A fluoroscopic analysis of the length changes of the capsulo-osseous layer of the distal iliotibial band

  • Mark Abbott
  • Amanda Dentremont
  • Alan Getgood
  • Timothy A. BurkhartEmail author



Previous studies have implicated the iliotibial band and its deeper capsulo-osseous layer as key restraints against internal rotation. However, the kinematic properties of the capsulo-osseous layer, throughout knee range of motion, are not currently known. Therefore, the purpose of this research was to quantify the length changes of this structure through various degrees of knee flexion.


Ten cadaveric knee specimens were dissected to expose the capsulo-osseous layer of the iliotibial band. Radiopaque beads were embedded, at standardized increments, into the tissue and fluoroscopic images were taken from 0° to 105° of knee flexion in 15° increments. The positions of the beads were identified in each image and the length, width, and area changes of the capsulo-osseous layer were calculated. The data were analyzed as a percent change from 0° and compared across flexion angles using a repeated-measures analysis of variance (α = 0.05).


There was a significant increase in the length of the capsulo-osseous layer at flexion angles greater than 30°, with changes occurring primarily at the level of the femoral insertion. Meanwhile, non-homogenous decreases in width and area were found with increasing flexion angle. The distance between the capsulo-osseous layer insertion on the distal femur and proximal tibia significantly increased from 60° to 105°; maximal changes occurred at 105° [9.64 (4.12) %, p = 0.003].


The capsulo-osseous layer of the iliotibial band behaves in a non-isometric fashion and this work suggests that tensioning and fixation should occur between 75° and 105° of flexion, if repair or reconstruction is indicated.


Capsulo-osseous layer Anterolateral rotatory laxity Iliotibial band Biomechanics Isometry 



We would like to thank Haley Linklater and Kevin Walker for their help with specimen acquisition and dissections, and Dr. Alexander El-Warrak and Heather-Anne Cadieux-Pitre for their help with fluoroscopy. We would also like to acknowledge Smith & Nephew and Western’s Bone and Joint Institute for providing funding support for this project.


This study was funded by Western University’s Bone and Joints Institute and Smith and Nephew.

Compliance with ethical standards

Conflict of Interest

Dr. Timothy Burkhart receives salary support from Smith and Nephew. Dr. Alan Getgood receives consulting fees from Smith and Nephew and Ossur.

Ethics approval

This article does not contain any studies with human participants performed by any of the authors.

Informed consent

For this type of study is formed consent is not required.


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Copyright information

© European Society of Sports Traumatology, Knee Surgery, Arthroscopy (ESSKA) 2019

Authors and Affiliations

  1. 1.Department of Anatomy and Cell BiologyWestern UniversityLondonCanada
  2. 2.Department of Medical SciencesWestern UniversityLondonCanada
  3. 3.Fowler Kennedy Sport Medicine ClinicLondonCanada
  4. 4.Department of SurgeryWestern UniversityLondonCanada
  5. 5.Department of Surgery and Mechanical and Materials EngineeringWestern University and Lawson Health Research InstituteLondonCanada

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