists of rest, physical therapy, and anti-inflammatory medications. Ultrasound-guided local steroid injections are effective in relieving symptoms.
Collapse
Affiliation(s)
- Fernando Jiménez Díaz
- Sport Sciences Faculty, Castilla La Mancha University, Toledo, Spain
- San Antonio Catholic University (UCAM), Murcia, Spain
| | - Salvatore Gitto
- Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Via Luigi Mangiagalli 31, 20133, Milan, Italy.
| | - Luca Maria Sconfienza
- Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Via Luigi Mangiagalli 31, 20133, Milan, Italy
- IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
| | - Ferdinando Draghi
- Istituto di Radiologia, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| |
Collapse
|
28
|
Magnetic resonance imaging of impingement and friction syndromes around the knee. Skeletal Radiol 2020; 49:823-836. [PMID: 31993687 DOI: 10.1007/s00256-020-03379-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Revised: 01/11/2020] [Accepted: 01/16/2020] [Indexed: 02/02/2023]
Abstract
The knee is a complex joint with its function dependent on a combination of osseous and soft tissue structures. Alteration in the relationship of these tissues, due to either acute or chronic repetitive injury with possible underlying congenital predisposing factors, can result in impingement between the structures resulting in pain, particularly on activity. The purpose of this article is to provide a comprehensive review of the MRI features of various impingement syndromes around the knee.
Collapse
|
29
|
McKay J, Maffulli N, Aicale R, Taunton J. Iliotibial band syndrome rehabilitation in female runners: a pilot randomized study. J Orthop Surg Res 2020; 15:188. [PMID: 32448384 PMCID: PMC7247177 DOI: 10.1186/s13018-020-01713-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Accepted: 05/13/2020] [Indexed: 01/15/2023] Open
Abstract
Background Iliotibial band syndrome (ITBS) carries marked morbidity in runners. Its management is not standardized and lacks evidence base. We evaluated the effectiveness of three different exercises programs in reducing ITBS symptoms. Methods Patients were divided into three equal treatment groups: ITB stretching (group A), conventional exercise (group B), and experimental hip strengthening exercise (group C). Numeric pain rating scale (NPRS; every week), lower extremity functional scale (LEFS; every 2 weeks), dynamometer (DN; weeks 0, 2, 4, 6, 8), single-limb mini squat (SLMS; week 0, 8), and Y-balance test™ (YBT), between and within group’s differences were evaluated using ANOVA model. Results Twenty-four female runners (age 19–45 years) were included into one of three groups (A, B, and C). Statistical significance (p < 0.05) within group C was observed for composite YBT and DN for injured and non-injured leg, the YBT (injured leg for the posterior medial), LEFS, NPRS, and the SLMS. Statistical significance (p < 0.05) was found between group A and group C. The stretching group exhibited statistically significant (p < 0.05) YBT anterior reach for the injured/non-injured leg and the LEFS. Conclusion There were no statistical differences between the three groups. The subjects who underwent experimental hip strengthening exercises consistently showed improvements in outcome measures, and never scored less than the other two groups. Trial registration ClinicalTrials.gov identifier (NCT number): NCT0229615
Collapse
Affiliation(s)
- Janine McKay
- Emirates Integra Medical and Surgery Centre, Dubai, UAE
| | - Nicola Maffulli
- Department of Musculoskeletal Disorders, School of Medicine and Surgery, University of Salerno, Salerno, Italy. .,Clinica Ortopedica, Ospedale San Giovanni di Dio e Ruggi D'Aragona, 84131, Salerno, Italy. .,Queen Mary University of London, Barts and the London School of Medicine and Dentistry, Centre for Sports and Exercise Medicine, Mile End Hospital, 275 Bancroft Road, London, E1 4DG, England. .,School of Pharmacy and Bioengineering, Keele University School of Medicine, Thornburrow Drive, Stoke on Trent, England.
| | - Rocco Aicale
- Department of Musculoskeletal Disorders, School of Medicine and Surgery, University of Salerno, Salerno, Italy.,Clinica Ortopedica, Ospedale San Giovanni di Dio e Ruggi D'Aragona, 84131, Salerno, Italy
| | - Jack Taunton
- Allan McGavin Sports Medicine Centre, Vancouver, BC, Canada.,Fortius Institute, Burnaby, BC, Canada
| |
Collapse
|
30
|
Abstract
Each year increasing numbers of people participate in a wider variety of athletic endeavors. Unlike previous generations, many patients remain in these activities later into their lives, some well beyond retirement. As the population ages and their activities continue, they are subject to injury of various forms affecting all aspects of their bodies.
Collapse
Affiliation(s)
| | - Christina Lin
- Department of Physical Medicine and Rehabilitation, Johns Hopkins School of Medicine, Baltimore, MD, USA
| |
Collapse
|
31
|
Who Wants to be IT: An Underappreciated Cause of Lateral Thigh Pain and Paresthesias. Can J Neurol Sci 2020. [DOI: 10.1017/cjn.2019.336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
|
32
|
Abstract
Pain is often the initial complaint for which patients seek medical care, presenting both a diagnostic and therapeutic challenge to the primary care provider. The appreciation of pain is not merely the result of abnormal sensory stimulation causing an unpleasant sensation but rather a combination of the recognition of the somatic discomfort in association with an emotional response to that discomfort. The perception of pain and the extent of distress and disability can vary depending on previous experience, cultural background, situational factors, and comorbid psychiatric disease. Though acute pain is usually the result of tissue damage, this is not always the case, as evidenced by primary headache disorders. Chronic pain may be the result of an injury, irreversible underlying disease, or clinical conditions such as fibromyalgia for which the mechanism remains unclear. Treatment of the underlying cause will usually effect a resolution or improvement in the pain, but when the discomfort persists, a consultation with a neurologist or pain management specialist should be considered.
Collapse
Affiliation(s)
- Victor C Wang
- Department of Neurology, Department of Anesthesia, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass.
| | - William J Mullally
- Graham Headache Center, Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass
| |
Collapse
|
33
|
Everhart JS, Kirven JC, Higgins J, Hair A, Chaudhari AAMW, Flanigan DC. The relationship between lateral epicondyle morphology and iliotibial band friction syndrome: A matched case-control study. Knee 2019; 26:1198-1203. [PMID: 31439366 DOI: 10.1016/j.knee.2019.07.015] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Revised: 07/23/2019] [Accepted: 07/27/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND Iliotibial band friction syndrome (ITBFS) is an overuse injury with pain at the level of the knee lateral epicondyle. We sought to determine whether there is greater knee lateral epicondyle prominence among patients with ITBFS versus matched controls. METHODS Seventy five patients with ITBFS and 75 age-, height-, and sex-matched controls (n = 150 total patients) with knee magnetic resonance imaging from 2015 to 2017 were included. All cases had a diagnosis of ITBFS and a lack of other identified lateral knee injuries on magnetic resonance imaging. Controls had medial knee pain with medial meniscus tear on MRI and no clinical evidence of ITBFS. Lateral knee epicondyle height in millimeters was measured. RESULTS Mean patient age was 39.1 years (SD 15.1), 57% were female, and mean height was 170.0 cm (SD 9.3) with no difference between cases and controls. Mean lateral epicondyle height for cases was 13.1 mm (SD 1.6) and for controls was 12.2 (SD 1.4) with a mean difference of 0.9 mm (95% CI 0.4-1.3 mm) between matched pairs (p < 0.001). Mean epicondyle height:condylar AP width ratio was 0.211 (SD 0.023) for cases and 0.198 (SD 0.020) for controls with a mean difference of 0.013 (95% CI 0.006-0.020) between matched pairs (p < 0.001). CONCLUSIONS There is a significant association between greater lateral epicondyle prominence and IT band friction syndrome, suggesting another anatomic risk factor for this multifactorial condition.
Collapse
Affiliation(s)
- Joshua S Everhart
- Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, OH, United States of America
| | - James C Kirven
- Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, OH, United States of America
| | - John Higgins
- Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, OH, United States of America
| | - Andrew Hair
- Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, OH, United States of America
| | - Ajit A M W Chaudhari
- Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, OH, United States of America
| | - David C Flanigan
- Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, OH, United States of America.
| |
Collapse
|
34
|
Abstract
Hip and knee injuries are a common presenting concern for patients to a primary care office. This pathology represents a large differential and it can often be a diagnostic challenge for providers to determine the etiology of a patient's symptoms. This article discusses several of the most common causes for hip and knee pain while providing an evidence based review of physical examination maneuvers, imaging studies and treatment modalities to assist a primary care provider when encountering active patients with underlying hip or knee pain.
Collapse
Affiliation(s)
- Stephen M Carek
- Department of Family Medicine, University of South Carolina, School of Medicine-Greenville, Center for Family Medicine - Greenville, 877 West Faris Road, Greenville, SC 29605, USA..
| |
Collapse
|
35
|
Ultrasound-guided injection for the diagnosis and treatment of posteromedial knee friction syndrome. Skeletal Radiol 2019; 48:563-568. [PMID: 30206677 DOI: 10.1007/s00256-018-3060-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Revised: 08/24/2018] [Accepted: 08/28/2018] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To describe an ultrasound guided injection technique for diagnosing and treating posteromedial knee friction syndrome, which occurs between the sartorius/gracilis tendons and medial femoral condyle (MFC). MATERIALS AND METHODS Our study was IRB-approved and HIPAA-compliant. We identified patients via a retrospective review of medical records and MRI with posteromedial knee pain and isolated edema between MFC and sartorius/gracilis tendons and no evidence for meniscal tear, ruptured Baker's cyst or degenerative joint disease. Patients were referred for an ultrasound-guided procedure to inject anesthetic and corticosteroid at the site of edema. Procedures were evaluated for technical success, which was defined as satisfactory identification of the injection site and adequate delivery of medication. Follow-up was available up to 8 weeks after the procedure to determine the response and any potential complications. RESULTS Fourteen subjects with MRI and symptoms of posteromedial knee friction syndrome underwent 14 injections. Technical success was achieved in all procedures, with no complications. At 8 weeks' follow-up, 92% of patients had symptom improvement. VAS before and 8 weeks after the procedure changed from 5.2 ± 2.7 to 0.9 ± 2.1 (p = 0.0002), respectively. CONCLUSION Ultrasound-guided injection of edema between the MFC and sartorius/gracilis tendons supports the diagnosis of a posteromedial knee friction syndrome and successfully treats its associated symptoms.
Collapse
|
36
|
Fox MG, Chang EY, Amini B, Bernard SA, Gorbachova T, Ha AS, Iyer RS, Lee KS, Metter DF, Mooar PA, Shah NA, Singer AD, Smith SE, Taljanovic MS, Thiele R, Tynus KM, Kransdorf MJ. ACR Appropriateness Criteria® Chronic Knee Pain. J Am Coll Radiol 2018; 15:S302-S312. [DOI: 10.1016/j.jacr.2018.09.016] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Accepted: 09/07/2018] [Indexed: 12/12/2022]
|
37
|
Static and Dynamic Ultrasound Imaging of the Iliotibial Band/Fascia Lata: Brief Review of Current Literature and Gaps in Knowledge. CURRENT RADIOLOGY REPORTS 2018. [DOI: 10.1007/s40134-018-0295-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
|
38
|
Iliotibial Band Impingement by Overhanging Tibial Tray: A Pain Generator after Total Knee Replacement Treatable without Revision. JOURNAL OF ORTHOPAEDICS, TRAUMA AND REHABILITATION 2018. [DOI: 10.1016/j.jotr.2017.12.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Soft-tissue impingement can cause disabling pain after total knee arthroplasty. We report a case of painful crepitus over Gerdy's tubercle after total knee replacement. Iliotibial band impingement by overhanging tibial tray was diagnosed. The symptom persisted despite physiotherapy and local corticosteroid injection. A combined arthroscopic and open approach was used to excise intraarticular scarring and release the impinged iliotibial band. The painful crepitus was resolved instantaneously without recurrence at 3 year follow-up. Morbidity associated with component revision has been avoided.
Collapse
|
39
|
Anandkumar S, Miller J, J Werstine R, Young S. Effect of mobilization with movement on lateral knee pain due to proximal tibiofibular joint hypomobility. Physiother Theory Pract 2018; 34:813-820. [PMID: 29364749 DOI: 10.1080/09593985.2018.1424979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
This case report describes a 45-year-old female who presented with lateral knee pain over the right proximal tibiofibular joint (PTFJ) managed unsuccessfully with rest, medications, bracing, injection, and physiotherapy. Clinical diagnosis of PTFJ hypomobility was based on concordant symptom reproduction with palpatory tenderness, accessory motion testing, and restricted anterior glide of the fibula. Intervention consisted of Mulligan's mobilization with movement and taping over the right PTFJ with immediate improvements noticed in pain, range of motion, and function. The patient was seen twice a week and was discharged after four treatment sessions. A follow-up after 6 months revealed that the patient was pain free and fully functional.
Collapse
Affiliation(s)
- Sudarshan Anandkumar
- a Registered Physiotherapist , CBI health centre , Chilliwack, British Columbia , Canada
| | - Jack Miller
- b Body Mechanics Physiotherapy , London , Ontario , Canada and founding member of the Mulligan Concept Teacher's Association
| | - Robert J Werstine
- c Fowler-Kennedy Sports Medicine Clinic at Fanshawe College , London , Ontario , Canada
| | - Steve Young
- d Tall Tree Integrated Health , Victoria, BC , Canada and Physiotherapy educator , Accelerated Motion Physiotherapy
| |
Collapse
|
40
|
THE INFLUENCE OF EXTRINSIC FACTORS ON KNEE BIOMECHANICS DURING CYCLING: A SYSTEMATIC REVIEW OF THE LITERATURE. Int J Sports Phys Ther 2017; 12:1023-1033. [PMID: 29234554 DOI: 10.26603/ijspt20171023] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Background The knee is susceptible to injury during cycling due to the repetitive nature of the activity while generating torque on the pedal. Knee pain is the most common overuse related injury reported by cyclists, and intrinsic and extrinsic factors can contribute to the development of knee pain. Purpose Due to the potential for various knee injuries, this purpose of this systematic review of the literature was to determine the association between biomechanical factors and knee injury risk in cyclists. Study Design Systematic review of the literature. Methods Literature searches were performed using CINAHL, Ovid, PubMed, Scopus and SPORTDiscus. Quality of studies was assessed using the Downs and Black Scale for non-randomized trials. Results Fourteen papers were identified that met inclusion and exclusion criteria. Only four studies included cyclists with knee pain. Studies were small with sample sizes ranging from 9-24 participants, and were of low to moderate quality. Biomechanical factors that may impact knee pain include cadence, power output, crank length, saddle fore/aft position, saddle height, and foot position. Changing these factors may lead to differing effects for cyclists who experience knee pain based on specific anatomical location. Conclusion Changes in cycling parameters or positioning on the bicycle can impact movement, forces, and muscle activity around the knee. While studies show differences across some of the extrinsic factors included in this review, there is a lack of direct association between parameters/positioning on the cycle and knee injury risk due to the limited studies examining cyclists with and without pain or injury. The results of this review can provide guidance to professionals treating cyclists with knee pain, but more research is needed. Level of Evidence 3a.
Collapse
|
41
|
Alves TI, Girish G, Kalume Brigido M, Jacobson JA. US of the Knee: Scanning Techniques, Pitfalls, and Pathologic Conditions. Radiographics 2017; 36:1759-1775. [PMID: 27726755 DOI: 10.1148/rg.2016160019] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Pain and other disorders of the knee are a common presenting complaint in the ambulatory setting. Although the cornerstones of imaging evaluation of the knee are radiographs and magnetic resonance (MR) imaging, ultrasonography (US) is less expensive than MR imaging, easily available, and of comparable accuracy in the evaluation of certain pathologic conditions of the knee. The benefits of US include portability, low cost, high spatial resolution, dynamic imaging, and ability to guide percutaneous interventions when indicated. US also allows direct patient contact, facilitating immediate clinical correlation and the ability to compare with the contralateral knee. US evaluation of the knee can be targeted to a specific region on the basis of the complaint or be a comprehensive review. For comprehensive evaluation, the knee is divided into anterior, medial, lateral, and posterior compartments for structured evaluation of the tendons, ligaments, joint space, osseous structures, as well as peripheral nerves and vasculature. US is particularly well suited for evaluating injuries of the quadriceps and patellar tendons, injuries of the medial and lateral collateral ligaments, joint effusions, and fluid collections around the knee. There is additional utility in evaluation of the distal hamstrings tendons, the iliotibial tract, the superficial patellar cortex, the common peroneal nerve, the popliteal vessels, and juxta-articular cystic collections including Baker cyst. In-depth appreciation of relevant sonographic anatomy, common pathologic conditions, knowledge of important pitfalls, and mastery of US technique will allow one to effectively use this powerful bedside tool for the evaluation of a wide variety of knee disorders. ©RSNA, 2016.
Collapse
Affiliation(s)
- Timothy I Alves
- From the Department of Radiology, Division of Musculoskeletal Imaging, University of Michigan Health System, 2910 S Taubman Center, SPC 5326, 1500 E Medical Center Dr, Ann Arbor, MI 48109
| | - Gandikota Girish
- From the Department of Radiology, Division of Musculoskeletal Imaging, University of Michigan Health System, 2910 S Taubman Center, SPC 5326, 1500 E Medical Center Dr, Ann Arbor, MI 48109
| | - Monica Kalume Brigido
- From the Department of Radiology, Division of Musculoskeletal Imaging, University of Michigan Health System, 2910 S Taubman Center, SPC 5326, 1500 E Medical Center Dr, Ann Arbor, MI 48109
| | - Jon A Jacobson
- From the Department of Radiology, Division of Musculoskeletal Imaging, University of Michigan Health System, 2910 S Taubman Center, SPC 5326, 1500 E Medical Center Dr, Ann Arbor, MI 48109
| |
Collapse
|
42
|
Pierce TP, Mease SJ, Issa K, Festa A, McInerney VK, Scillia AJ. Iliotibial Band Lengthening: An Arthroscopic Surgical Technique. Arthrosc Tech 2017; 6:e785-e789. [PMID: 28706832 PMCID: PMC5495937 DOI: 10.1016/j.eats.2017.02.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2016] [Accepted: 02/06/2017] [Indexed: 02/03/2023] Open
Abstract
Iliotibial (IT) band syndrome is a common cause of lateral knee pain in runners and cyclists. Many can be treated nonoperatively; however, some may require surgical lengthening of their IT band to achieve optimal pain relief and a return to preinjury level of activity. Several studies have been published detailing surgical lengthening procedures and satisfactory outcomes after these procedures. However, it is important to continue to improve on and optimize outcomes. We present our arthroscopic IT band-lengthening procedure.
Collapse
Affiliation(s)
| | | | | | | | | | - Anthony J. Scillia
- Address correspondence to Anthony J. Scillia, M.D., Department of Orthopaedics, School of Health and Medical Sciences, Seton Hall University, 400 S Orange Ave, South Orange, NJ 07079, U.S.A.Department of OrthopaedicsSchool of Health and Medical SciencesSeton Hall University400 S Orange AveSouth OrangeNJ07079U.S.A.
| |
Collapse
|
43
|
Flato R, Passanante GJ, Skalski MR, Patel DB, White EA, Matcuk GR. The iliotibial tract: imaging, anatomy, injuries, and other pathology. Skeletal Radiol 2017; 46:605-622. [PMID: 28238018 DOI: 10.1007/s00256-017-2604-y] [Citation(s) in RCA: 62] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2016] [Revised: 02/06/2017] [Accepted: 02/09/2017] [Indexed: 02/02/2023]
Abstract
The iliotibial tract, also known as Maissiat's band or the iliotibial band, and its associated muscles function to extend, abduct, and laterally rotate the hip, as well as aid in the stabilization of the knee. A select group of associated injuries and pathologies of the iliotibial tract are seen as sequela of repetitive stress and direct trauma. This article intends to educate the radiologist, orthopedist, and other clinicians about iliotibial tract anatomy and function and the clinical presentation, pathophysiology, and imaging findings of associated pathologies. Specifically, this article will review proximal iliotibial band syndrome, Morel-Lavallée lesions, external snapping hip syndrome, iliotibial band syndrome and bursitis, traumatic tears, iliotibial insertional tendinosis and peritendonitis, avulsion fractures at Gerdy's tubercle, and Segond fractures. The clinical management of these pathologies will also be discussed in brief.
Collapse
Affiliation(s)
- Russell Flato
- Department of Radiology, Keck School of Medicine, University of Southern California, 1520 San Pablo Street, Suite L1600, Los Angeles, CA, 90033, USA
| | - Giovanni J Passanante
- Department of Radiology, Keck School of Medicine, University of Southern California, 1520 San Pablo Street, Suite L1600, Los Angeles, CA, 90033, USA
| | - Matthew R Skalski
- Department of Radiology, Palmer College of Chiropractic-West Campus, San Jose, CA, 95134, USA
| | - Dakshesh B Patel
- Department of Radiology, Keck School of Medicine, University of Southern California, 1520 San Pablo Street, Suite L1600, Los Angeles, CA, 90033, USA
| | - Eric A White
- Department of Radiology, Keck School of Medicine, University of Southern California, 1520 San Pablo Street, Suite L1600, Los Angeles, CA, 90033, USA
| | - George R Matcuk
- Department of Radiology, Keck School of Medicine, University of Southern California, 1520 San Pablo Street, Suite L1600, Los Angeles, CA, 90033, USA.
| |
Collapse
|
44
|
Wong YM. The Effects of Electroacupuncture with Direct Current on Iliotibial Band Syndrome. Med Acupunct 2017. [DOI: 10.1089/acu.2016.1212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Yiu Ming Wong
- Health Science Unit (PEC), Hong Kong Physically Handicapped & Able Bodied Association, Shamshuipo, Kowloon, Hong Kong
| |
Collapse
|
45
|
Larson HH, Khalili-Borna D, Uzosike E, Sugiyama D. Medical Coverage of Ultramarathons and Its Unique Challenges. Curr Sports Med Rep 2016; 15:154-60. [PMID: 27172078 DOI: 10.1249/jsr.0000000000000267] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Medical coverage of ultramarathons must take into account unique logistical, environmental, and psychological components in addition to the medical conditions that may arise. Each ultramarathon is unique and carries with it distinct specific challenges with regard to appropriate planning and organizing. The medical issues encountered with ultramarathons can overlap with those seen in other endurance events, but the extreme and protracted nature of ultramarathons also lends itself to various other medical challenges not frequently encountered in other aspects of sports medicine. This article gives an overview of logistical considerations that go into the medical planning, as well as information regarding diagnosis and acute management of some of the most common and most important conditions that one might encounter when covering an ultramarathon.
Collapse
|
46
|
Lapègue F, Sans N, Brun C, Bakouche S, Brucher N, Cambon Z, Chiavassa H, Larbi A, Faruch M. Imaging of traumatic injury and impingement of anterior knee fat. Diagn Interv Imaging 2016; 97:789-807. [PMID: 27118690 DOI: 10.1016/j.diii.2016.02.012] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2016] [Accepted: 02/24/2016] [Indexed: 11/17/2022]
Abstract
Fat is not just used by the body as bulk tissue. In addition to its role in storing energy and regulating hormone action, fat is used in some parts of the body for its mechanical properties. The anatomy of anterior knee fat is more complex than it appears at first sight and is capable of withstanding considerable compressive and shear stress. Specific lesions occur when such mechanical stress exceeds the physiological limits and are yet little known. Superficial fat can be the site of either acute injury by closed degloving called the Morel-Lavallée lesion or chronic injury, when subject to repeat excessive shear forces, due to more complex and less well-defined disruptions that result in pseudo-bursitis. There are three main anterior, intracapsular and extrasynovial fat pads in the knee joint, which are the infrapatellar fat pad (IFP) or Hoffa's fat pad, the quadriceps fat pad and the prefemoral fat pad. The IFP plays an important role as a mechanical shock absorber and guides the patella tendon and even the patella itself during flexion-extension movements. In response to repeated excessive stress, an inflammatory reaction and swelling of the IFP is first observed, followed by a fibrotic reaction with metaplastic transformation into fibrous, cartilaginous or bone tissue. More rarely, the two other deep fat pads (quadriceps and prefemoral) can, if subject to repeated stress, undergo similar restructuring inflammatory reactions with metaplasia resulting in tissue hardening, anterior pain and partial loss of function.
Collapse
Affiliation(s)
- F Lapègue
- Service d'imagerie, CHU de Toulouse-Purpan, bâtiment Pierre-Paul-Riquet, place du Dr-Baylac, TSA 40031, 31059 Toulouse cedex 9, France; Centres d'imagerie du Languedoc, 26, rue Ernest-Cognacq, ZAC Bonne source, 11100 Narbonne, France.
| | - N Sans
- Service d'imagerie, CHU de Toulouse-Purpan, bâtiment Pierre-Paul-Riquet, place du Dr-Baylac, TSA 40031, 31059 Toulouse cedex 9, France
| | - C Brun
- Service d'imagerie, CHU de Toulouse-Purpan, bâtiment Pierre-Paul-Riquet, place du Dr-Baylac, TSA 40031, 31059 Toulouse cedex 9, France
| | - S Bakouche
- Service d'imagerie, CHU de Toulouse-Purpan, bâtiment Pierre-Paul-Riquet, place du Dr-Baylac, TSA 40031, 31059 Toulouse cedex 9, France
| | - N Brucher
- Service d'imagerie, CHU de Toulouse-Purpan, bâtiment Pierre-Paul-Riquet, place du Dr-Baylac, TSA 40031, 31059 Toulouse cedex 9, France
| | - Z Cambon
- Service d'imagerie, CHU de Toulouse-Purpan, bâtiment Pierre-Paul-Riquet, place du Dr-Baylac, TSA 40031, 31059 Toulouse cedex 9, France
| | - H Chiavassa
- Service d'imagerie, CHU de Toulouse-Purpan, bâtiment Pierre-Paul-Riquet, place du Dr-Baylac, TSA 40031, 31059 Toulouse cedex 9, France
| | - A Larbi
- Service d'imagerie médicale, CHU de Nîmes, place du Pr-R.-Debré, 30029 Nîmes cedex 9, France
| | - M Faruch
- Service d'imagerie, CHU de Toulouse-Purpan, bâtiment Pierre-Paul-Riquet, place du Dr-Baylac, TSA 40031, 31059 Toulouse cedex 9, France
| |
Collapse
|
47
|
Abstract
BACKGROUND Recent studies have questioned the importance of the iliotibial band (ITB) in lateral knee pain. The Ober test or modified Ober test is the most commonly recommended physical examination tool for assessment of ITB tightness. No studies support the validity of either Ober test for measuring ITB tightness. PURPOSE/HYPOTHESIS The purpose of this study was to assess the effects of progressive transection of the ITB, gluteus medius and minimus (med/min) muscles, and hip joint capsule of lightly embalmed cadavers on Ober test results and to compare them with assessment of all structures intact. In addition, thigh position change between gluteus med/min transection and hip capsule transection was also assessed for both versions of the Ober test. It was hypothesized that transection of the ITB would significantly increase thigh adduction range of motion as measured by an inclinometer when performing either Ober test and that subsequent structure transections (gluteus med/min muscles followed by the hip joint capsule) would cause additional increases in thigh adduction. STUDY DESIGN Controlled laboratory study. METHODS The lower limbs of lightly embalmed cadavers were assessed for midthigh ITB transection versus intact by use of the Ober (n = 28) and modified Ober (n = 34) tests; 18 lower limbs were assessed for all conditions (intact band, followed by sequential transections of the ITB midthigh, gluteus med/min muscles, hip joint capsule) by use of both Ober tests. Paired t tests were used to compare changes in Ober test results between conditions. RESULTS No significant changes in thigh position (adduction) occurred in either version of the Ober test after ITB transection. Significant differences were noted for intact band versus gluteus med/min transection and intact band versus hip joint capsule transection (P < .0001) for all findings for both tests. Mean inclinometer measurements for the modified Ober were 4.28° (n = 34 for intact vs ITB transection comparisons), 3.33° (n = 18 for subsequent intact vs gluteus muscle and hip capsule transection comparisons), 5.00° (n = 34 for midthigh ITB transection), 11.20° (gluteus med/min transection), and 13.20° (hip capsule transection). For the Ober test, measures were -2.90° (n = 28 for intact vs ITB transection comparisons), -2.20° (n = 18 for subsequent intact vs gluteus muscle and hip capsule transection comparisons), -2.20° (n = 34 for midthigh ITB transection), 6.50° (gluteus med/min transection), and 9.53° (hip capsule transection). Statistically significant differences were also noted between test findings comparing gluteus med/min transection to hip capsule transection (Ober, P < .0001; modified Ober, P = .0036). CONCLUSION The study findings refute the hypothesis that the ITB plays a role in limiting hip adduction during either version of the Ober test and question the validity of these tests for determining ITB tightness. The findings underscore the influence of the gluteus medius and minimus muscles as well as the hip joint capsule on Ober test findings. CLINICAL RELEVANCE The results of this study suggest that the Ober test assesses tightness of structures proximal to the hip joint, such as the gluteus medius and minimus muscles and the hip joint capsule, rather than the ITB.
Collapse
Affiliation(s)
- Gilbert M Willett
- Department of Genetics, Cell Biology and Anatomy, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Sarah A Keim
- Department of Genetics, Cell Biology and Anatomy, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Valerie K Shostrom
- College of Public Health Biostatistics, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Carol S Lomneth
- Department of Genetics, Cell Biology and Anatomy, University of Nebraska Medical Center, Omaha, Nebraska, USA
| |
Collapse
|
48
|
Lalam RK, Winn N, Cassar-Pullicino VN. Interventional articular and para-articular knee procedures. Br J Radiol 2015; 89:20150413. [PMID: 26682669 DOI: 10.1259/bjr.20150413] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
The knee is a common area of the body to undergo interventional procedures. This article discusses image-guided interventional issues specific to the knee area. The soft tissues in and around the knee are frequently affected by sport-related injuries and often need image-guided intervention. This article details the specific technical issues related to intervention in these soft tissues, including the iliotibial tract, fat pads, patellar tendon and other tendons, bursae and the meniscus. Most often, simple procedures such as injection and aspiration are performed without image guidance. Rarely image-guided diagnostic arthrography and therapeutic joint injections are necessary. The technique, indications and diagnostic considerations for arthrography are discussed in this article. Primary bone and soft-tissue tumours may involve the knee and adjacent soft tissues. Image-guided biopsies are frequently necessary for these lesions; this article details the technical issues related to image-guided biopsy around the knee. A number of newer ablation treatments are now available, including cryoablation, high-frequency ultrasound and microwave ablation. Radiofrequency ablation, however, still remains the most commonly employed ablation technique. The indications, technical and therapeutic considerations related to the application of this technique around the knee are discussed here. Finally, we briefly discuss some newer, but as of yet, unproven image-guided interventions for osteochondral lesions and Brodie's abscess.
Collapse
Affiliation(s)
- Radhesh K Lalam
- Department of Diagnostic imaging, Robert Jones and Agnes Hunt Orthopaedic hospital, Oswestry, UK
| | - Naomi Winn
- Department of Diagnostic imaging, Robert Jones and Agnes Hunt Orthopaedic hospital, Oswestry, UK
| | | |
Collapse
|
49
|
Posteromedial knee friction syndrome: an entity with medial knee pain and edema between the femoral condyle, sartorius and gracilis. Skeletal Radiol 2015; 44:557-63. [PMID: 25527466 DOI: 10.1007/s00256-014-2081-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2014] [Revised: 11/12/2014] [Accepted: 12/04/2014] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To describe MRI features of an entity consisting of medial knee pain and edema between the posteromedial femoral condyle (PMFC), sartorius and/or gracilis tendons and determine whether reduced tendon-bone distances may account for these findings. METHODS We retrospectively identified MRI cases of edema between the PMFC, sartorius and/or gracilis tendons (25 subjects, 26 knees). Two musculoskeletal radiologists independently graded edema and measured the sartorius- and gracilis-PMFC distances and knee flexion angle. Age- and gender-matched subjects with normal knee MRIs (27 subjects, 27 knees) served as controls for measurements. Statistical analyses compared abnormal to control subjects. RESULTS Sartorius-PMFC and gracilis-PMFC spaces were narrower in abnormal compared to control subjects (1.6 ± 1.0 vs. 2.1 ± 1.2 mm, P = 0.04; 2.3 ± 2.0 vs. 4.6 ± 3.0 mm, P = 0.002, respectively). The knee flexion angle was similar between groups (P > 0.05). In subjects with clinical information, medial knee pain was the main complaint in 58 % (15/26) of abnormal subjects, with 42 % (11/26) having clinical suspicion of medial meniscal tear. Edema between the PMFC, sartorius and/or gracilis was mild in 54 % (14/26), moderate in 35 % (9/26) and severe in 12 % (3/26), and it was most frequent deep to both the sartorius and gracilis (50 %, 13/26). CONCLUSIONS Edema between the PMFC, sartorius and/or gracilis tendons identified on knee MRI may be associated with medial knee pain and may represent a friction syndrome.
Collapse
|
50
|
Ha DH, Choi S, Kim SJ, Lih W. Intra-articular fibroma of tendon sheath in a knee joint associated with iliotibial band friction syndrome. Korean J Radiol 2015; 16:169-74. [PMID: 25598686 PMCID: PMC4296266 DOI: 10.3348/kjr.2015.16.1.169] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2014] [Accepted: 10/09/2014] [Indexed: 11/23/2022] Open
Abstract
Iliotibial band (ITB) friction syndrome is a common overuse injury typically seen in the active athlete population. A nodular lesion on the inner side of the ITB as an etiology or an accompanying lesion from friction syndrome has been rarely reported. A 45-year-old male presented with recurrent pain and a movable nodule at the lateral joint area, diagnosed as ITB friction syndrome. The nodule was confirmed as a rare intra-articular fibroma of the tendon sheath (FTS) on the basis of histopathologic findings. We describe the MRI findings, arthroscopic and pathologic features, in this case of intra-articular FTS presenting with ITB friction syndrome.
Collapse
Affiliation(s)
- Dong-Ho Ha
- Department of Radiology, Dong-A University Medical Center, Busan 602-715, Korea
| | - Sunseob Choi
- Department of Radiology, Dong-A University Medical Center, Busan 602-715, Korea
| | - Soo-Jin Kim
- Department of Pathology, Dong-A University Medical Center, Busan 602-715, Korea
| | - Wang Lih
- Department of Orthopedics, Dong-A University Medical Center, Busan 602-715, Korea
| |
Collapse
|