Korean J Pain.  2021 Apr;34(2):229-233. 10.3344/kjp.2021.34.2.229.

The role of the iliotibial band cross-sectional area as a morphological parameter of the iliotibial band friction syndrome: a retrospective pilot study

• Park J
• Cho HR
• Kang KN
• Choi KW
• Choi YS
• Jeong HW
• Yi J
• Kim YU

• KMID: 2514422
• DOI: http://doi.org/10.3344/kjp.2021.34.2.229

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 mm 2 in the normal group and 38.75 ± 9.11 mm 2 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 mm 2 , 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.

Keyword

Anatomy; Cross-Sectional; Cumulative Trauma Disorders; Diagnosis; Fascia Lata; Friction; Hypertrophy; Iliotibial Band Syndrome; Knee Injuries; Magnetic Resonance Imaging; ROC Curve; Sensitivity and Specificity

Figure

• 

  Fig. 1 Measurement of both iliotibial band thickness (ITBT) (white arrow) (A) and iliotibial band cross-sectional area (ITBCSA) (white arrow) (B) in the iliotibial band friction syndrome group was carried out on magnetic resonance T1 weighted images.

• 

  Fig. 2 Receiver operating characteristic (ROC) curve of iliotibial band thickness (ITBT) and iliotibial band cross-sectional area (ITBCSA) for prediction of iliotibial band friction syndrome (ITBFS). The best cut off point of ITBT was 2.29 mm versus 30.66 mm2 of ITBCSA, with sensitivity 76.7% vs. 79.1%, specificity 79.1% vs. 79.1% and AUC 0.87 vs. 0.88, respectively. ITBT area under the curve (AUC) (95% confidence interval [CI]) = 0.87 (0.80-0.94), ITBCSA AUC (95% CI) = 0.88 (0.81-0.95).

Reference

1. Flato R, Passanante GJ, Skalski MR, Patel DB, White EA, Matcuk GR Jr. 2017; The iliotibial tract: imaging, anatomy, injuries, and other pathology. Skeletal Radiol. 46:605–22. DOI: 10.1007/s00256-017-2604-y. PMID: 28238018.

2. Hadeed A, Tapscott DC. 2020. Iliotibial band friction syndrome [Internet]. StatPearls Publishing;Treasure Island (FL): Available at: https://www.ncbi.nlm.nih.gov/books/NBK542185/.

3. Hong JH, Kim JS. 2013; Diagnosis of iliotibial band friction syndrome and ultrasound guided steroid injection. Korean J Pain. 26:387–91. DOI: 10.3344/kjp.2013.26.4.387. PMID: 24156006. PMCID: PMC3800712.

4. Lavine R. 2010; Iliotibial band friction syndrome. Curr Rev Musculoskelet Med. 3:18–22. DOI: 10.1007/s12178-010-9061-8. PMID: 21063495. PMCID: PMC2941581.

5. Lee S, Cho HR, Yoo JS, Kim YU. 2020; The prognostic value of median nerve thickness in diagnosing carpal tunnel syndrome using magnetic resonance imaging: a pilot study. Korean J Pain. 33:54–9. DOI: 10.3344/kjp.2020.33.1.54. PMID: 31888318. PMCID: PMC6944367.

6. Yan R, Huang Z, Wang L, Zhang X. 2014; [MR manifestations and clinical significance of iliotibial band friction syndrome]. Zhonghua Yi Xue Za Zhi. 94:1473–5. Chinese. PMID: 25143167.

7. Khaund R, Flynn SH. 2005; Iliotibial band syndrome: a common source of knee pain. Am Fam Physician. 71:1545–50. PMID: 15864895.

8. Strauss EJ, Kim S, Calcei JG, Park D. 2011; Iliotibial band syndrome: evaluation and management. J Am Acad Orthop Surg. 19:728–36. DOI: 10.5435/00124635-201112000-00003. PMID: 22134205.

9. Rathore S, Quadri V, Tapadia S, Krishnaiah K, Krishna VPN. 2017; Intra-articular fibroma of tendon sheath in knee joint associated with iliotibial band friction syndrome: rare occurrence in a teenage girl. J Orthop Case Rep. 7:28–31. DOI: 10.13107/jocr.2250-0685.674. PMID: 28630835. PMCID: PMC5458692.

10. Takagi K, Inui H, Taketomi S, Yamagami R, Kono K, Nakazato K, et al. 2020; Iliotibial band friction syndrome after knee arthroplasty. Knee. 27:263–73. DOI: 10.1016/j.knee.2019.09.004. PMID: 31883856.

11. Walbron P, Jacquot A, Geoffroy JM, Sirveaux F, Molé D. 2018; Iliotibial band friction syndrome: an original technique of digastric release of the iliotibial band from Gerdy's tubercle. Orthop Traumatol Surg Res. 104:1209–13. DOI: 10.1016/j.otsr.2018.08.013. PMID: 30341031.

12. Decker G, Hunt D. 2019; Proximal iliotibial band syndrome in a runner: a case report. PM R. 11:206–9. DOI: 10.1016/j.pmrj.2018.06.017. PMID: 30010051.

13. Everhart JS, Kirven JC, Higgins J, Hair A, Chaudhari AAMW, Flanigan DC. 2019; The relationship between lateral epicondyle morphology and iliotibial band friction syndrome: a matched case-control study. Knee. 26:1198–203. DOI: 10.1016/j.knee.2019.07.015. PMID: 31439366.

14. Foch E, Milner CE. 2019; Influence of previous iliotibial band syndrome on coordination patterns and coordination variability in female runners. J Appl Biomech. 35:305–11. DOI: 10.1123/jab.2018-0350. PMID: 31141437.

15. Landreau P, Catteeuw A, Hamie F, Saithna A, Sonnery-Cottet B, Smigielski R. 2019; Anatomic study and reanalysis of the nomenclature of the anterolateral complex of the knee focusing on the distal iliotibial band: identification and description of the condylar strap. Orthop J Sports Med. 7:2325967118818064. DOI: 10.1177/2325967118818064. PMID: 30729141. PMCID: PMC6350136.

16. Pegrum J, Self A, Hall N. 2019; Iliotibial band syndrome. BMJ. 364:l980. DOI: 10.1136/bmj.l980. PMID: 30898786.

17. Everhart JS, Kirven JC, Higgins J, Hair A, Chaudhari AMW, Flanigan DC. 2020; Corrigendum to "The relationship between lateral epicondyle morphology and iliotibial band friction syndrome: A matched case-control study [The Knee 26 (2019) 1198-1203]". Knee. 27:1291. DOI: 10.1016/j.knee.2020.06.002. PMID: 32620349.

18. Joo Y, Cho HR, Kim YU. 2020; Evaluation of the cross-sectional area of acromion process for shoulder impingement syndrome. Korean J Pain. 33:60–5. DOI: 10.3344/kjp.2020.33.1.60. PMID: 31888319. PMCID: PMC6944366.

19. Gadsden JC, Sata S, Bullock WM, Kumar AH, Grant SA, Dooley JR. 2020; The relative analgesic value of a femoral nerve block versus adductor canal block following total knee arthroplasty: a randomized, controlled, double-blinded study. Korean J Anesthesiol. 73:417–24. DOI: 10.4097/kja.20269. PMID: 32842722. PMCID: PMC7533174.

20. Ciftci B, Ekinci M, Atalay YO. 2020; Ultrasound guided rhomboid intercostal block provides effective pain control after video-assisted thoracoscopic surgery: a brief report of three cases. Korean J Anesthesiol. doi: 10.4097/kja.20538. DOI: 10.4097/kja.20538. PMCID: PMC7714626. PMID: 33198430.

21. Abdelbaser I, Mageed NA, El-Emam EM, ALseoudy MM, Elmorsy MM. 2020; Preemptive analgesic efficacy of ultrasound-guided transversalis fascia plane block in children undergoing inguinal herniorrhaphy: a randomized, double-blind, controlled study. Korean J Anesthesiol. doi: 10.4097/kja.20601. DOI: 10.4097/kja.20601. PMID: 33307633.

22. Mudumbai SC, Kim TE, Howard SK, Giori NJ, Woolson S, Ganaway T, et al. 2020; Corrigendum: an ultrasound-guided fascia iliaca catheter technique does not impair ambulatory ability within a clinical pathway for total hip arthroplasty. Korean J Anesthesiol. 73:267. DOI: 10.4097/kjae.2016.69.4.368.e1. PMID: 32506897. PMCID: PMC7280886.