Modified Technique for Labral Reconstruction of Hip Joint Using Autologous Iliotibial Band (ITB)—Make Labral Reconstruction Stress-Free

Tian, Kang; Gao, Guanying; He, Tong-Chuan; Dong, Hanmei; Zhang, Siqi; Zhang, Weiguo; Wang, Jianquan; Xu, Yan

doi:10.1016/j.eats.2023.05.005

Cited by 1 publication

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“…Nowadays, the ITB is mostly used for ACL reconstruction in the paediatric population, as it spares the growth plates [1, 23]. Additionally, it may be successfully utilised in hip labrum reconstruction [29], anterior shoulder capsule reconstruction [18] or for massively injured rotator cuff repairs [24, 35].…”

Section: Introductionmentioning

confidence: 99%

Identifying iliotibial band graft length and incision site may minimise the potential risk of harming adjacent structures: A novel approach for surgeon guidance

Gonera,

Balcerzak,

Ruzik

et al. 2024

Knee surg. sports traumatol. arthrosc.

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PurposeThe Iliotibial band (ITB) is a fibrous thickening of the fascia lata originating at the iliac crest and inserting at Gerdy's tubercle on the lateral tibia. The ITB significantly contributes to lateral knee stabilisation. Due to its size, tensile strength and easy access, it is widely used in orthopaedic surgery as an autograft during reconstruction procedures. Although ITB harvesting may result in complications, such as reduced knee extension or hip flexion, no safety margins or guidelines have been proposed for the procedure. Our aim was to determine the maximal safe length of an ITB graft, that is, that does not harm the lateral collateral ligament (LCL), tensor fasciae latae (TFL), gluteus maximus (GM) or adjacent structures, and reduce the complication rate.MethodsThe study included 50 lower limbs of 25 human cadavers, previously fixed in 10% formalin solution. The inclusion criterion was the lack of visible signs of surgical interventions in the study region. Forty lower limbs were included in the study: 16 female (mean age 83.1 ± 3.4 years) and 24 male (mean age 84.2 ± 6.8 years). Dissection was performed with a previously established protocol. Morphometric measurements were then obtained twice by two researchers.ResultsThe mean femur length was 404.8 mm [female (F) = 397.3 mm, male (M) = 409.9 mm, standard deviation (SD): F = 23.8 mm, M = 24.1 mm]. The mean ITB length was 318.9 mm (F = 309.4 mm, M = 325.2 mm, SD: F = 25.7 mm, M = 33.7 mm). Longer femurs were associated with longer ITB (p < 0.05). The mean distance from the insertion of the GM to the myofascial junction of TFL and ITB was 34.6 mm (F = 34.5 mm, M = 34.6 mm, SD: F = 3.2 mm, M = 3.3 mm). The longer femurs or ITBs demonstrated a greater distance from GM insertion to the myofascial junction of the TFL and ITB (p < 0.05).ConclusionITB grafts longer than 21 cm may contribute to the greater risk of TFL rupture. Based on simple measurements of the femur length, the surgeon may assess approximate ITB length, and thus assess the length of the maximal graft length. Moreover, to avoid harming the LCL, the incision should be performed 5 cm proximal to the articular surface of the lateral femoral condyle or 13 mm proximal to the lateral femoral epicondyle. Such preparation and preoperative planning may greatly reduce the risk of complications during ITB harvesting, while performing, for instance, the over‐the‐top technique for anterior cruciate ligament reconstruction in skeletally immature patients.Level of the StudyBasic I.

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