Research hotspots and current status of iliotibial band studies: A bibliometric analysis (1934–2023)

Abstract

Background:

The iliotibial band (ITB), a unique musculoskeletal structure, is gaining interest in various fields such as biomechanics, orthopedics, sports medicine, and rehabilitation medicine. The pathogenesis, prevention, and treatment of ITB-related diseases are controversial. Despite an increasing number of studies, there is a lack of organized literature sorting and hotspot analysis. This study aims to comprehensively analyze publications related to the ITB and summarize the research focal points and current state in this domain.

Methods:

Literature characteristics were extracted from the Web of Science Core Collection (WoSCC) database from inception to January 17, 2023. Quantitative and qualitative analyses were performed, and the data were visualized using Microsoft Excel, CiteSpace, VOSviewer, and Tableau software.

Results:

A total of 1230 relevant articles were identified, with the majority from the United States (594 articles). Most articles were published in 2018, and the article with the highest number of citations (1013) was published in 2002. The American Journal of Sports Medicine had the most articles. Harvard University and Andrew Amis were the most prolific institution and author, respectively. Research hotspots identified through citation and keyword analysis included knee, anterior cruciate ligament, anatomy, iliotibial band syndrome, anterolateral ligament, injuries, and biomechanics.

Conclusion:

This study provides a comprehensive summary of the research hotspots and current status of ITB research, offering a fresh perspective for scholars to gain a deeper understanding. The findings suggest additional research directions relevant to this subject in the future.

1. Introduction

As a unique musculoskeletal structure, the iliotibial band (ITB) is attracting increasing attention in the fields of biomechanics, orthopedics, sports medicine, and rehabilitation medicine, among others. It is widely believed that the ITB is a tough, fibrous fascial tissue with anatomical paths spanning the hip and knee joints from the lateral edge of the anterior iliac crest, with the posterior edge continuing with the tendon of the gluteus maximus, and the lower end attached to the lateral tibial condyle, fibular head, and knee capsule. Its function differs in different postures and activities.

The exact anatomy and function of the ITB are currently highly controversial, in addition to the advanced evidence-based nature of related diseases such as iliotibial band syndrome (ITBS). ITBS is shown to be the main cause of knee pain in 62% of female runners, 38% of male runners, and 24% of cyclists.^[1] Nonetheless, the ITB-related diseases’ pathogenesis, prevention, and treatment remain controversial. The ITB is also an important part of the anterior cruciate ligament (ACL) injury and reconstruction, as well as an important component of the anterolateral complex of the knee joint, making it an unavoidable topic in related discussions. Currently, scholars worldwide are paying increasing attention to ITB, and the number of relevant studies is also increasing. Although most articles involve clinical studies or reviews, there remains a lack of systematic literature sorting and hotspot analysis.

Bibliometric analysis is a mathematical statistical method for analyzing bibliometric characteristics^[2] and is used to evaluate and explore a large volume of published scientific results. It can reveal cooperation patterns, research components, and emerging trends, thus helping researchers quickly understand a research area, identify gaps, and gain inspiration.^[3]

Bibliometric research in the medical field has received increasing attention recently.^[4,5] However, bibliometric studies of ITB research is limited. Therefore, this study aims to conduct a visual analysis of ITB-related publications over the past few decades from a bibliometric perspective, combining the research hotspots and current status in this field to identify possible research trends.

2. Methods

2.1. Data collection

We used the following search strategy to conduct a comprehensive search of the web of science core collection (WoSCC) database. Literature types included online publications, papers, and review articles limited to the English language. The time span of the self-built database was from the start of the WoSCC database to January 17, 2023. Although Web of Science Core Collection indexes literature since 1900, the earliest retrievable publication on iliotibial band studies within our search parameters was published in 1934. The indices included in the database search were SCI-Expanded, SSCI, A&HCI, CPCI-S, CPCI-SSH, BKCI-S, BKCI-SSH, ESCI, CCR-Expanded, and IC. The specific search formula is as follows: topic = (“iliotibial band” or “iliotibial tract”). After comprehensive screening, 1230 English research articles were obtained from a total of 1427 papers. We then exported the records in “plain text” format and with completed records and references. All literature searches and download processes were completed within 1 day, on January 17, 2023, to avoid errors caused by frequent database updates. The literature search and screening process is shown in Figure 1.

Figure 1.

Literature search and screening strategy.

2.2. Statistical analysis

Basic characteristics of the literature, such as publication frequency and journal, were obtained from the WoSCC literature analysis report. A visual analysis of the journal/institution/author, emergence and citation analysis, literature mixing analysis, and outbreak keyword detection were performed using Microsoft Excel, Tableau, CiteSpace (version 6.1. R6 (64-hit) and VOSviewer software. The CiteSpace software was developed by Professor Chen Chaomei team based on common citation analysis theory and the path finding network algorithm of reliable and practical bibliometric software, while VOSviewer is a visualization software developed by Professors van Eck and Waltman Both software systems are used primarily in the field of scientific literature knowledge structures and to explore the evolutionary trend through visual analysis.^[6] In addition, CiteSpace and VOSviewer can extract subsets from the overall structure of the literature network through cluster analysis to identify research subfields, namely research hotspots.^[7] Through an in-depth review of the research results, researchers can quickly identify the current research hotspots and development trends in the field and thus adjust their own research strategies.

3. Results

3.1. Overview of published literature

A total of 1230 articles were published and confirmed over the time frame of this study, including 1104 articles and 126 reviews. We analyzed and evaluated these studies. Figure 2 shows the number of publications (Fig. 2A) and total number of citations (Fig. 2B). As can be seen from the bar chart, the number of publications and frequency of citations show a fluctuating trend, especially in the past 2 decades, with an overall upward trend. The number of publications was the highest in 2018, reaching 108, and the average number of citations per publication remained above 29.57. To explore the correlation between the annual number of publications and citation counts, a Spearman rank correlation analysis was conducted. The results revealed a statistically significant strong positive correlation (ρ = 0.870, P < .001), indicating that increased publication volume is associated with higher citation frequency, or vice versa.

Figure 2.

The number of articles regarding ITB published annually (A) and the frequency of citations of articles regarding ITB published annually (B). ITB = iliotibial band.

We also analyzed the research areas and disciplines included in the published literature. As shown in Figure 3, the most published research area was in orthopedics, followed by sports sciences, surgery, rehabilitation, radiology, nuclear medicine, and medical imaging.

Figure 3.

Research areas of publications.

3.2. Leading countries/regions and institutions

Table 1 lists the top 10 publishing countries and funding agencies in the research field, with the largest number of publications in the United States (594). Figure 4 details the published contributions of the different countries and regions. In addition, the top 5 funding agencies were also from the United States: Arthrex (37), National Institutes of Health (31), Smith Nephew (31), United States Department of Health and Human Services (31), and Ossur (18).

Table 1.

The top 10 most productive countries and funding agencies in ITB research field.

Top 10 countries in ITB area		Top 10 Fund Agencies of article
Country	Count	Fund agency	Count
USA	594	Arthrex	37
England	106	National Institutes of Health	31
Germany	93	Smith Nephew	31
Canada	72	United States Department of Health Human Services	31
France	60	Ossur	18
Australia	57	National Institute of Arthritis Musculoskeletal Skin Diseases	16
Japan	56	Linvatec	10
Italy	52	German Research Foundation	9
Brazil	44	National Natural Science Foundation of China	8
Peoples R China	36	Siemens AG	8

ITB = iliotibial band.

Figure 4.

Distribution of countries/regions participating in the study (depth of color bar represents number of literature).

A total of 3327 institutions worldwide participated in research in this field. Table 2 lists the top 10 most productive research institutions, with Harvard University in the United States ranking first with 49 total publications. Figure 5 shows the collaboration between institutions, with the University of Pittsburgh, Stanford University, the Hospital for Special Surgery, and the Steadman Philippon Research Institute appearing in larger circles on the network graph, indicating the importance of these institutions in the entire partnership.

Table 2.

The top 10 research institutions in ITB research field.

Affiliation	Count
Harvard University	49
Pennsylvania Commonwealth System of Higher Education Pcshe	47
Imperial College London	42
Steadman Philippon Research Institute	38
University of Pittsburgh	38
Harvard Medical School	30
Stanford University	24
Hosp Special Surg	23
University System of Ohio	23
Western University/University of Western Ontario	22

ITB = iliotibial band.

Figure 5.

ITB field research institution collaboration diagram. ITB = iliotibial band.

3.3. Active journals and authors

A total of 286 academic journals published articles on the ITB, and the top 10 journals in the research field are shown in Table 3. The American Journal of Sports Medicine has the largest number of published papers (106), followed by Knee Surgery Sports Traumatology Arthroscopy (59), Arthroscopy Techniques (57), Arthroscopy, Journal of Arthroscopic and Related Surgery (56), and the Journal of Orthopaedic and Sports Physical Therapy (29). A total of 4383 authors contributed to ITB research. Table 4 lists the top 10 published authors, with the most prolific author being Andrew Amis who published 33 articles. The tenth most frequent author, Michael Fredericson, published 15 articles, 10 of which discussed the prevention and treatment of ITBS.

Table 3.

The top 10 journals published in ITB research field.

Journal	Count
American Journal of Sports Medicine	106
Knee Surgery Sports Traumatology Arthroscopy	59
Arthroscopy Techniques	57
Arthroscopy The Journal of Arthroscopic and Related Surgery	56
Journal of Orthopaedic Sports Physical Therapy	29
Skeletal Radiology	25
Clinics in Sports Medicine	24
Knee	24
Orthopaedic Journal of Sports Medicine	24
Archives of Orthopaedic and Trauma Surgery	22

ITB = iliotibial band.

Table 4.

The top 10 authors in ITB research field.

Author	Count
Amis	33
Philippon	26
Musahl	22
Laprade	20
Williams	19
Fu	17
Sonnery-cottet	17
Hammer	16
Helito	16
Fredericson	15

ITB = iliotibial band.

Academic influence can be quantitatively evaluated using the total number of citations, impact factor, h-index, and other indicators, but the influence of excessive self-citations and other factors cannot be excluded.^[8] The h-index was calculated using the John-Hirsch method.^[9] The field removed self-citations, cited 16,388 times, with an h-index of 89. Citation analysis is an effective method for determining the core information in a specific knowledge network.^[10] The top 10 articles on the ITB are shown in Table 5. The most-cited paper (1013 times) was published in the British Journal of Sports Medicine in 2002. There were 4 high-quality cited papers on ITB in the WoSCC (see Table 6).

Table 5.

The top 10 cited articles in ITB research field.

Rank	Title	Author	Journal	Year	Citations
1	A retrospective case-control analysis of 2002 running injuries	Taunton	Brit J Sport Med	2002	1013
2	The influence of abnormal hip mechanics on knee injury: a biomechanical perspective	Powers	J Orthop Sport Phys	2010	607
3	Anatomy of the anterolateral ligament of the knee	Claes	J Anat	2013	560
4	Hip abductor weakness in distance runners with iliotibial band syndrome	Fredericson	Clin J Sport Med	2000	356
5	Reconstruction of the chronically insufficient anterior cruciate ligament with the central 3rd of the patellar ligament	Obrien	J Bone Joint Surg Am	1991	353
6	Effects of step rate manipulation on joint mechanics during running	Heiderscheit	Med Sci Sport Exer	2011	342
7	Treatment of anterior cruciate ligament injuries, part I	Beynnon	Am J Sport Med	2005	311
8	The anterolateral ligament anatomy, length changes and association with the segond fracture	Dodds	Bone Joint J	2014	291
9	Rehabilitation following anterior – cruciate ligament injury current recommendations for sports participation	Kvist	Sports Medicine	2004	285
10	The anterolateral ligament of the human knee: an anatomic and histologic study	Vincent	Knee Surg Sport Tr A	2012	271

ITB = iliotibial band.

Table 6.

The top 4 high-quality cited papers in ITB research field in web of science.

Rank	Author	Title	Journal	Year	Citations
1	Claes	Anatomy of the anterolateral ligament of the knee	Journal of Anatomy	2013	560
2	Dodds	The anterolateral ligament anatomy, length changes and association with the segond fracture	Bone and Joint Journal	2014	291
3	Getgood	Lateral extra-articular tenodesis reduces failure of hamstring tendon autograft anterior cruciate ligament reconstruction: 2-yr outcomes from the stability study randomized clinical trial	American Journal of Sports Medicine	2020	166
4	Getgood	The anterolateral complex of the knee: results from the international alc consensus group meeting	Knee Surgery Sports Traumatology Arthroscopy	2019	155

ITB = iliotibial band.

3.4. Co-occurrence keywords and burst keywords

Keywords typically express the main idea or theme of an article. Through keyword analysis, research trends and hotspots can be quickly identified.^[2] Of the 3358 keywords identified – including author keywords and additional keywords – a superimposed visualization of the top 426 keywords is shown in Figure 6A. The figure shows that the higher the quality of the article, the larger the sizes of the labels and circles. The colors of the items were determined based on the average amount of time of occurrence. The lines between the items represent the links, and the color bar at the lower right (blue, green, and yellow) indicates the time from far to near. According to the centrality arrangement, excluding “iliotibial band” and “iliotibial track” (the 2 keywords with the highest frequency), the top keywords were as follows: knee (270), ACL (196), anatomy (189), iliotibial band syndrome (152), anterolateral ligament (137), injuries (131), and biomechanics (128). These have been identified as research hotspots. Figure 6B shows a visualization of the co-occurrence network with keywords attributed to different clusters. Among the main clusters, the red cluster focuses on clinical symptoms, etiology and prevention, and treatment, including IBS, friction syndrome, runners, anterior knee pain, biomechanics, manual therapy, and injury prevention. The blue cluster focuses on anatomy and surgery, such as knee, anatomy, anterolateral ligament, ACL reconstruction, Segond fractures, and follow-up.

Figure 6.

Overlay visualization of keywords (A) and cluster network map (B) Nodes of the same color form a cluster.

The visual analysis of the phased hotspots is based on a timeline viewer (Fig. 7). Early ITB studies (1991–1999) of clinical conditions, etiology, and treatment, mostly focused on the knee joint. In this regard, the main keywords were friction syndrome, reconstruction, overuse stress, and distance runner. Thereafter (2000–2009), ITB studies have focused on the hip joint, such as the hip, snapping hip, coxa saltans, and gluteus medius. Later studies (2010–2022) were more specific and diversified, suggesting the evolution of evaluation methods, with keywords such as patellofemoral pain syndrome and MRI, among others.

Figure 7.

Timeline viewer of keywords evolution.

CiteSpace software was used to fully understand the evolution of research hotspots. Figure 8 shows the top 10 hotspots for the 2002 to 2022 period. The most obvious bursts were follow-up (burst strength: 10.68), in vitro robotic assessment (burst strength: 9.07), iliotibial band syndrome (burst strength: 8.6), Segond fracture (burst strength: 8. 36), and patellofemoral pain syndrome (burst strength: 6.86). To verify the correlation between total burst strength and established bibliometric indicators, we conducted Spearman rank correlation analysis on annual data spanning 2002 to 2022. The total burst strength of keywords was examined against 2 metrics: total publications and average citations per paper. The results revealed a negligible correlation coefficient of 0.045 (P = .845) between Total burst strength and total publications, and a slightly negative coefficient of −0.092 (P = .693) with average citations per paper. These outcomes indicate no statistically significant association between total burst strength and either of the 2 variables: total publications or average citations per paper.

Figure 8.

Top 10 keywords with the strongest citation bursts in the ITB field from 2002 to 2022. The green line represents the time period from 2002 to 2022. The period of each burst keyword is plotted by the red line. ITB = iliotibial band.

4. Discussion

4.1. Paper characteristics

Annual changes in the number of articles related to the ITB clearly demonstrate the developmental status of the field and trends in its academic output. The earliest ITB studies in WoSCC date back to the 1930s, but the increase in the number of studies and citations began in the 1990s, especially after 2010. Studies of the ITB also gradually progressed from exclusive focus on knee pain to focus on the overall movement chain evolution. From the perspective of biomechanics, Powers^[11] proposed that hip mechanics abnormalities may cause ACL tear, IBS and patellofemoral joint pain, and that a knee rehabilitation program can strengthen pelvis and trunk stability and dynamic hip control. Currently, more than 70 papers related to the ITB are published annually. Although the ITB remains a relatively small research area, scholars in several fields continue to pay more attention to it. Among these, orthopedics, sports sciences, surgery, rehabilitation, radiology, nuclear medicine, and medical imaging are the most prominent research areas (Fig. 3).

The United States dominates the ITB research field, contributing the highest proportion of academic results and the most funding. The United Kingdom, Germany, Canada, France, Australia, and other European and American countries dominate the research positions in this field and have formed a number of university-centered institutional cooperation organizations. Among the 3327 participating institutions worldwide, Harvard University in the United States ranked first with the highest output, while the University of Pittsburgh, Stanford University, Hospital for Special Surgery, and Steadman Philippon Research Institute had relatively close academic cooperation with major institutions.

Regarding study authors, there were 4383 authors who participated in ITB research, but the number of articles published per person was not large. The most prolific author Amis, AA published 33 articles, and ranked 10th in Fredericson, M published 15 articles (2/3 of which focused on the prevention and treatment of ITBS). In addition, the top 3 authors have published no fewer than 20 papers each, indicating that there are still few researchers focused on this field and only a few core authors. Although some sub-research directions have been formed, core research teams have yet to be formed. This suggests that we should continue to expand the scale of research and strengthen information exchange among different research teams to promote the vigorous development of the field.

4.2. Literature sources

A total of 286 academic journals published articles on the ITB, (Table 3), a majority of which appearing in the American Journal of Sports Medicine (106), indicating its high popularity among researchers. As shown in Table 3, the top 5 journals that follow it also ranked publications, indicating that these journals are also good choices for researchers to publish their studies.

The first 10 cited papers on ITB were all published after 1990, of which 2 were related to ITBS due to a running injury. The most-cited article (1013 times) appeared in the British Journal of Sports Medicine (Table 5), and although it is related to the incidence of various running injuries, it also reflects the relatively good quality of the papers published in this journal. Regarding the topics of the top 10 cited papers, Taunton et al^[12] conducted a retrospective case-control analysis in 2002 on patients with running-related injuries, showing that ITB friction syndrome was the second ranked injury after patellofemoral pain syndrome. Fredericson et al^[13] found that the hip abduction strength of the lateral leg was weaker than that of the lateral leg in healthy runners, and the improvement in hip abduction strength was an important factor in successful recovery from the pre-traumatic training program. Of the remaining studies, 3 were related to the reconstruction of ACL injuries with rehabilitation. The portion of the ITB involved in these studies was mainly used for ACL reconstruction.^[14,15] Two other studies addressed the biomechanics of the hip and knee,^[11,16] and 3 were related to the anatomy of the anterolateral ligament.^[17–19] The content of these highly-cited studies also reflect the research hotspots and benchmarks at different stages in the ITB research field.

Two of the 10 highly-cited papers were in the first and second places of high-quality cited papers in WoSCC (Table 6). In addition to closer publication, originality, and better readability, both articles involved the anatomy of the anterolateral complex of the knee, indicating that many studies on the ITB are based on its unique anatomical structure.

4.3. Analysis of research hotspots and current status

Figure 6A shows the results of the keyword co-occurrence analysis, showing that knee, ACL, anatomy, iliotibial band syndrome, anterolateral ligament, injuries, and biomechanics are the current research hotspots. Knee (occurrences: 270) was the most frequent keyword, indicating that the highest proportion of knee-related studies were observed in the ITB research field. Combined with the co-occurrence network analysis shown in Figure 6B, we found that these research hotspots form different clusters, the largest 2 clusters: the red cluster represented by iliotibial band syndrome, focus on the clinical symptoms, etiology, and prevention, which is closely connected to injuries, friction syndrome, runners, anterior knee pain, biomechanics, manual therapy, and injury prevention. The blue cluster represented by the knee, focusing on anatomy and surgery, was closely related to anatomy, anterolateral ligament, ACL reconstruction, segond fracture, and follow-up, etc. At the same time, however, other closely connected keywords also form smaller clusters, such as the yellow cluster, which mainly focuses on structure and the means of evaluation means, such as the ITB, tendon, gluteus medius, ultrasound, arthroscopy, and MRI.

4.3.1. Exploring ITBS causes, prevention, and treatment

ITBS is undoubtedly a hot topic in the ITB research field, which is also the original impetus for researchers to explore this structure. ITBS is generally considered an overuse-type injury and is one of the main causes of lateral knee pain. With an increase in troubled runners and cyclists, research on ITBS has emerged. The etiology of ITBS is still inconclusive, and the most common explanation is that it is a friction syndrome. In 1975, Dr James W. Renne proposed that the tense ITB constantly rubbing the lateral epicondyle during knee flexion and extension, eventually causes inflammation of the ITB due to excessive friction and causing periosteal and medial capsule pain. Subsequent studies have suggested that the ITB is tight at the lateral epicondyle at a 30° knee flexion; therefore, the pain at this point is greatest in the gait.^[20] Other studies believe that the essence of ITBS is a compression syndrome between the ITB and lateral epicondyle.^[21]

With the continuous exploration of its etiology, research on the prevention and treatment of ITBS is also deepening. Commonly used nonsurgical treatments for ITBS include drug therapy, physical factor therapy, hip abductor training, ITB traction, ligation technology, and restorative training.^[22] Shivananda et al^[23] conducted a study involving 60 distance runners suffering ITBS, comparing the application of cold therapy and ligation technology in ITBS. Thirty subjects were given ice for 15 to 20 minutes along the length of the muscle, and 30 subjects used intramuscular adhesion, all continuously extending the ITB and performing hip flexions, knee extensions, and hip abduction training. Pain and range of motion were assessed at 1, 7, and 14d using the visual analogue scale (VAS) and knee range of motion (ROM). The results showed that the VAS score in the muscle therapy group was significantly lower than that in the cold therapy group, and the activity angle increased significantly in both groups. Weckström et al^[24] compared the efficacy of loose extracorporeal shockwave therapy and manual therapy on ITBS, combining both with a 4-week exercise rehabilitation program, showing that both were effective in reducing pain in patients. Craig et al^[25] also achieved good results in ITBS treatment. In conclusion, ITBS treatment is a long-term integrated management process that aims to control pain, improve muscle and joint structure, and reduce the local inflammatory response. As it is a common disease among sports people, helping individuals return to exercise without pain and with unrestricted joint movement has also become one of the purposes of ITBS treatment.^[26]

4.3.2. Anatomical exploration and surgical progress around the knee

The knee is an ITB research hotspot that is outstanding in the co-occurrence network, with ITBS studies mainly surrounding knee pain. However, the ITB is an important structure involved in the anterolateral anatomy of the knee complex, and a Segond fracture and ACL tear, or ACL reconstruction material, are all around the knee joint.

Knowledge of the anterolateral knee complex has undergone a lengthy evolution. In 1879, the French surgeon Segond first described the presence of a “pearly, resistant fibrous band in the anterior lateral human knee” and has since been associated with the Segond fracture of the same name. It was not until 2013 that Claes^[18] performed an autopsy, qualitatively and quantitatively studied, and named it the anterolateral ligament. Since the “rediscovery” of this ligament, the structure and function of the anterolateral complex of the knee has caused much controversy. Getgood et al^[27] suggested that the anterolateral complex is divided into 3 layers according to the anatomical hierarchy: the superficial ITB and iliopatellar band, deep ITB (including the Kaplan fiber system), anterolateral ligament, and joint capsule. Many attached structures are involved in Segond fractures and ACL tears, including the cystic layer of the ITB and anterolateral ligament, and the head of the biceps. Surgery for ACL reconstruction encompasses ACL reconstruction with the ITB alone, ACL combined with anterolateral ligament reconstruction, or even ACL combined with extra-articular tenofixation surgery.^[28,29] Although there is still much controversy regarding combined surgery, this reflects the continuous progress of research in this field.

Although ITBS is mainly a nonsurgical treatment, studies abound on its surgical treatment. Villanueva et al^[30] showed that ultrasound-guided distal release of the ITB with Z-plasty or ITB cross-section in patients with ITBS can result in faster recovery. The application of modern evaluation and surgical techniques has improved the accuracy of ITBS treatment and effectively shortened patient recovery time, which may suggest a future breakthrough in this field.

4.3.3. Overall view of the motion chain and the evolution of evaluation means

Biomechanics is also a significant hotspot in ITB research. As a common running injury, ITBS is naturally the object of research in sports science and biomechanics. Abnormal biomechanics, such as stress and strain during running, are risk factors for ITBS in runners,^[31] and ITBS, in turn, affects runner biomechanics. Foch et al^[32] found that female runners with a history of ITB disease had smaller hip adduction angles during the standing stage than healthy controls, which may be a movement pattern adopted by runners to reduce pain. The biomechanical study of the ITB gradually developed from the initial debate around the anatomy and etiology of the knee to a discussion of the perihip muscle structure, extending further into the whole lower limb motor chain as a focus of observation. This can also be observed in the periodic hotspots shown by the timeline viewer of the CiteSpace software. Since 2000, the research shows that the periphery of the hip joint, hip, snapping hip, coxa saltans, and gluteus medius among others are all hot words. The hip abductor (including the gluteus medius and tensor fascia latae) controls hip adduction in response to standing loading, and its weak strength or altered activation time may also be the cause of ITBS.^[33] Studies have also shown that ITBS patients have significant strength defects in their hip abductors compared to healthy controls and that 6 weeks of training treatment can significantly improve knee pain, hip muscle strength, and lower limb function.^[34] Powers^[11] found that because the ITB crosses the lateral aspects of the hip and knee, the combination of altered frontal and transverse plane motions of the hip are expected to compound the loading of the ITB. Knee varus, the relative rotation between the femur and tibia, and joint angle velocity change may play a similar role. We believe that in the future, we can further understand the potential relationship between hip and knee injuries to develop more effective rehabilitation and injury prevention plans.

Along with biomechanical studies, various assessments of the ITB have been conducted. It is clear from the cluster network map and the timeline viewer of CiteSpace that ultrasound, arthroscopy, and MRI have successively become important nodes in ITB research. Ultrasound and arthroscopy are not only simple examination methods but also include ultrasound guidance, arthroscopic surgery, and other therapeutic effects. The examination of ITB-related diseases has also progressed from the landmark structure of the knee and hip joint to the thickness and contour of soft tissue structures, such as the ITB itself and the gluteus maximus muscle. As the means of assessment continue to evolve, such as MRI combined with finite element analysis, more favorable conditions may be created to study the ITB.

Furthermore, keyword bursts can be used to identify hot topics, frontiers, and trends in particular research area. As shown in Figure 8, in the last 20 years, “follow-up” has been the most explosive keyword and is considered the latest research frontier. This may be related to the increasing number of surgeries involving the ITB in recent years or to the vulnerability of runners to recurrent ITBS attacks. In vitro robotic assessment, ITBS, Segond fractures, and patellofemoral pain syndrome also deserve further investigation. However, we also observed no significant correlation between Total Burst Strength and Total Publications or Average Citations per Paper. This may be attributed to the fact that burst strength primarily reflects the sudden surge in activity of a research topic within a specific temporal window. Such hot topics often attract substantial short-term attention (manifested as a rapid increase in publication volume), but this transient popularity does not necessarily translate into enduring academic influence (as measured by citation metrics). Furthermore, bursty themes frequently involve exploratory studies with immature methodologies – as exemplified by vitro robotic assessment in this analysis – which may lack the methodological rigor required to generate high-impact, citation-worthy findings. Additionally, CiteSpace’s burst detection algorithm prioritizes frequency variations over absolute quantity metrics during its analytical process, causing Total Burst Strength to exhibit weaker direct correlations with Total Publications and citation counts.

This study is the first to apply bibliometric methods to analyze the scientific output of ITB research, though it still has some limitations. First, to ensure the accuracy of the analysis results, this study did not extend the retrieval strategy, and a few articles on ITB may have been missed as a result. Because only English articles were searched, relevant studies in other languages were not included. In addition, we analyzed all keywords, including author keywords and “keywords-plus” added by the database editor according to the article topic.^[35] However, because author keywords are always selected by the author, they may not necessarily represent the research problem of the paper and could be misleading.

5. Conclusion

This study provides a comprehensive analysis of the scientific output of ITB research over several decades. Research teams in the United States have contributed the most to the development of this field. Based on a bibliometric review, we propose hotspots such as the knee, ACL, anatomy, iliotibial band syndrome, anterolateral ligament, injuries, biomechanics, and possible future development directions expressed in the keyword “follow-up.” We expect more and better research to promote the development of this field.

Acknowledgments

The authors would like to thank Dr Yuhang Ma and Mr. Xiaodong Zhu for helpful discussions on topics related to this work.

Author contributions

Conceptualization: Fei He, Bo Yu.

Data curation: Fei He, Yiyi Chen, Wenhua Chen, Yu Liu.

Formal analysis: Siliang Zeng, Yi Huang, Bo Yu.

Funding acquisition: Jianqiang Lu.

Methodology: Fei He, Yiyi Chen, Yi Huang, Wenhua Chen.

Project administration: Siliang Zeng.

Resources: Yiyi Chen, Yi Huang, Wenhua Chen.

Software: Bo Yu, Yu Liu.

Supervision: Siliang Zeng, Jianqiang Lu.

Visualization: Jianqiang Lu.

Writing – original draft: Fei He, Yiyi Chen, Siliang Zeng, Yi Huang, Bo Yu, Wenhua Chen, Yu Liu, Jianqiang Lu.

Writing – review & editing: Fei He, Yiyi Chen, Siliang Zeng, Yi Huang, Bo Yu, Wenhua Chen, Yu Liu, Jianqiang Lu.