How iliotibial tract injuries of the knee combine with acute anterior cruciate ligament tears to influence abnormal anterior tibial displacement

Abstract

A knowledge of the patterns of injury to the compo nents of the iliotibial tract allows a clearer interpretation of motion limits testing in patients with abnormal ante rior tibial translation of the knee (anterior cruciate liga ment-deficient knees).

Eighty-two consecutive patients with acute knee in juries were classified as anteromedial-anterolateral ro tatory instability (anterior cruciate ligament-deficient) based on the abnormal motion demonstrated by clinical examination tests for instability. At surgery, injuries to the intraarticular and extraarticular anatomic structures were identified and correlated to the abnormal grades of motion demonstrated by the knee motion limits ex amination.

Tears of the anterior cruciate ligament occurred in 80 (98%) of the knees. However, the grade of abnormal motion demonstrated by the Lachman and pivot shift tests was quite variable. This variation did not correlate statistically with anterior cruciate ligament tears.

Injuries to the anatomic components of the iliotibial tract were confirmed in 76 (93%) of the knees. These injuries correlated highly with variations in grades of abnormal motion detected by the following tests: lateral joint line opening at 30° (r ² = 0.05); Lachman test (r ² = 0.08); pivot shift (r ² = 0.16); and anterior translation at 90° of flexion (r ² = 0.34). Thus, injuries to the components of the iliotibial tract are thought to contrib ute to the variation in grades of abnormal motion ob served in this complex subgroup of anterior tibial trans lation instabilities.

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References

American Medical Association Standard Nomenclature of Athletic Injuries Chicago, American Medical Association, 1966

Andrews JR, Sanders RA A "mini-reconstruction' technique in treating anterolateral rotatory instability (ALRI) Clin Orthop 172 93-96, 1983

Draganich LF , Reider B., Miller PR An in vitro study of the Muller anterolateral femorotibial ligament tenodesis in the anterior cruciate ligament deficient knee Am J Sports Med 17 357-362, 1989

Ellison AE Distal iliotibial-band transfer for anterolateral rotatory instability of the knee J Bone Joint Surg 61A 330-337, 1979

Galway RD The pivot shift syndrome J Bone Joint Surg 54B 558, 1972

Galway HR, MacIntosh DL The lateral pivot shift A symptom and sign of ACL insufficiency Clin Orthop 147 45-50, 1980

Gerdy PN Trosiere monographie maladies des organs dir mouvement os muscles Paris, Chez Victor Masson, 1855

Hughston JC A simple meniscectomy (Presidential Address to AOSSM, March 1975 ) Am J Sports Med 3 179-187, 1975

Hughston JC, Andrews JR, Cross MJ, et al Classification of knee ligament instabilities Part I The medial compartment and cruciate ligaments J Bone Joint Surg 58A 159-172, 1976

10.

Hughston JC, Andrews JR, Cross MJ, et al Classification of knee ligament instabilities Part II The lateral compartment J Bone Joint Surg 58A 173-179, 1976

11.

Hughston JC , Eilers AF The role of the posterior oblique ligament in repairs of acute medial (collateral) ligament tears of the knee J Bone Joint Surg 55A 923-940,1973

12.

Insall J., Joseph DM, Aglietti P., et al Bone-block iliotibial-band transfer for anterior cruciate insufficiency J Bone Joint Surg 63A 560-569, 1981

13.

Jakob RP, Hassler H., Staeubli H-U. Observations on rotatory instability of the lateral compartment of the knee, experimental studies on the functional anatomy and the pathomechanism of the true and the reversed pivot shift sign Acta Orthop Scand (Suppl) 52 1-32, 1981

14.

Johnson LL Lateral capsular ligament complex Anatomical and surgical considerations Am J Sports Med 7 156-160, 1979

15.

Kaplan EB Factors responsible for stability of the knee joint Bull Hosp Jt Dis 18 51-59, 1957

16.

Kaplan EB Surgical approach to the lateral (peroneal) side of the knee joint Surg Gynecol Obstet 104 346-356, 1957

17.

Krackow KA, Brooks RL Optimization of knee ligament position for lateral extraarticular reconstruction Am J Sports Med 11 293-302, 1983

18.

Lemaire M. Ruptures anciennes du ligament croise anterieur du Genou J Chir (Pans) 93 311-320, 1967

19.

Lobenhoffer P., Posel P., Witt S., et al Distal femoral fixation of the iliotibial tract Arch Orthop Trauma Surg 106 285-290, 1987

20.

Losee RE, Johnson TR, Southwick WO Anterior subluxation of the lateral tibial plateau A diagnostic test and operative repair J Bone Joint Surg 60A 1015-1030, 1978

21.

MacIntosh DL The anterior cruciate ligament The over-the-top repair J Bone Joint Surg 56B 591, 1974

22.

Milch H. Cortical avulsion fracture of the lateral tibial condyle J Bone Joint Surg 18 159-164, 1936

23.

Muller W. The Knee Form, Function and Ligament Reconstruction Berlin , Springer-Verlag, 1983, pp 39-45

24.

Ritchey SJ Ligamentous disruption of the knee A review with analysis of 28 cases U S Armed Forces Med J 11 167-176, 1960

25.

Segond P. Recherches cliniques et experimentales sur les epanchments sanguins du genou par entorse Progres Medical (Pans) VI, 7 297-318, 1879

26.

Terry GC, Hughston JC Associated joint pathology in the anterior cruciate ligament-deficient knee with emphasis on a classification system and injuries to the meniscocapsular ligament-musculotendinous unit complex Orthop Clin North Am 16 29-39, 1985

27.

Terry GC, Hughston JC, Norwood LA The anatomy of the iliopatellar band and iliotibial tract Am J Sports Med 14 39-45, 1986

28.

Vallois HV Etude anatomique de l'articulation du genou chez les primates Thesis University of Montpellier, No 63, 1914

29.

Wang CJ, Walker PS, Wolf B.: The effects of flexion and rotation on the length patterns of the ligaments of the knee. J Biomech 6 587-596, 1973

30.

Woods GW, Stanley RF, Tullos HS Lateral capsular sign X-ray clue to a significant knee instability Am J Sports Med 7 27-33, 1979