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Scientific Basis and Surgical Technique for Iliotibial Band Tenodesis Combined with ACL Reconstruction

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Controversies in the Technical Aspects of ACL Reconstruction

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Abstract

Anatomy: Due to the complexity of the lateral side of the knee, it may be best to describe these structures in terms of three tissue layers from superficial to deep. The distal part of the fascia lata – (1) the superficial layer of the iliotibial band (ITB) – is tethered to the distal femur by the (2) deep and capsulo-osseous fibres of the ITB. Removal of these ITB layers exposes the (3) anterolateral capsule and other deeper structures, which has been described as including the anterolateral ligament (ALL) with differing interpretations.

Biomechanics: The anterior cruciate ligament (ACL) and the ITB have been shown to be the primary restraints to anterior tibial translation and internal tibial rotation, respectively. An injury of the ACL and the anterolateral structures may therefore result in a combined translatory and rotatory instability, called anterolateral rotatory instability (ALRI). As a logical rationale, a surgical intervention would include an intra-articular ACL reconstruction alongside a reconstruction of the anterolateral structures. This has been shown to restore normal knee kinematics in a simulated ALRI-injured knee.

Conclusion: The anatomy of the anterolateral side is complex and yet not fully understood. Thus, there is an urgent need for a standardised nomenclature/terminology for these structures. A combined ALRI injury may be treated with an intra-articular ACL reconstruction and a nonanatomic ITB tenodesis.

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Acknowledgements

Work leading to this chapter was supported by the following sources: AGA, Fortius Clinic, Bergen Regional Health Authority, and Smith & Nephew Endoscopy. The joint testing system was supported by the EPSRC and Wellcome Trust via the Centre of Excellence in application of technology to the treatment of osteoarthritis at Imperial College London.

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Authors and Affiliations

  1. Sporthopaedicum, Berlin, Germany

    Christoph Kittl

  2. Biomechanics Group, Mechanical Engineering Department, Imperial College London, London, UK

    Christoph Kittl, Eivind Inderhaug, Joanna Stephen, Hadi El-Daou & Andrew A. Amis

  3. Haraldsplass Deaconess Hospital, Bergen, Norway

    Eivind Inderhaug

  4. Fortius Clinic, London, UK

    Joanna Stephen & Andy Williams

  5. Musculoskeletal Surgery Group, Department of Surgery & Cancer, Imperial College London School of Medicine, London, UK

    Andrew A. Amis

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  1. Christoph Kittl
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  5. Andy Williams
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  6. Andrew A. Amis
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Correspondence to Andrew A. Amis .

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Editors and Affiliations

  1. Institute for Medical Science in Sports, Osaka Health Science University, Osaka, Japan

    Norimasa Nakamura

  2. Istituto Ortopedico Rizzoli, University of Bologna, Bologna, Italy

    Stefano Zaffagnini

  3. Hospital for Special Surgery, New York, New York, USA

    Robert G. Marx

  4. UPMC Center for Sports Medicine, Pittsburgh, Pennsylvania, USA

    Volker Musahl

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Kittl, C., Inderhaug, E., Stephen, J., El-Daou, H., Williams, A., Amis, A.A. (2017). Scientific Basis and Surgical Technique for Iliotibial Band Tenodesis Combined with ACL Reconstruction. In: Nakamura, N., Zaffagnini, S., Marx, R., Musahl, V. (eds) Controversies in the Technical Aspects of ACL Reconstruction. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-662-52742-9_36

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  • DOI: https://doi.org/10.1007/978-3-662-52742-9_36

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