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Abstract Purpose The visualization of potentially injured anatomical structures is crucial. Lately the anterolateral ligament (ALL) and the deep structures of the iliotibial tract (ITT) have been of increased clinical interest because of their role as important lateral stabilizers of the knee. The aim of this study was to assess the visibility of the ALL and the deep structures of the ITT using MRI. Good intra- and inter-observer reproducibility was hypothesized. Methods Knee MRI data from patients without ligamentous lesions were retrospectively analyzed by two radiologists at two time points using axial and coronal sequences. The visibility of the different parts of the ALL (femoral, meniscal and tibial part) and of the deep ITT, namely the deep attachments of the ITT to the distal femur and capsulo-osseous layer of the ITT, were determined on a binary (yes/no) basis. Results Seventy-one cases (42 men, 29 women) were studied. Inter-observer agreement was high. Cohen’s kappa was 0.97 for the tibial part of the ALL and 0.76 for the femoral part. For the deep attachments of the ITT to the distal femur Cohen’s kappa was 0.94. For each of the investigated parameters absolute agreement between the observers was at least 88%. Regarding intra-observer agreement Cohen’s kappa was 0.62 for the femoral part of the ALL and 0.85 for the tibial part of the ALL. For the deep attachments of the ITT to the distal femur Cohen’s kappa was 0.94. For each investigated parameter absolute agreement between the two time points was at least 83%. Conclusions The presence of the anterolateral structures of the knee can be determined with substantial inter- and intra-observer agreement using MRI examination. This is applicable for both the ALL and the deep ITT. Level of evidence Diagnostic study – Level III.

The objective was to compare the effectiveness of isolated anatomical antegrade reconstruction of the anterior cruciate ligament (ACL) with bonetendon-bone autograft (BTB autograft) and in combination with lateral extra-articular tenodesis (LEAT) graft from the iliotibial tract (ITT).Material and methods. We analyzed 187 arthroscopic ACL reconstructions in patients with a Pivot shift test – 3+ degree. We performed an isolated ACL-R in 118 (63.1 %) patients in group 1 and added the LEAT from ITB to it in group 2.Results. According to IKDC-2000: 176 (94.1 %) patients were included in categories A and B, 11 (5.9 %) – in C. Significant differences in these groups appeared 15 months after the operation. According to KOSS: in group 2, the anterior and rotational knee stability, as well as the level of sports activity were higher, and pathological symptoms were less common.Conclusion. LEAT from ITB increases stability and functionality of the knee joint in patients with anatomical antegrade ACL reconstructions with BTB-autograft for terms over 15 months after the operation, and is an economically procedure.

Fascia is a fibrous connective tissue present all over the body. At the lower limb level, the deep fascia that is overlying muscles of the outer thigh and sheathing them (fascia lata) is involved in various pathologies. However, the understanding and quantification of the mechanisms involved in these sheathing effects are still unclear. The aim of this study is to observe and quantify the strain field of the fascia lata, including the iliotibial tract (ITT), during a passive movement of the knee. Three fresh postmortem human subjects were studied. To measure hip and knee angles during knee flexion-extension, passive movements from 0° to around 120° were recorded with a motion analysis system and strain fields of the fascia were acquired using digital image correlation. Strains were computed for three areas of the fascia lata: anterior fascia, lateral fascia, and ITT. Mean principal strains showed different strain mechanisms depending on location on the fascia and knee angle. For anterior and lateral fascia, a tension mechanism was mainly observed with major strain greater than minor strain in absolute value. While for the ITT, two strain mechanisms were observed depending on knee movement: tension is observed when the knee is extended relatively to reference position of 47°, however, pure shear can be observed when the knee is flexed. In some cases, minor strain can also be higher than major strain in absolute value, suggesting high tissue compression probably due to microstructural fiber rearrangements. This in situ study is the first attempt to quantify the superficial strain field of fascia lata during passive leg movement. The study presents some limitations but provides a step in understanding strain mechanism of the fascia lata during passive knee movement.