Anatomy, Function, and Surgical Access of the Iliotibial Band in Total Knee Arthroplasty by Leo A....

Anatomy, Function, and Surgical Access of the Iliotibial Band in Total Knee Arthroplasty

by Leo A. Whiteside, and Marcel E. Roy

J Bone Joint Surg AmVolume 91(Supplement 6):101-106

November 1, 2009

©2009 by The Journal of Bone and Joint Surgery, Inc.

The iliotibial band is connected broadly to the bone structures below the knee.

Leo A. Whiteside, and Marcel E. Roy J Bone Joint Surg Am 2009;91:101-106


The posterior portion of the iliotibial band tightens in extension, and tethers the central band, holding it posteriorly so that the central band fibers are angled anteriorly.



The anterior portion of the iliotibial band tightens in flexion and its attachments to the patella tether the central portion of the iliotibial band, holding it anteriorly so that the central fibers are

angled posteriorly.



The posterior portion of the iliotibial band attaches firmly to the biceps femoris muscle and tendon.



When the knee is in flexion, the posterior portion of the iliotibial band slackens but remains closely applied to the lateral collateral ligament (LCL) and other epicondylar ligament structures

of the lateral side of the knee.



The posterior portion of the iliotibial band has been transected and partially elevated from the underlying structures, and a clamp has been inserted through a medial parapatellar arthrotomy

to reach the posterior portion of the iliotibial band.



The posterior portion of the iliotibial band has been elevated, exposing the epicondylar ligamentous structures.



Complete release of the iliotibial band can be done outside the synovial membrane and without damaging the lateral ligaments.



This clinical case illustrates how, during total knee arthroplasty, selective release of the iliotibial band can restore stability to the valgus knee with a conservative operative procedure.



The patella (P) has been retracted medially and the interval between the deep fascia and the iliotibial band has been dissected, exposing the posterior portion of the iliotibial band.



The posterior portion is transected with a knife while the synovial membrane (S) is left intact.



The posterior portion of the iliotibial band has been partially transected, leaving the posterior joint anterior to the biceps femoris.



The posterior portion of the iliotibial band has been completely transected, and the fibers of the biceps femoris muscle are exposed.



The knee is fully extended and the fibers of the remaining iliotibial band are held with forceps.



The knee is flexed and a finger is used to palpate the edge of the remaining anterior portion of the iliotibial band.



With the knee in 90° of flexion and with varus stress applied, the remaining anterior (A-ITB) portion of the iliotibial band becomes tight, thus providing lateral stability to the knee.



The posterior portion of the iliotibial band has been completely transected, and the fibers of the biceps femoris muscle are exposed.



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Anatomy, Function, and Surgical Access of the Iliotibial Band in Total Knee Arthroplasty by Leo A....

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