A quantitative MRI investigation of the association between iliotibial band syndrome and patellofemoral malalignment

Jia Li; Bo Sheng; Lanyu Qiu; Fan Yu; Fa-Jin Lv; Fu-Rong Lv; Haitao Yang

doi:10.21037/qims-20-1101

A quantitative MRI investigation of the association between iliotibial band syndrome and patellofemoral malalignment

Quant Imaging Med Surg. 2021 Jul;11(7):3209-3218. doi: 10.21037/qims-20-1101.

Authors

Jia Li¹, Bo Sheng¹, Lanyu Qiu¹, Fan Yu¹, Fa-Jin Lv¹, Fu-Rong Lv¹, Haitao Yang¹

Affiliation

¹ Department of Radiology, the First Affiliated Hospital of Chongqing Medical University, Chongqing, China.

Abstract

Background: The iliotibial band (ITB) has a wide patellar insertion that provides lateral restraint to the patella and maintains the patellofemoral joint's stability. There has been limited investigation into the relationship between patellofemoral malalignment and iliotibial band syndrome (ITBS).

Methods: We retrospectively analyzed 47 knees with ITBS by retrieving magnetic resonance imaging (MRI) data collected over an approximately 6-year period from our database. The Insall-Salvati ratio, lateral patellofemoral angle (LPA), lateral patellar tilt (LPT), lateral trochlear length (LTL), angle of the non-weight-bearing facet of the lateral femoral condyle (nwb-LFCA), and the ITB-lateral femoral condyle (IT-LFC) distance were measured on MR images. The knees of 47 age- and gender-matched subjects were enrolled as the normal group.

Results: In the ITBS group, over one third (34%, 16/47) of knees had abnormal patellofemoral measurements, including 8 (17%, 8/47) knees with patellar alta, 11 (23.4%, 11/47) knees with an abnormally decreased LPA, and 5 (10.6%, 5/47) knees with an abnormally increased LPT indicating lateral patellar tilt. Moreover, 8 knees had simultaneous combinations of two or three abnormality parameters, and 8 (17%, 8/47) knees presented with superolateral Hoffa's fat pad edema. The Insall-Salvati ratio, LPT, and nwb-LFCA in the ITBS group were significantly higher than those in the normal group (P=0.001, P<0.001, and P<0.001, respectively); the LPA and IT-LFC distances in the ITBS group were significantly lower (P=0.003, P<0.001, respectively) than those in the normal group. There were mild to moderate correlations between the MRI parameters and ITBS (P=0.006, P<0.001, respectively).

Conclusions: This study confirmed that a higher position or lateral tilt of the patella and a steeper morphology of the anterior part of the lateral femoral condyle were associated with the development of ITBS, which is helpful in understanding and further exploring the mechanism of ITBS.

Keywords: Iliotibial band syndrome (ITBS); lateral femoral condyle; magnetic resonance imaging; patella.