Table 2.
Studies Reporting Surgical Therapy for ITBS and the Associated Clinical Outcomes
| Study, year Type of Study, Level of Evidence |
Study Population (Participants, Age) |
ITBS Treatment Protocol | Follow-Up Assessment Tool and Timeline | Clinical Outcome | Complications |
|---|---|---|---|---|---|
| Walbron et al.,13 2018 Orthopaedics and Traumatology, Surgery and Research Case series, IV |
13 athletes (14 knees) Age in years mean, (range): 36 (19-51) |
Digastric distal ITB release from Gerdy’s tubercle: via 2 cm approach above Gerdy’s tubercle, the ITB is incised longitudinally and partially released from the tubercle | Return to preoperative level of sport rate and time Satisfaction rate Postoperative Tegner and Lysholm scores Mean follow-up time: 21 (5-61) months |
Return to preoperative level of sport rate: 100% Mean time to return to sport: 4 months (range: 1-8) Mean postoperative Tegner score: 6 (range: 4-9) Mean postoperative Lysholm: 93 (range: 80-100) Patient satisfaction rate: 85.7% were very satisfied or satisfied |
DVT: 2 patients |
| Inoue et al.,16 2018 International Journal of Sports Medicine Case series, IV |
31 runners, 34 knees Mean age in years: 20.2 |
Lengthening of the central part of the ITB by splitting it into a superficial and a deep layer, maintaining the anterior and posterior fibers immediately above the lateral epicondyle |
Time to resume sports activity Personal best times to run a 5000-m race before and after surgery 2-month postsurgery muscle strength comparison between injured and healthy side Recurrence of symptoms |
Mean time to return to sport: 5.8 weeks 17 runners completed the 5000 m race before and after surgery 13/17 runners had improved time for a 5000 m race postoperatively 2 months postsurgery: the mean extensor and flexor muscle strengths on the healthy and affected sides did not significantly differ No recurrence of ITBS through the end of competitive career |
none |
| Michels et al.,14 2009 Knee Surgery Sports Traumatology Arthroscopy Case series, IV |
36 athletes (15 females, 21 males), 38 knees with ITBS Mean age: 31.7 years (range 19-44) |
Arthroscopic debridement of the lateral synovial recess up to the bone of the lateral femoral condyle | Return to activity rate Subjective functional outcome: Drogset score Patient satisfaction using visual analogue scale 0for lowest 10 for highest satisfaction Rate of patients who would have been Mean follow-up time: 28 months Pre injury: VAS, Tegner Latest postoperative follow-up: VAS, Tegner, Lysholm, IKDC, patient satisfaction with surgical outcome Mean follow-up time: 38 months (range: 20-66) Minimum follow-up: 20 months |
3 patients lost to follow-up For the remaining 33 patients: 2 months postoperative: 74.2% were able to start slow running 3 months postoperative: 100% were able to run Drogset scores: excellent results: 28 (80%) good results: 6 patients (17.1%) fair result 1 patient (2.9%) poor results:0 patients Mean patient satisfaction: 9 (range: 6-10) |
Hematoma: 1 patient (evacuated postoperative day 4) |
| Hariri et al.,17 2009 American Journal of sports Medicine Retrospective Case series, IV |
11 recreational athletes (7 males, 4 females) Mean age in years: 32 (range: 24-41) |
Diagnostic knee arthroscopy + open ITB bursectomy | VAS mean (range): Preinjury: 8 (4-10) Postoperative: 2 (0-9) Tegner score: preinjury 6 (range: 2-9) postoperative Tegner activity score 5 (range: 3-8) no significant difference = patients on average were able to return to their preinjury level of activity IKDC postoperative mean (range): 88 range, 66-100) Lysholm score postoperatively: Excellent result: 7/11 64% Good result: 4/11 34% Fair/poor result: 0/11 0% Patient satisfaction Completely satisfied with the surgical outcome: 6/11 55% Mostly satisfied: 3/11 27% Somewhat satisfied: 2/11 18% Dissatisfied: 0/11 0% Patients said that, knowing what they know now, they would have the surgery performed again for the same problem: 9/11 82% |
Not reported | |
| Barber et al.,19 2007 Journal of Knee Surgery Case series, IV |
8 runners (4 males, 4 females) Mean age in years: 39.6 (range: 17-63) |
Z-lengthening of the ITB using a 5-cm oblique incision overlying the ITB | Postoperative evaluation Cincinnati score, Tegner score, Lysholm score, IKDC activity score, pain evaluation, return to activity Mean follow-up time: 75.6 months (range: 59-97) |
Cincinnati score mean: 82.9 (range: 55-95) Tegner score 4.4 (range: 2-7) Lysholm score was 88.6 (range: 57-100) IKDC activity score: 2.6 (range: 1-4) Complete resolution of lateral knee pain + full return to preoperative activity∗ levels: 8/8 patients, 100% ∗improvement was maintained out to 8 years postoperatively |
none |
| Drogset et al.,18 1999 Scandinavian Journal of Medicine and Science in Sports Retrospective case series, IV |
45 patients (25 females, 20 males), 49 cases (6 bilateral) Mean age in years: 27 (range: 14-46) |
27/45 patients: the posterior half of the width of the ITB was transected at the level where it passes over the most prominent part of the lateral epicondyle 17/45 patients: posterior half of the width of the ITB was transected + ITB 1/45: bursectomy |
Subjective patient self-evaluation using rating scale Excellent = no pain or weakness in the operated knee during activity and rest Good = much less pain than before the surgery Fair = little less pain than before the surgery Poor = condition uncharged or worsened Mean follow-up time: 25 months (range:2-108) |
Excellent results: 22/45 (48.9%) Good results: 16/45 (35.5%, Fair results: 6/45 (13.3%) Poor result: 1/45 (2.2%) Had the postoperative result been known beforehand, 75.6% of the patients would have been operated on again |
Minor wound infection: 1 patient Persistent pain which resolve following spine surgery: 1 patient 20/45 patients pain sensation in the area at follow-up. 2/45 patients felt weakness of the knee 1/45 patients had a swelling in the operated area for some weeks after surgery |
| Holmes et al.,27 1993 American Journal of sports Medicine Retrospective case series, IV |
25 cyclists out of a group of 61 cyclists (47 males, 14 females) | 4/25 patients: percutaneous release of TIB 21/25 patients: open surgical release with elliptical excision, Note: 3/25 patients had previous percutaneous release |
Return to sport Follow-up via phone call Routine follow-up: 1,3, 8 weeks postoperatively Mean follow-up time: 6-24 months for long term follow-up via phone |
4 patients who underwent percutaneous release of ITB: ¾ failed and required open release 21 patients underwent open release: 81% (17/21) cyclists had returned to preoperative level of sport at 8 weeks 2/21 cyclists did not resume full training for 3 months postoperatively 2/21 cyclists did not resume full training for 4 months due to lateral knee discomfort Phone follow-up:
|
Seroma: 9 patients Hematoma: 2 patients |
| Martens et al.,15 1989 American Journal of Sports Medicine Retrospective case series, IV |
19 athletes (18 males, 1 female) Mean age in years: 24.5 (range: 19-33) |
Resection of a triangular piece of the ITB from the posterior base of ITB at 30° of knee flexion | Return to sport rate Mean follow-up time: 45 months (range: 2-11 years) |
Return to sport (cycling, running, football) rate: 100% time: mean 7 weeks postoperatively |
Hematoma requiring evacuation: 1 patient |
| Noble,28 1979 British Journal of Sports Medicine Retrospective case series, IV |
9 long-distance runners (total 221 cases of ITBS seen) | Surgical release of posterior fibers of ITB | Rate of return to sport Follow-up time: 2-16 months |
Return to sport rate: 89% (8/9) | Not reported |
DVT, deep venous thrombosis; IKDC, International Knee Documentation Committee; ITB, iliotibial band; ITBS, iliotibial band syndrome; VAS, visual analog scale.