Department of Anatomical Dissection and Donation, Medical University of Lodz, Lodz, Poland.
Clinic of Orthopaedic and Paediatric Orthopaedics, Central Teaching Hospital of the Medical University of Lodz, Lodz, Poland.
Knee Surg Sports Traumatol Arthrosc. 2024 Aug;32(8):2032-2039. doi: 10.1002/ksa.12238. Epub 2024 Jun 3.
The 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.
The 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.
The 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).
ITB 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.
Basic I.
阔筋膜张肌（ITB）是阔筋膜的纤维增厚带，起始于髂嵴，止于胫骨外侧 Gerdy 结节。ITB 对膝关节外侧稳定性有重要作用。由于其大小、拉伸强度和易于接近，在重建过程中常被用作骨科手术中的自体移植物。尽管 ITB 采集可能导致诸如膝关节伸展受限或髋关节屈曲受限等并发症，但尚未提出关于该程序的安全裕度或指南。我们的目的是确定 ITB 移植物的最大安全长度，即不会损伤外侧副韧带（LCL）、阔筋膜张肌（TFL）、臀大肌（GM）或相邻结构，并降低并发症发生率。
本研究纳入了 25 具人体尸体的 50 条下肢，此前均固定在 10%福尔马林溶液中。纳入标准为研究区域无可见手术干预迹象。共有 40 条下肢纳入研究：16 条女性（平均年龄 83.1±3.4 岁）和 24 条男性（平均年龄 84.2±6.8 岁）。采用预先确定的方案进行解剖。然后由两名研究人员进行两次形态测量。
平均股骨长度为 404.8mm[女性（F）=397.3mm，男性（M）=409.9mm，标准差（SD）：F=23.8mm，M=24.1mm]。平均 ITB 长度为 318.9mm（F=309.4mm，M=325.2mm，SD：F=25.7mm，M=33.7mm）。股骨较长的患者 ITB 也较长（p<0.05）。从 GM 插入点到 TFL 和 ITB 的筋膜结合部的平均距离为 34.6mm[女性（F）=34.5mm，M=34.6mm，SD：F=3.2mm，M=3.3mm]。股骨或 ITB 较长的患者，从 GM 插入点到 TFL 和 ITB 的筋膜结合部的距离也较大（p<0.05）。
长度超过 21cm 的 ITB 移植物可能会增加 TFL 撕裂的风险。根据股骨长度的简单测量，外科医生可以评估 ITB 的大致长度，从而评估最大移植物长度。此外，为了避免损伤 LCL，切口应在外侧股骨髁关节面上方 5cm 或外侧股骨髁上 13mm 处进行。这种准备和术前规划可以大大降低 ITB 采集过程中并发症的风险，例如在骨骼未成熟的患者中进行前交叉韧带重建时采用过顶技术。
基础 I。
