Search

AIM OF STUDY To analyze the results of lateral extra-articular tenodesis (LET) of the semitendinosus muscle tendon (STMT) and iliotibial tract (ITT) in patients with severe anterior rotational instability of the knee joint during anatomical anterograde reconstruction of the anterior cruciate ligament (rACL) with a BTB graft. MATERIAL AND METHODS We studied 138 patients with the Pivot shift test – 3+ and the Lachman test 2+ or 3+ degree after arthroscopic rACL with a BTB autograft. In 65 cases (47.1%) rACL was supplemented with LET of STMT (group 1), the remaining 73 patients (52.9%) – LET of ITT (group 2). RESULTS According to IKDC-2000, KOSS and Lysholm-Tegner scores, the groups did not differ statistically. However, pain in the LET zone, LET failure with the appearance of the Pivot shift test – 1+, revision reconstructions – were more often observed in group 2 (p

Purpose To determine the accuracy of detection, injury rate and inter- and intrarater reproducibility in visualizing lesions to the anterolateral ligament (ALL) and the deep portion of the iliotibial tract (dITT) in anterior cruciate ligament (ACL) deficient knees. Methods Ninety-one consecutive patients, out of those 25 children (age 14.3 ± 3.5 years), with diagnosed ACL tears were included. Two musculoskeletal radiologists retrospectively reviewed MRI data focusing on accuracy of detection and potential injuries to the ALL or dITT. Lesion were diagnosed in case of discontinued fibers in combination with intra- or peri-ligamentous edema and graded as intact, partial or complete tears. Cohen’s Kappa and 95% confidence intervals (95% CI) were determined for inter- and intrarater reliability measures. Results The ALL and dITT were visible in 52 (78.8%) and 56 (84.8%) of adult-and 25 (100%) and 19 (76.0%) of pediatric patients, respectively. The ALL was injured in 45 (58.5%; partial: 36.4%, compleate: 22.1%) patients. Partial and comleate tears, where visualized in 21 (40.4%) and 16 (30.8%) adult- and seven (28.0%) and one (4%) peditric patients. A total of 16 (21.3%; partial: 13.3%, compleate: 8.0%) dITT injuries were identified. Partal and complete lesions were seen in seven (12.5%) and five (8.9%) adult- and three (15.8%) and one (5.3%) pediatric patients. Combined injuries were visualized in nine (12.7%) patients. Inter-observer (0.91–0.95) and intra-observer (0.93–0.95) reproducibility was high. Conclusion In ACL injured knees, tears of the ALL are observed more frequently compared to lesions to the deep iliotibial tract. Combined injuries of both structures are rare. Clinically, the preoperative visualization of potentially injured structures of the anterolateral knee is crucial and is important for a more personalized preoperative planning and tailored anatomical reconstruction. The clinical implication of injuries to the anterolateral complex of the knee needs further investigation. Level of evidence II.

PurposeThe purpose of this study was to examine the length change patterns of the native medial structures of the knee and determine the effect on graft length change patterns for different tibial and femoral attachment points for previously described medial reconstructions.MethodsEight cadaveric knee specimens were prepared by removing the skin and subcutaneous fat. The sartorius fascia was divided to allow clear identification of the medial ligamentous structures. Knees were then mounted in a custom-made rig and the quadriceps muscle and the iliotibial tract were loaded, using cables and hanging weights. Threads were mounted between tibial and femoral pins positioned in the anterior, middle, and posterior parts of the attachment sites of the native superficial medial collateral ligament (sMCL) and posterior oblique ligament (POL). Pins were also placed at the attachment sites relating to two commonly used medial reconstructions (Bosworth/Lind and LaPrade). Length changes between the tibiofemoral pin combinations were measured using a rotary encoder as the knee was flexed through an arc of 0–120°.ResultsWith knee flexion, the anterior fibres of the sMCL tightened (increased in length 7.4% ± 2.9%) whilst the posterior fibres slackened (decreased in length 8.3% ± 3.1%). All fibre regions of the POL displayed a uniform lengthening of approximately 25% between 0 and 120° knee flexion.The most isometric tibiofemoral combination was between pins placed representing the middle fibres of the sMCL (Length change = 5.4% ± 2.1% with knee flexion). The simulated sMCL reconstruction that produced the least length change was the Lind/Bosworth reconstruction with the tibial attachment at the insertion of the semitendinosus and the femoral attachment in the posterior part of the native sMCL attachment side (5.4 ± 2.2%). This appeared more isometric than using the attachment positions described for the LaPrade reconstruction (10.0 ± 4.8%).ConclusionThe complex behaviour of the native MCL could not be imitated by a single point-to-point combination and surgeons should be aware that small changes in the femoral MCL graft attachment position will significantly effect graft length change patterns. Reconstructing the sMCL with a semitendinosus autograft, left attached distally to its tibial insertion, would appear to have a minimal effect on length change compared to detaching it and using the native tibial attachment site. A POL graft must always be tensioned near extension to avoid capturing the knee or graft failure.

© 2020 Elsevier B.V. Background: Lateral approaches to total knee arthroplasty (TKA) provide good surgical exposure and may provide greater ease of soft tissue balancing in patients with a valgus deformity; however, little is known about the versatility in non-valgus knees. The present study evaluated if a lateral subvastus approach can achieve adequate surgical exposure while maintaining less soft tissue damage compared with the medial parapatellar approach in knees without any significant deformity. Methods: Using paired fresh-frozen cadaveric knees, the present study provides the first specimen-matched, side-by-side comparison of the lateral subvastus approach to the standard medial parapatellar approach to TKA. Ten knees were selected to undergo a lateral subvastus approach; the contralateral knee had a medial parapatellar approach as control. Incision length, surgical exposure and iatrogenic soft tissue damage were compared between the two approaches. Results: The lateral subvastus approach was successfully performed using an incision length that was not different from that used in the medial parapatellar approach (p > 0.05). The resultant surgical exposure was comparable between approaches (p > 0.05). The risk of the approach included tearing of the vastus lateralis fibers, and/or abrasion of the iliotibial tract/patellar ligament. Conclusions: The lateral subvastus approach to TKA provided a comparable method to the standard medial parapatellar approach. Despite adequate exposure, the approach did risk soft tissue injury. Caution needs to be exercised to reduce the risk of iatrogenic injury to the vastus lateralis and surrounding ligaments. The successful implementation in this cadaveric study substantiates the need for further consideration of this approach in clinical practice.

Introduction. The modern development of technologies of ACL-R allows us to take a fresh look at the methods for recovery of anterior and rotational knee instability of the knee joint, which were used in the middle of the XX century. The objective was to evaluate the non-free tendon grafts while maintaining their anatomical attachment point for the isolated and complex ACL-R. Methods and materials. From 2014 to 2018, 128 patients were operated on the isolated ACL injuries (102 patients – 79.7 %) and complex ACL injuries (26 patients – 20.3 %). 26 (20.3 %) patients were operated on the rupture of a previously installed ACL graft. There were 72 men (56.3 %) and 56 women (43.7 %). The average age was (34.7±2.5) years. The average body weight was (82.7±1.6) kg; 24 (18.8 %) patients weighed over 85 kg. In 87 (68.0 %) cases, an anatomic single bundle ACL-R was performed by non-free graft either from the tendon of semitendinosus or in combination with the gracilis tendon. In 41 (32.0 %) cases, ACL-R was supplemented by LEAT (non-free iliotibial tract or free gracilis tendon grafts). The results were evaluated clinically, radiologically, and using the 2000 IKDC, KOSS and Lysholm Knee Scoring Scale integrated scales. In all cases, high stability of the knee joint was noted. Lachman and the pivot shift test recorded only 0 and 1 degrees. By the KOSS scale: «pain» was (86.7±2.3) points, «pathological symptoms» – (88.5±1.6) points, «daily activity» – (93.1±2.8) points, «sports activity» – (73.9±2.1) points, «quality of life» – (84.6±1.9) points. The average values of knee function by the Lysholm Knee Scoring Scale was 95.1±2.1. According to the 2000 IKDC, 117 (91.4 %) patients were included in group A, and 11 (8.6 %) in group B. Patients with moderate or severe impaired knee function (C and D) were not observed. The average time of the ACL-R was (82.1±2.4) min., ACL-R and LEAT – (94.7±6.9) min. The mean hospital stay was (3.2±1.8) days and (3.8±1.3) days, respectively. Conclusion. Non-free grafts for ACL-R and LEAT have an anatomically reliable fixation point, which allows to achieve high functional results of the knee joint. The proposed techniques can be reproduced with standard instruments and implants, taking into account the average operating time and blood loss, and without significant infection complications, persistent synovitis, contractures and hypotrophy of the thigh muscles.

ResumoUma fratura osteocondral desviada da tíbia anterolateral associada a avulsão da cabeça da fíbula em um paciente de 50 anos é relatada. A fratura avulsão do trato iliotibial em geral está associada lesões do ligamento cruzado, do menisco, e das estruturas laterais do joelho, como no caso em questão.

Introdução: No tratamento cirúrgico da lesão do ligamento cruzado anterior (LCA) em pacientes pediá-tricos, é necessário o equilíbrio entre a restauração da anatomia, e o risco de dano à fise de crescimento durante o ato operatório. Objetivo: Relatar caso de paciente com 9 anos, de-senvolvimento puberal de Tanner I, submetido a reconstrução do LCA pela técnica de Ko-cher, técnica de reconstrução extra fisária com enxerto de trato iliotibial autólogo.Palavras chave: Joelho, Reconstrução do ligamento cruzado anterior, Maturidade sexual AbstractIntroduction: In the surgical treatment of anterior cruciate ligament (ACL) injury in pediatric patients, a balance between anatomical restoration and the risk of damage to the growth plate during the surgery is necessary. Objective: Report a case of a 9-year-old patient, pubertal development of Tanner I, underwent ACL reconstruction using the technique of Kocher et al., a physeal-sparing reconstruction technique with autologous iliotibial tract graft.Keywords: Knee, Anterior cruciate ligament reconstruction, Sexual maturation

To reveal differences in the pattern of trabecular architecture in the epiphysis and metaphysis of the proximal tibia. The trabecular architecture of the proximal tibia was observed in 27 P45 plastinated knee specimens. In the medial and lateral condyles, under the articular cartilage surrounded by the medial or lateral meniscus, the cancellous bone is formed by thick and dense trabecular bands, which run longitudinally in the epiphysis and then pass through the epiphyseal line to terminate on the slanted cortex of the metaphysis. In the intercondylar eminence, the trabeculae are arranged basically in a network. In the central portion of the tibial metaphysis, cancellous bone consists of fine arcuate trabeculae, which extend to the anterior and posterior cortices, respectively. These trabeculae are intersected sparsely and form trusses over the medullary cavity. Near the areas of attachment of the iliotibial tract, tibial collateral ligament, anterior and posterior cruciate ligaments, and patellar ligament, the cancellous bone is locally reinforced with patchy trabeculae, dense radiating trabeculae, or two orthotropic trabecular bands. This study provides further accurate anatomical information on the trabeculae of the proximal tibia. The soft structures of knee joint, including the articular cartilage, menisci, and ligaments, and the slanted cortices of the metaphysis are important landmarks for the location of different arrangements of the cancellous architecture. The present results are beneficial for clinical diagnosis and treatment of pathologies of the knee joint, or the establishment of a finite element analysis model of the knee joint.

The purpose of this study was to investigate if the anterolateral ligament of the knee (ALL) is present in the human fetus and describe its topography along with other structures of the region. Forty human fetuses knee joints, at mean age 34 weeks (± 2.57 weeks), fixed in 10% formalin, were submitted to cross-sectional dissection and mesoscopic analysis. The ALL was not identified, although the usual topography of the region was identified in all specimens: skin, subcutaneous tissue, iliotibial tract (ITT), fibular collateral ligament, popliteal muscle tendon, lateral meniscus, patellar ligament, infrapatellar fat pad, lateral patellar retinaculum, knee joint capsule, lateral inferior genicular vessels, and the biceps femoris tendon. The ITT reveals anterior (n = 12) and lateral thickening (n = 17) in some specimens. This thickening was found in both knees of the same subject in 6/20 specimens. The anterolateral ligament of the knee is not a congenital or solid structure. Our results suggest that the ALL may be a deep layer of the ITT or part of the knee joint capsule, or its identification is evaluator dependent.

The latest procedural statistics from the American Society of Plastic Surgeons rank liposuction as the second most common aesthetic surgical procedure performed by board certified plastic surgeons. In the author’s experience, 40% of liposuction cases involve the extremities and the great majority of these cases are carried out on female patients. Individuals who are close to their ideal body weight and have a disproportionately high distribution of fat in the lower extremities in relation to their trunk are still the best candidates for thigh liposuction. Poor patient selection and overextraction resulting in excessive skin laxity and contour deformities are the most common causes of inferior aesthetic results following contouring of the thighs. There are five zones of adherence in the thighs and these are areas that should be avoided during liposuction procedures: (1) the gluteal crease, (2) the posterior distal thigh above the popliteal crease, (3) the lower lateral thigh area of the iliotibial tract, (4) the lateral gluteal depression, and (5) the mid-medial thigh area. The author’s approach to thigh contouring involves the use of VASER-assisted liposuction since it is associated with less blood loss, good skin retraction, and a relatively comfortable postoperative course for the patient. Patients with significant skin laxity are best treated with thighplasty or VASER-assisted thighplasty depending on the degree of lipodystrophy present. Preoperative planning of upper extremity contouring involves a comparison of the relationship between the excess arm fat and the skin envelope of the arm. In cases of arm lipodystrophy with good skin tone, VASER-assisted liposuction allows for easier fat extraction with good skin retraction. Poor skin tone, regardless of the amount of arm fat, usually dictates that an open tightening procedure be performed in order to properly contour the arm. Patients with poor skin tone and a significant amount of excess arm fat are best treated by a VASER-assisted brachioplasty.

Case We present an 18-year-old man with poor alignment of the lower limbs, marked by congenital dislocation of the left patella, with gait impairment, and an associated 20° flexion contracture. Surgical treatment was performed with a single complex procedure with the release of the lateral retinaculum, capsule, and iliotibial tract, followed by a subtraction trochleoplasty, tibial tubercle transfer, elongation of the quadriceps tendon, and anatomical reconstruction of the medial patellofemoral ligament. At the 5-year follow-up, the patient had a significant improvement in gait pattern, with the patella centered on the new trochlear groove without any signs of patellar instability. Conclusions The approach of congenital dislocation of the patella is controversial, and although numerous procedures have been described in children, the approach in adults should be individually tailored. In this case, trochlear deepening and preserving the trochlear cartilage proved to be an effective option for treating a congenital dislocation.

The objectives of this work was to conduct a comprehensive state-of-the art review of the current literature to identify any gaps or discrepancies and summarize the main challenges for obtaining a homogeneous evaluation of muscular fascia in healthy individuals. An electronic document search using key words and MeSH terms was performed with various databases. Two independent investigators were tasked with the screening of articles and data extraction. A critical appraisal of what is known was then conducted. The literature search identified 65 articles related to healthy facia in the various databases consulted and 20 articles were kept for the review. The thickest portion of the fascia lata (the iliotibial tract) and the plantar fascia are the most often studied muscular fasciae whereas there is paucity of studies on fascia related to other muscles in the body. US imaging is suitable to complement physical examination and for evaluating treatment outcomes. However, the small number of studies and the heterogeneity of the methods did not allow us to establish normal reference values for muscular fascia thickness and to provide strong recommendations about measurement protocols.

Introduction. Congenital contracture of the iliotibial tract is a rather rare pathology that causes difficulties in diagnosing and planning treatment activities. The lack of a clear idea of the causes of the disease has led to disagreement in the interpretation of the diagnosis in patients with this pathology. In the Russian-language literature, this disease is referred to as idiopathic extension and abduction contracture of a hip joint or idiopathic contracture of the dorsal gluteal muscle (a congenital contracture of the tendons of the dorsal gluteal muscles), whereas the English-language literature more often highlights congenital or idiopathic contracture of the dorsal gluteal muscles. Clinical сase. The results of treatment of a 6-year-old child with congenital contracture of the iliotibial tract is presented. The child exhibited lameness when walking first started, but the correct diagnosis was not established. Clinically, along with the limitation of adduction and extension in the hip joint and an induration of the soft tissue along the external surface of the right thigh, the pelvis was skewed, and there was shortening of the right lower limb and a valgus deformity of diaphysis of the right femoral bone. Ultrasonographic and magnetic resonance imaging indicated the presence of a fibrous bridle over the outer surface of the right thigh. The fibrous bridle was excised for 15 cm, and a temporary hemiepiphysiodesis of the medial portion of the distal growth zone of the right femur was performed. Results and discussion. At the 1-year control examination, the patient did not present any complaints. There was no relapse of the contracture. According to X-ray study results, correction of the valgus deformity of the right femur was achieved, and the metal structures were removed. Despite the more frequent extension and abduction direction of the contracture of the iliotibial tract indicated by most authors, the direction and severity apparently may depend on the predominant zone of fibrous degeneration of the muscle groups. Additionally, with the predominant lesion of the dorsal gluteal muscle, a more pronounced extension component can be expected, whereas with the predominant lesion of the musculus tensor fasciae latae, a flexion component can be expected and was observed in our patient.

Reconstruction is challenging in a patient with loss of a segment of Achilles tendon and infection in the overlying soft tissue. Here the authors describe one-stage tendon reconstruction, using an anterolateral thigh free flap incorporating a vascularized muscle flap and a strip of iliotibial tract in a patient with re-rupture of an Achilles tendon and soft tissue infection. Postoperative immobilization of the affected ankle using an external fixator enabled us to observe the flap directly and reduce pressure on the flap. The patient had a successful outcome, with no difficulty in walking, running, or climbing stairs and no limitation of range of motion at the ankle joint postoperatively. This is a promising technique for reconstruction of the Achilles tendon and treatment of infection as a one-step procedure.

Objective Snapping of the iliotibial band over the greater trochanter should be eliminated by reducing tension via lengthening, release, and incision of the iliotibial band. Indications Positive clinical examination and painful snapping of the iliotibial band over the greater trochanter, despite extensive conservative treatments, for over 6 months. Contraindications Weakness of the abductor muscles with positive Trendelenburg sign. Surgical technique Direct approach to the iliotibial tract. The snapping of the tract over the greater trochanter can be provoked and observed in situ via internal rotation and adduction of the hip. Lengthening of the iliotibial band is performed with a tongue-shape flap technique ("Griffelschachtelplastik") directly over the greater trochanter. This leads to simultaneous release and incision over the greater trochanter. Hereafter, no snapping of the tract should be observed upon motion analysis. Postoperative management Pain-adapted mobilization with full weightbearing, no active abduction against resistance, and no adduction over and exceeding the 0‑degree level for 6 weeks. Results The snapping of the iliotibial band could be eliminated in all cases. Apart from 2 patients with previous surgery who still complain of unimproved pain, improvement of symptoms with consequent subjective satisfaction with the outcome of surgery was reported in all cases.

Patients who present for anterior cruciate ligament (ACL) revision with a high-grade pivot shift at the time of an index ACL revision procedure and subsequent reconstruction failure or a high-grade pivot shift at revision surgery, patients with generalized joint laxity, and those requiring softs tissue grafts should be considered candidates for lateral tenodesis to supplement intraarticular graft revision. Although there is no consensus regarding the optimal lateral tenodesis technique, due to the tibial positioning associated with tensioning and fixation of extra-articular procedures, a lateral tenodesis should not be used in patients with posterolateral corner injuries or lateral compartment articular disease.

The human gluteus maximus muscle (GMX) is characterised by its insertion to the iliotibial tract (a lateral thick fascia of the thigh beneath the fascia lata), which plays a critical role in lateral stabilisation of the hip joint during walking. In contrast, in non-human primates, the GMX and biceps femoris muscle provide a flexor complex. According to our observations of 15 human embryos and 11 foetuses at 7-10 weeks of gestation (21-55 mm), the GMX anlage was divided into 1) a superior part that developed earlier and 2) a small inferior part that developed later. The latter was adjacent to, or even continuous with, the biceps femoris. At 8 weeks, both parts inserted into the femur, possibly the future gluteal tuberosity. However, depending on traction by the developing inferior part as well as pressure from the developing major trochanter of the femur, most of the original femoral insertion of the GMX appeared to be detached from the femur. Therefore, at 9-10 weeks, the GMX had a digastric muscle-like appearance with an intermediate band connecting the major superior part to the small inferior mass. This band, most likely corresponding to the initial iliotibial tract, extended laterally and distally far from the muscle fibres. The fascia lata was still thin and the tensor fasciae latae seemed to develop much later. It seems likely that the evolutionary transition from quadripedality to bipedality and a permanently upright posture would require the development of a new GMX complex with the iliotibial tract that differs from that in non-human primates. (Folia Morphol 2018; 77, 1: 144-150).

Background Anterior skull base reconstruction after resection of sinonasal cancers may be challenging when pedicled flaps are unavailable. The purpose of the present study was to analyze the complication rate and donor site morbidity of 3-layer reconstruction with the iliotibial tract (ITT). Methods We retrospectively reviewed all anterior skull base reconstructions with ITT performed from 2007 to 2015. Donor site morbidity was investigated by a dedicated questionnaire. Factors impacting on cerebrospinal fluid (CSF) leak were assessed using the Fisher's exact test. Results One hundred eighty-six patients were included. The overall complication rate was 9.7%. A CSF leak occurred in 11 patients (5.8%). Twenty patients (10.8%) and 130 patients (69.9%) underwent previous or adjuvant radiotherapy, respectively. Neither radio(chemo)therapy nor age impacted the risk of CSF leak. Six patients (3.2%) experienced complications at the donor site. The questionnaire demonstrated minimal functional and aesthetic morbidity. Conclusion Three-layer reconstruction with the ITT is a safe procedure with acceptable complication rate and donor site morbidity.

The anatomy of the lateral compartment of the knee is very complex, rich in different structures, and difficult to fully understand. Magnetic resonance imaging is the examination of choice for the diagnosis of musculoskeletal pathologies. This article reviews the historical perspectives and the normal and pathologic aspects of the anterolateral complex of the knee, consisting of the iliotibial tract, the lateral collateral ligament, the biceps tendon, and the anterolateral ligament, including the causative structures of the Segond fracture.

Recent research, focusing on rotatory knee laxity, has intrigued the whole orthopaedic knee community. First popularized by Hughston et al, peripheral knee injuries at the time of cruciate ligament rupture have regained more and more recognition, which has led to a better understanding of these injuries. Recent research has been focused on anterolateral rotatory instability, especially regarding those structures that are responsible for the high-grade anterior subluxation of the lateral tibial plateau when damaged. Work at Imperial College London showed that the iliotibial tract (ITT) was the primary restraint to internal tibial rotation, especially the capsulo-osseous layer of the ITT, which contributed almost 25% of controlling a 5-Nm internal rotation torque at early flexion angles. However, due to the complex fiber arrangement, the functional anatomy of the ITT is difficult to understand. Thus, this article focuses on the involvement of the internal tibial rotation in restraining internal rotation and the pivot-shift phenomenon.

Purpose The purpose of this study was to evaluate the separate contribution of the two definitions of the anterolateral ligament (ALL), the mid-third lateral capsular ligament (MTLCL) and deep capsule-osseous layer of the iliotibial tract (dcITT) in addition to the superficial iliotibial tract (sITT) to the control of tibial motion with respect to the femur during the application of force/torque seen during the three tests of the standard clinical knee examination (AP Lachman test, tibial axial rotation test and varus–valgus stress test). Methods Six pelvis-to-toe cadaveric specimens were examined using an automated testing device that carried out the three components of the clinical knee examination. Internal/external rotation torque, anteroposterior load and adduction/abduction torque were applied, while torque/force and positional measurements were recorded. Sequential sectioning of the structures followed the same order for each knee, sITT, dcITT and MTLCL. Testing was repeated after release of each structure. Results During the tibial axial rotation test, releasing the sITT caused an increase in internal rotation of 2.6° (1.4–4.1°, p

Because reconstruction of the anterior cruciate ligament (ACL) in a double-bundle technique did not solve the problem of persistent rotatory laxity after surgery, new potential answers to this issue are of great interest. One of these is an extraarticular stabilization based on the rediscovery of the anterolateral ligament (ALL). Knowledge about its biomechanical function and benchmark data for an optimal reconstruction remain lacking. Therefore, the purpose of this study was to assess the function of the ALL under passive motion, anterior tibial translation and tibial rotational moments. Continuous passive motion (0°–120° flexion), ap-translation and static pivot shift tests were performed on eight cadaveric knees. The knees were measured in intact, ACL-resected (ACLres) and ACL + ALL-resected (ALLres) conditions. Ap-translation and static pivot shift under 134 N anterior shear load were determined at 0°, 30°, 60° and 90° flexion. Strain of the ALL was recorded in intact and ACLres conditions. During continuous passive motion under unloaded conditions, no significant difference in internal rotation between ACLres and ALLres was observed. With an additional internal tibial torque of 1–4 Nm, internal rotation increased significantly between 60° and 120° after resection of the ALL (p ≤ 0.05). Anterior tibial translation was significantly higher at 30° in ALLres (p = 0.01) and for a simulated pivot shift at 60° and 90° in ACLres (p ≤ 0.01). The ALL was not strained under unloaded passive motion. Adding different internal tibial torques led to strain starting at 60° flexion (1 N m internal torque) and 15° flexion (4 N m internal torque) in intact ligaments. In ACLres, significantly greater ALL strains under lower flexion angles were seen for each condition (p ≤ 0.05). This study demonstrated the ALL to be without function under passive motion and with no influence on tibial rotation. On application of extrinsic loads, the ALL had a low but significant stabilizing effect against anterior tibial shear load at low flexion angles. For this reason, it can be concluded that the ALL is supporting the ACL against internal tibial loads to a minor degree. A relationship between the ALL and the pivot shift cannot be concluded. With these results ALL-reconstruction cannot be recommended at the moment without further biomechanical investigations.

OBJECTIVES To assess the learning curve of the direct superior approach (DSA) for total hip arthroplasty (THA) and to compare surgical, clinical, and radiological results with a matched control group using the mini posterior approach (MPA). METHODS A prospective cohort study was performed from October 2016 to May 2017 including our first 52 patients undergoing THA using the DSA. Patients with primary osteoarthritis or osteonecrosis and a body mass index (BMI)

PURPOSE: To compare knee kinematics before and after anterior cruciate ligament ACL reconstruction (ACL-R) using hamstring graft (HG) and a double-stranded iliotibial tract graft attached to Gerdy's tubercle (providing an extra-articular anterolateral tenodesis) (named the modified iliotibial tract graft = MIT). METHOD: Eighteen cadaveric knees were tested in a 6 degree of freedom kinematics rig. An optical tracking system recorded kinematics of the knee from 0 to 80 degrees of flexion applying no load, internal/external rotation (IR/ER), valgus/varus rotation (VGR/VRR), simulated pivot shift (SPS), anterior translation (AT) and posterior translation loads. The knee was tested before and after resection of the ACL and the anterolateral ligament (ALL), respectively; then after HG-ACL-R and MIT-ACL-R. Grafts were fixed at 20° of flexion. Results were compared to the intact knee. RESULTS: ACL resection resulted in a significant increase in AT (p

Summary Background The utility of anterolateral thigh (ALT) + iliotibial tract (ITT) flaps for the reconstruction of large abdominal wall defects has been reported, especially in cases with huge skin defects, surgical contamination, or a history of radiotherapy. However, previous reports have mainly described short-term results such as flap success rates or incidence of wound complications. The present study reviewed 50 consecutive cases of abdominal wall reconstruction using an ALT+ITT flap after extensive tumor resection and evaluated the durability of this approach (incidence of bulge or hernia) and the factors affecting the results. Patients and methods A detailed retrospective review of 50 consecutive cases was conducted. Computed tomography or magnetic resonance imaging findings were reviewed to assess the incidence of abdominal bulge or hernia. Items extracted as variables from patient records were subjected to univariate and multivariate logistic regression analyses to identify their relationship with postoperative abdominal bulge or hernia. Results Forty-six cases that were followed up for more than six months were analyzed. Twenty-three patients (50.0%) developed abdominal bulge, while none (0%) developed hernia. The multivariate logistic regression analysis revealed that old age and a high body mass index were independently associated with abdominal bulge, while abdominal defect size was not. Conclusions Abdominal wall reconstruction using an ALT+ITT flap after extensive tumor resection was considered a reasonable option with a low risk of hernia despite a marked incidence of postoperative abdominal bulge; however, the usage of additional material may be considered depending on the situation.

© 2018, European Society of Sports Traumatology, Knee Surgery, Arthroscopy (ESSKA). The structure and function of the anterolateral complex (ALC) of the knee has created much controversy since the ‘re-discovery’ of the anterolateral ligament (ALL) and its proposed role in aiding control of anterolateral rotatory laxity in the anterior cruciate ligament (ACL) injured knee. A group of surgeons and researchers prominent in the field gathered to produce consensus as to the anatomy and biomechanical properties of the ALC. The evidence for and against utilisation of ALC reconstruction was also discussed, generating a number of consensus statements by following a modified Delphi process. Key points include that the ALC consists of the superficial and deep aspects of the iliotibial tract with its Kaplan fibre attachments on the distal femur, along with the ALL, a capsular structure within the anterolateral capsule. A number of structures attach to the area of the Segond fracture including the capsule-osseous layer of the iliotibial band, the ALL and the anterior arm of the short head of biceps, and hence it is not clear which is responsible for this lesion. The ALC functions to provide anterolateral rotatory stability as a secondary stabiliser to the ACL. Whilst biomechanical studies have shown that these structures play an important role in controlling stability at the time of ACL reconstruction, the optimal surgical procedure has not yet been defined clinically. Concern remains that these procedures may cause constraint of motion, yet no clinical studies have demonstrated an increased risk of osteoarthritis development. Furthermore, clinical evidence is currently lacking to support clear indications for lateral extra-articular procedures as an augmentation to ACL reconstruction. The resulting statements and scientific rationale aim to inform readers on the most current thinking and identify areas of needed basic science and clinical research to help improve patient outcomes following ACL injury and subsequent reconstruction. Level of evidence V.

Supplemental Digital Content is available in the text., Summary: The surgical management of abdominal wall tumor in women with childbearing potential is a thorny issue. A synthetic mesh is widely used for abdominal wall reconstruction but not necessarily applicable in case of women of childbearing potential because it has been reported to cause severe pain during pregnancy. Autologous reconstruction is usually considered a feasible option for such cases; however, there is no consensus on this approach and almost no evidence to support it. In the present 2 cases, 2 female patients (age, 17 years and 35 years) with abdominal wall desmoid tumor underwent primary radical resection and autologous reconstruction of an abdominal wall defect in the lateral oblique muscle area (defect size, 13 × 5 cm and 8 × 6 cm) using an anterolateral thigh and iliotibial tract flap. The postoperative course was uneventful. Both patients achieved pregnancy and a full-term delivery without complications with the exception of a feeling of mild stretching in the area of the operation. Magnetic resonance imaging and a clinical examination after the delivery revealed no signs of abdominal wall hernia or bulging. Normal pregnancy and full-term delivery could be obtained after abdominal wall resection and autologous reconstruction using an anterolateral thigh + iliotibial tract flap. This reconstructive method is considered to be a versatile option for the management of abdominal wall tumor in women with childbearing potential; however, further evidence should be accumulated on the reconstruction of wider and central abdominal wall defects.

Background Fibrous dysplasia of the proximal femur presents with heterogeneous clinical manifestations dictating different surgical approaches. However, to date there are no clear recommendations to guide the choice of surgical approach and no general guidelines for the optimal orthopedic management of these lesions. The objective of this study was to evaluate treatment outcomes of angled blade plates and intramedullary nails, using as outcome indicators revision-free survival, pain, function and femoral neck-shaft-angle. Based on a review of published literature and our study findings, we propose a treatment algorithm, taking into account different factors, which may play a role in the selection of one surgical approach over another. Methods Data were evaluated in thirty-two patients (18 male) from a combined cohort from the Netherlands and Austria, who had a surgical intervention using an angled blade plate (n = 27) or an intramedullary nail (n = 5) between 1985 and 2015, and who had a minimal follow-up of one year. The primary outcome was success of the procedure according to the revised Henderson classification. Secondary outcomes, which were assessed at one year and at the end of follow-up included: function (as measured by walking ability), pain and change in femoral neck-shaft angle over time. Results Analysis of data showed that revision-free survival was 72% after a median follow-up of 4.1 years. Revision was necessary in two patients for structural failure due to a fracture distal to an angled blade plate and in 7 patients due to angled blade plate-induced iliotibial tract pain. At the end of follow-up 91% of all patients had good walking ability and 91% were pain free. There was no significant postoperative change in femoral neck shaft angle. Conclusion Our data show that fibrous dysplasia of the proximal femur can be adequately and safely treated with angled blade plates or intramedullary nails, providing these are used according to specific characteristics of the individual patient. Based on published literature and our own experience, we propose an individualized, patient-tailored approach for the surgical management of fibrous dysplasia of the proximal femur. Electronic supplementary material The online version of this article (10.1186/s13023-018-0805-7) contains supplementary material, which is available to authorized users.

Case: A twenty-eight-year-old man presented with a Pipkin type-III femoral head fracture and open floating knee injury. Initially debridement was performed, during which the extensor apparatus could not be salvaged. The top priority in management of the floating knee was achievement of adequate soft-tissue coverage followed by skeletal stabilization as staged procedures. Because the femoral head was split, dislocated, comminuted, and deemed nonreconstructible, arthroplasty was considered the best option. The extensor mechanism damage was addressed by reconstruction using an iliotibial tract flap. Conclusion: This case report is presented for its uniqueness, the management protocol, and the difficulties encountered during the multistage treatment.

Background An examination of the vascular anatomy of the iliotibial tract (IT) has not been previously reported. Because a flap resists infection better than an avascular graft, a vascularized IT graft is useful for reconstructive surgeries pertaining to infected wounds or wounds in contact with artificial material. The purpose of this study was to examine the vascular anatomy of the IT. Materials and Methods The study sample consisted of 39 limbs of freshly frozen cadavers. The study was divided into three parts. The ascending and transverse branches of the lateral circumflex femoral artery (LCFA) of all cadavers were injected with latex. Distance from the tensor fasciae latae muscle and the most distal point at which the vessel on the IT was stained by latex was recorded. A microscopic observation was performed for these limbs. The deep femoral artery (DFA) or superior lateral genicular artery (SLGA) was also observed. Results The length of the IT fed by the LCFA was 162.3 ± 36.2 mm. The IT vascularity was located between the layered structure of the fascia and there was a vascular source for the IT within 1 mm above the IT by optical microscopy. The vascularity derived from the DFA or SLGA was not confirmed in any specimens. Conclusions Blood supply of the IT was derived from the LCFA and a vascularized IT graft could be elevated in length to approximately 16 cm. This knowledge may be useful for improving the safety of surgery when transferring an IT flap. © 2015 Wiley Periodicals, Inc. Microsurgery, 2015.

Background Reconstruction of extensive axillary defects after sarcoma resection presents a challenging problem in reconstructive microsurgery. The purpose of this report was to investigate the feasibility of the free anterolateral thigh (ALT) flap for oncologic axillary reconstruction. Methods The extensive axillary defects in six patients with sarcoma was reconstructed using a free ALT flap. The defect size ranged from 15 × 11 to 28 × 25 cm2. Five patients had recurrent cases and the ipsilateral latissimus dorsi flap had been already used in three patients. Two patients with a full-thickness defect underwent chest wall reconstruction with the iliotibial tract. Results All flaps survived completely and the wounds healed without complications in all patients. Conclusions The free ALT flap is an ideal flap for axillary reconstruction after extensive sarcoma resection. It can be tailored to the requirements of the individual's defect and provides durable coverage for the axillary neurovascular bundle and intrathoracic structures. Flap harvesting in the lateral decubitus position enables a two-team approach. © 2015 Wiley Periodicals, Inc. Microsurgery, 2015.

To date, various surgical techniques to treat posterolateral knee instability have been described. Recent studies recommended an anatomical and isometric reconstruction of the posterolateral corner addressing the key structures, such as lateral collateral ligament (LCL), popliteus tendon (POP) and popliteofibular ligament (PFL). Two clinical established autologous respective local reconstruction methods of the posterolateral complex were tested for knot-bone cylinder press-fit fixation to assess efficacy of each reconstruction technique in comparison to the intact knee.The knot-bone cylinder press-fit fixation for both anatomic and isometric reconstruction techniques of the posterolateral complex shows equal biomechanical stability as the intact posterolateral knee structures.This was a controlled laboratory study.Two surgical techniques (Larson: fibula-based semitendinosus autograft for LCL and PFL reconstruction/Kawano: biceps femoris and iliotibial tract autograft for LCL, PFL and POP reconstruction) with press-fit fixation were used for restoration of posterolateral knee stability. Seven cadaveric knees (66 ± 3.4 years) were tested under three conditions: intact knee, sectioned state and reconstructed knee for each surgical technique. Biomechanical stress tests were performed for every state at 30° and 90° knee flexion for anterior-posterior translation (60 N), internal-external and varus-valgus rotation (5 Nm) at 0°, 30° and 90° using a kinemator (Kuka robot).At 30° and 90° knee flexion, no significant differences between the four knee states were registered for anterior-posterior translation loading. Internal-external and varus-valgus rotational loading showed significantly higher instability for the sectioned state than for the intact or reconstructed posterolateral structures (p0.05). There were no significant differences between the intact and reconstructed knee states for internal-external rotation, varus-valgus rotation and anterior-posterior translation at any flexion angles (p0.05). Comparing both reconstruction techniques, significant higher varus-/valgus stability was registered for the fibula-based Larson technique at 90° knee flexion (p0.05).Both PLC reconstructions showed equal biomechanical stability as the intact posterolateral knee structures when using knot-bone cylinder press-fit fixation. We registered restoration of the rotational and varus-valgus stability with both surgical techniques. The anterior-posterior translational stability was not influenced significantly. The Larson technique showed significant higher varus/valgus stability in 90° flexion. The latter is easier to perform and takes half the preparation time, but needs grafting of the semitendinosus tendon. The Kawano reconstruction technique is an interesting alternative in cases of missing autografts.

The objective of this study was to evaluate the potential of the partial plastination technique in minimizing material slippage and to discuss the effects on the tensile properties of thin dense connective tissue. The ends of twelve iliotibial tract samples were primed with polyurethane resin and covered by plastic plates to provide sufficient grip between the clamps. The central part of the samples remained in an anatomically unfixed condition. Strain data of twelve partially plastinated samples and ten samples in a completely anatomically unfixed state were obtained using uniaxial crosshead displacement and an optical image tracking technique. Testing of agreement between the strain data revealed ongoing but markedly reduced material slippage in partially plastinated samples compared to the unfixed samples. The mean measurement error introduced by material slippage was up to 18.0% in partially plastinated samples. These findings might complement existing data on measurement errors during material testing and highlight the importance of individual quantitative evaluation of errors that come along with self-made clamping techniques.

Since the early years of orthopaedics, it is a well-known fact that anatomy follows function. During the evolution of mankind, the knee has been optimally adapted to the forces and loads acting at and through the knee joint. However, anatomy of the knee joint is variable and the only constant is its complex function. In contrast to the time of open surgery, nowadays the majority of reconstructive knee surgery is done arthroscopically. Keyhole surgery is less invasive, but on the backside, the knee surgeon lacks daily visualisation of the complex open anatomy. As open anatomical knowledge is less present in our daily practice, it is even more important to highlight this complex anatomy and function of the knee. It is the purpose of this review to perform a systematic review of knee anatomy, highlight the complex function of the knee joint and present an overview about recent and current knowledge about knee function. Level of evidence Systematic review, Level IV.

Introduction Surgical approaches through smaller incisions reveal less of the underlying anatomy, and therefore, detailed knowledge of the local anatomy and its variations is important in minimally invasive surgery. The aim of this study was to determine the location, extension, and histomorphology of the deep layer of the iliotibial band during minimally invasive hip surgery using the direct anterior approach (DAA). Materials and methods The morphology of the iliotibial tract was determined in this cadaver study on 40 hips with reference to the anterior superior iliac spine and the tibia. The deep layer of the tractus iliotibialis was exposed up to the hip-joint capsule and length and width measurements taken. Sections of the profound iliotibial tract were removed from the hips and the thickness of the sections was determined microscopically after staining. Results The superficial tractus iliotibialis had a length of 50.1 (SD 3.8) cm, while tensor fasciae latae total length was 18 (SD 2) cm [unattached 15 (SD 2.5) cm]. Length and width of the deep layer of the tractus iliotibialis were 10.4 (SD 1.3) × 3.3 (SD 0.6) cm. The deep iliotibial band always extended from the distal part of the tensor fascia latae (TFL) muscle to the lateral part of the hip capsule (mean maximum thickness 584 μm). Tractus iliotibialis deep layer morphology did not correlate to other measurements taken (body length, thigh length, and TFL length). Conclusions The length of the deep layer is dependent on the TFL, since the profound part of the iliotibial band reaches from the TFL to the hip-joint capsule. The deep layer covers the hip-joint capsule, rectus, and lateral vastus muscles in the DAA interval. To access the precapsular fat pad and the hip-joint capsule, the deep layer has to be split in all approaches that use the direct anterior interval.

Injury to the anterolateral ligament (ALL) has been reported to contribute to high-grade anterolateral laxity after anterior cruciate ligament (ACL) injury. Failure to address ALL injury has been suggested as a cause of persistent rotational laxity after ACL reconstruction. Lateral meniscus posterior root (LMPR) tears have also been shown to cause increased internal rotation of the knee.The purpose of this study was to determine the functional relationship between the ALL and LMPR in the control of internal rotation of the ACL-deficient knee. Specifically: (1) We asked if there was a difference in internal rotation among: the intact knee; the ACL-deficient knee; the ACL/ALL-deficient knee; the ACL/LMPR-deficient knee; and the ACL/ALL/LMPR-deficient knee. (2) We also asked if there was a difference in anterior translation among these conditions.Sixteen fresh frozen cadaveric knee specimens (eight men, mean age 79 years) were potted into a hip simulator (femur) and a 6 degree-of-freedom load cell (tibia). Rigid optical trackers were inserted into the proximal femur and distal tibia, allowing for the motion of the tibia with respect to the femur to be tracked during biomechanical tests. A series of points on the femur and tibia were digitized to create bone coordinate systems that were used to calculate internal rotation and anterior translation. Biomechanical testing involved applying a 5-Nm internal rotation moment to the tibia from full extension to 90° of flexion. Anterior translation was performed by applying a 90-N anterior load using a tensiometer. Both tests were performed in 15° increments tested sequentially in the following conditions: (1) intact; and (2) ACL injury (ACL-). The specimens were then randomized to either have the ALL sectioned (3) first (M+/ALL-); or (4) the LMPR sectioned first (M-/ALL+) followed by the other structure (M-/ALL-). A one-way analysis of variance was performed for each sectioning condition at each angle of knee flexion (α = 0.05).At 0° of flexion there was an effect of tissue sectioning such that internal rotation of the M-/ALL- condition was greater than ACL- by 1.24° (p = 0.03; 95% confidence interval [CI], 0.16-2.70) and the intact condition by 2.5° (p = 0.01; 95% CI, 0.69-3.91). In addition, the mean (SD) internal rotations for the M+/ALL- (9.99° [5.39°]) and M-/ALL+ (12.05° [5.34°]) were greater by 0.87° (p = 0.04; 95% CI, 0.13-3.83) and by 2.15°, respectively, compared with the intact knee. At 45° the internal rotation for the ACL- (19.15° [9.49°]), M+/ALL- (23.70° [7.00°]), and M-/ALL- (18.80° [8.27°]) conditions was different than the intact (12.78° [9.23°]) condition by 6.37° (p = 0.02; 95% CI, 1.37-11.41), 8.47° (p 0.01; 95% CI, 3.94-13.00), and 6.02° (p = 0.01; 95% CI, 1.73-10.31), respectively. At 75° there was a 10.11° difference (p 0.01; 95% CI, 5.20-15.01) in internal rotation between the intact (13.96° [5.34°]) and the M+/ALL- (23.22° [4.46°]) conditions. There was also a 4.08° difference (p = 0.01; 95% CI, 1.14-7.01) between the intact and M-/ALL- (18.05° [7.31°]) conditions. Internal rotation differences of 6.17° and 5.43° were observed between ACL- (16.28° [6.44°]) and M+/ALL- (p 0.01; 95% CI, 2.45-9.89) as well as between M+/ALL- and M-/ALL- (p = 0.01; 95% CI, -8.17 to -1.63). Throughout the range of flexion, there was no difference in anterior translation with progressive section of the ACL, meniscus, or ALL.The ALL and LMPR both play a role in aiding the ACL in controlling internal rotation laxity in vitro; however, these effects seem to be dependent on flexion angle. The ALL has a greater role in controlling internal rotation at flexion angles 30Injury to the ALL and/or LMPR may contribute to high-grade anterolateral laxity after ACL injury. The LMPR and the ALL, along with the iliotibial tract, appear to act in concert as secondary stabilizers of anterolateral rotation and could be considered as the "anterolateral corner" of the knee.

Watertight reconstruction to separate the intradural compartment from the sinonasal cavities is crucial after endoscopic resection with transnasal craniectomy for nasoethmoidal tumors. A 3-layer reconstruction with the iliotibial tract is a safe and reliable alternative when vascularized flaps are unavailable. The iliotibial tract graft is harvested on the lateral aspect of the thigh and divided into 3 portions, which are positioned in a multilayered fashion to close the skull base defect: the intracranial intradural layer (first layer), the intracranial extradural layer (second layer), and the extracranial extradural layer (third layer). Fat grafts from thigh subcutaneous tissue are placed between the second and third layers to fill the dead space between them. Use of fibrin glue and intradural irrigation may help the surgeon to stabilize the layers during reconstruction. Three-layer reconstruction with the iliotibial tract is a feasible, highly reproducible, safe, and always available option for reconstruction of anterior skull base defects after endoscopic resection with transnasal craniectomy for nasoethmoidal tumors.

Objective: To evaluate the clinical and functional results of two surgical treatments of patellar dislocation in children. Material and Methods: A prospective study was undertaken from January 1995 to December 2009. Pre-postoperatively, the clinical and roentgenographic examinations were performed. Patellar dislocation was classified according to Bensahel’s criteria. There were two surgical techniques performed: 1) the iliotibial tract passing through patella (ITT), and 2) transferring vastus medialis oblique muscle to superior border patella (VMO). Lateral retinacula were released to restore the tension of the medial retinacula and quadricepsplasty was used in all patients. The results of the operations were classified according to Kujala’s functional knee-scoring systems. Results: 128 patients (132 knees) were operated. There were 20 males and 108 females. 94 knees (71.2%) were Type 1, and 38 knees (28.8%) were Type 2. The ITT was in 74 patients (76 knees), and VM was in 54 patients (56 knees). Clinical signs, imaging finding before and after the operation and operative results of these patients were operated with ITT and VM with no significant difference (p > 0.05). Overall, we attained excellent results in 95 knees (72.0%), good results in 30 knees (22.7%), and fair results in 7 knees (5.3%). There have been no poor results or recurrences so far. Conclusion: These techniques are simple, safe and effective in skeletally immature children. Long-term follow-up of these patients was operated ITT and these patients which were operated VMO were not different, but time for operation was: ITT: 65 minutes, and VMO: 55 minutes.

Total knee replacement for patients with osteoarthritis and valgus deformity remains challenging, with soft tissue balance often difficult to achieve. Most orthopedic surgeons use the medial parapatellar approach for total knee replacement. However, the lateral approach described in this case allows direct access to the pathology. The valgus deformity is corrected by using a modified lateral parapatellar arthrotomy with a staged and gradual release of the contracted lateral capsuloligamentous structures and the iliotibial tract. A Z-shaped dissection of the lateral retinaculum and careful dissection and preservation of the infrapatellar fat pad is performed. The creation of this laterally based vascularized flap provides the necessary tissue to cover the soft tissue gap resulting on the lateral aspect of the knee after valgus correction. The lateral approach has advantages, including ligament balancing and preservation of the medial retinaculum and the medial neurovascular structures for the supply of the patella. However, this approach should be used with caution by experienced surgeons. [ Orthopedics. 2017; 40(5):313–316.]

Background Use of proximal tibia as a donor site has been applied in jawbone reconstruction since the 1990s. Catone and colleagues described a U-shaped incision made on the iliotibial tract during tibial cancellous bone procurement for maxillofacial reconstruction in 1992. We used a curvilinear incision on the iliotibial tract in lateral approach in our tibial cancellous bone harvesting procedure. Objectives The objectives of this retrospective study are to describe our modified lateral approach for procuring cancellous graft from the proximal tibia and to assess the bone volume, donor site morbidity, and associated complications. Material and Methods Eighty consecutive jawbone reconstructions utilizing autogenous tibial cancellous bone grafts in 78 patients from March 1998 through March 2008 were reviewed. The patient group consisted of 45 males and 33 females, ages 18 to 76 (average age 36.1 ± 12.3). Minimal postoperative follow-up period was 3 months. Unlike the traditional U-shaped trapdoor incision on the iliotibial tract, our curvilinear incision was made almost parallel to the fibers of that tract. Result Only mild complications were observed at donor sites, including temporary paresthesia, gait disturbance, and an unpleasant scar. The average procured graft volume was 17.8 mL. We also present the first case of reconstruction of mandibular continuity defects of up to 6 to 7 cm lengthwise by tibial cancellous bone grafting, which has not previously been reported in the English literature. Conclusion The modified incision on the iliotibial tract allowed access to obtain an equally good bone volume from the lateral aspect of the proximal tibia, and it rendered wound closure much easier than the procuring techniques described in the earlier literature.

Greater trochanteric pain syndrome (GTPS) is associated with excessive tension between the iliotibial band (ITB) and the greater trochanter. Several endoscopic procedures have been reported, but in most cases the endoscopic approach only consists of a bursectomy. The ITB and fascia lata act as a lateral tension band to resist tensile strains on the concave aspect of the femur and are often implicated as the source of GTPS. We therefore believe that the ITB must be addressed. We describe an endoscopic technique to release the ITB and remove the bursa and conclude that endoscopic bursectomy with cross incision of the ITB is a safe approach to treat patients with refractory GTPS.

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-Lavallee 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.

Summary: Reconstruction of large abdominal wall defects is challenging. We herein report the successful reconstruction of an extensive abdominal wall defect using a novel combination of flaps after sarcoma resection. A 74-year-old man presented with a dedifferentiated liposarcoma on his abdominal wall. He underwent excision of the tumor, which resulted in an extensive abdominal wall defect. The defect was reconstructed with a pedicled anterolateral thigh flap with an iliotibial tract and a pedicled superficial inferior epigastric artery flap. No skin graft was necessary. The wounds healed successfully, and no herniation occurred. The combination of an anterolateral thigh flap and a superficial inferior epigastric artery flap is a versatile option for reconstruction of extensive abdominal wall defects.

A technique for anatomic reconstruction of the anterolateral complex addressing anterolateral rotatory instability both in primary anterior cruciate ligament reconstruction and in revision cases is presented. The extra-articular reconstruction is performed with a pedicle strip of iliotibial tract, fixed on the anatomic origin and insertion points of the anterolateral ligament of the knee in a double-bundle V-shaped fashion.