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Iliotibial Band Friction Syndrome: MR Imaging Findings in 16 Patients and MR Arthrographic Study of Six Cadaveric Knees¹

¹ From the Depts of Radiology (C.M., J.M.A., L.R.Y., D.J.T., D.R.) and Pathology (P.H.), Veterans Affairs Medical Center, 3350 La Jolla Village Dr, San Diego, CA 92161; Dept of Diagnostic Radiology, University of Kiel, Germany (C.M.); Dept of Radiology, Stanford University, Calif (G.A.B.); Dept of Radiology, Beth Israel Deaconess Medical Center, Boston, Mass (R.D.B.); Dept of Radiology, Thomas Jefferson Hospital, Philadelphia, Pa (M.S.); and Dept of Diagnostic Radiology, Henry Ford Hospital, Detroit, Mich (J.A.J.). Received May 1, 1998; revision requested Jul 6; final revision received Jan 22, 1999; accepted Jan 27. Supported in part by the Deutsche Forschungsgemeinschaft and Veterans Administration grant SA360. Address reprint requests to D.R.

View larger version (38K): [in a new window]   Figure 1. Drawing of the normal anatomy of the ITT as seen from the lateral aspect of the thigh.

View larger version (24K): [in a new window]   Figure 2. Drawing of the relationship of the ITT to the lateral epicondyle, the lateral collateral ligament, and the lateral recess of the knee joint in the axial plane.

View larger version (153K): [in a new window]   Figure 3a. Axial images of a specimen obtained at extension and at 30° and 60° of knee flexion after intraarticular injection of contrast material. For a–c, arrowheads = ITT, black arrow = lateral femoral epicondyle, curved white arrow = lateral collateral ligament, straight white arrow = lateral recess. (a) T1-weighted spin-echo MR image (600/20) obtained after the intraarticular administration of gadopentetate dimeglumine shows the close relationship of the posterior fibers of the ITT to the lateral femoral epicondyle and the fibers of the lateral collateral ligament at full extension. (b) T1-weighted spin-echo MR image (600/20) shows 30° of knee flexion. (c) T1-weighted spin-echo MR image (600/20) shows that at 60° of knee flexion the ITT moves posteriorly and comes in contact with the lateral femoral epicondyle and the inserting fibers of the lateral collateral ligament. At extension and at 30° and 60° of knee flexion, the lateral recess extends anterior to the lateral femoral epicondyle. (d) Photograph of the corresponding macroscopic section reveals prominent inserting fibers of the lateral collateral ligament (curved white arrow) distal to the lateral femoral epicondyle (black arrow) in close proximity to the ITT (arrowheads). Straight white arrow = lateral recess, open arrow = popliteus tendon. (e) Photomicrograph shows layers of fatty tissue and vessels between the lateral femoral epicondyle (curved arrow) and the ITT (arrowheads). No bursa is identified. The lateral recess (straight arrow) extends anterior to the lateral femoral epicondyle (curved arrow). (Hematoxylin-eosin stain; original magnification, x4.)

View larger version (156K): [in a new window]   Figure 3b. Axial images of a specimen obtained at extension and at 30° and 60° of knee flexion after intraarticular injection of contrast material. For a–c, arrowheads = ITT, black arrow = lateral femoral epicondyle, curved white arrow = lateral collateral ligament, straight white arrow = lateral recess. (a) T1-weighted spin-echo MR image (600/20) obtained after the intraarticular administration of gadopentetate dimeglumine shows the close relationship of the posterior fibers of the ITT to the lateral femoral epicondyle and the fibers of the lateral collateral ligament at full extension. (b) T1-weighted spin-echo MR image (600/20) shows 30° of knee flexion. (c) T1-weighted spin-echo MR image (600/20) shows that at 60° of knee flexion the ITT moves posteriorly and comes in contact with the lateral femoral epicondyle and the inserting fibers of the lateral collateral ligament. At extension and at 30° and 60° of knee flexion, the lateral recess extends anterior to the lateral femoral epicondyle. (d) Photograph of the corresponding macroscopic section reveals prominent inserting fibers of the lateral collateral ligament (curved white arrow) distal to the lateral femoral epicondyle (black arrow) in close proximity to the ITT (arrowheads). Straight white arrow = lateral recess, open arrow = popliteus tendon. (e) Photomicrograph shows layers of fatty tissue and vessels between the lateral femoral epicondyle (curved arrow) and the ITT (arrowheads). No bursa is identified. The lateral recess (straight arrow) extends anterior to the lateral femoral epicondyle (curved arrow). (Hematoxylin-eosin stain; original magnification, x4.)

View larger version (144K): [in a new window]   Figure 3c. Axial images of a specimen obtained at extension and at 30° and 60° of knee flexion after intraarticular injection of contrast material. For a–c, arrowheads = ITT, black arrow = lateral femoral epicondyle, curved white arrow = lateral collateral ligament, straight white arrow = lateral recess. (a) T1-weighted spin-echo MR image (600/20) obtained after the intraarticular administration of gadopentetate dimeglumine shows the close relationship of the posterior fibers of the ITT to the lateral femoral epicondyle and the fibers of the lateral collateral ligament at full extension. (b) T1-weighted spin-echo MR image (600/20) shows 30° of knee flexion. (c) T1-weighted spin-echo MR image (600/20) shows that at 60° of knee flexion the ITT moves posteriorly and comes in contact with the lateral femoral epicondyle and the inserting fibers of the lateral collateral ligament. At extension and at 30° and 60° of knee flexion, the lateral recess extends anterior to the lateral femoral epicondyle. (d) Photograph of the corresponding macroscopic section reveals prominent inserting fibers of the lateral collateral ligament (curved white arrow) distal to the lateral femoral epicondyle (black arrow) in close proximity to the ITT (arrowheads). Straight white arrow = lateral recess, open arrow = popliteus tendon. (e) Photomicrograph shows layers of fatty tissue and vessels between the lateral femoral epicondyle (curved arrow) and the ITT (arrowheads). No bursa is identified. The lateral recess (straight arrow) extends anterior to the lateral femoral epicondyle (curved arrow). (Hematoxylin-eosin stain; original magnification, x4.)

View larger version (181K): [in a new window]   Figure 3d. Axial images of a specimen obtained at extension and at 30° and 60° of knee flexion after intraarticular injection of contrast material. For a–c, arrowheads = ITT, black arrow = lateral femoral epicondyle, curved white arrow = lateral collateral ligament, straight white arrow = lateral recess. (a) T1-weighted spin-echo MR image (600/20) obtained after the intraarticular administration of gadopentetate dimeglumine shows the close relationship of the posterior fibers of the ITT to the lateral femoral epicondyle and the fibers of the lateral collateral ligament at full extension. (b) T1-weighted spin-echo MR image (600/20) shows 30° of knee flexion. (c) T1-weighted spin-echo MR image (600/20) shows that at 60° of knee flexion the ITT moves posteriorly and comes in contact with the lateral femoral epicondyle and the inserting fibers of the lateral collateral ligament. At extension and at 30° and 60° of knee flexion, the lateral recess extends anterior to the lateral femoral epicondyle. (d) Photograph of the corresponding macroscopic section reveals prominent inserting fibers of the lateral collateral ligament (curved white arrow) distal to the lateral femoral epicondyle (black arrow) in close proximity to the ITT (arrowheads). Straight white arrow = lateral recess, open arrow = popliteus tendon. (e) Photomicrograph shows layers of fatty tissue and vessels between the lateral femoral epicondyle (curved arrow) and the ITT (arrowheads). No bursa is identified. The lateral recess (straight arrow) extends anterior to the lateral femoral epicondyle (curved arrow). (Hematoxylin-eosin stain; original magnification, x4.)

View larger version (196K): [in a new window]   Figure 3e. Axial images of a specimen obtained at extension and at 30° and 60° of knee flexion after intraarticular injection of contrast material. For a–c, arrowheads = ITT, black arrow = lateral femoral epicondyle, curved white arrow = lateral collateral ligament, straight white arrow = lateral recess. (a) T1-weighted spin-echo MR image (600/20) obtained after the intraarticular administration of gadopentetate dimeglumine shows the close relationship of the posterior fibers of the ITT to the lateral femoral epicondyle and the fibers of the lateral collateral ligament at full extension. (b) T1-weighted spin-echo MR image (600/20) shows 30° of knee flexion. (c) T1-weighted spin-echo MR image (600/20) shows that at 60° of knee flexion the ITT moves posteriorly and comes in contact with the lateral femoral epicondyle and the inserting fibers of the lateral collateral ligament. At extension and at 30° and 60° of knee flexion, the lateral recess extends anterior to the lateral femoral epicondyle. (d) Photograph of the corresponding macroscopic section reveals prominent inserting fibers of the lateral collateral ligament (curved white arrow) distal to the lateral femoral epicondyle (black arrow) in close proximity to the ITT (arrowheads). Straight white arrow = lateral recess, open arrow = popliteus tendon. (e) Photomicrograph shows layers of fatty tissue and vessels between the lateral femoral epicondyle (curved arrow) and the ITT (arrowheads). No bursa is identified. The lateral recess (straight arrow) extends anterior to the lateral femoral epicondyle (curved arrow). (Hematoxylin-eosin stain; original magnification, x4.)

View larger version (64K): [in a new window]   Figure 4. Drawing of the compartmentlike space in which signal intensity changes can be observed on coronal MR images in patients with ITBFS. The signal intensity abnormalities are located in the confines of a space demarcated laterally by the ITT and distally and medially by the meniscocapsular ligaments, the lateral meniscus, and the lateral femoral epicondyle. Proximal to the lateral femoral epicondyle, the signal intensity alterations extend into the fatty tissue distal to the vastus lateralis muscle.

View larger version (187K): [in a new window]   Figure 5a. Patient 10. Images obtained in a 17-year-old soccer player with lateral knee pain for 6 weeks. (a) Coronal T2-weighted fat-saturated fast spin-echo MR image (4,400/108, 4-mm section thickness) reveals poorly defined high-signal-intensity alterations (straight arrows) medial to the ITT (arrowheads) that extend into the fatty layer distal to the vastus lateralis muscle (curved arrow). (b) Corresponding axial T2-weighted fat-saturated fast spin-echo MR image (4,400/108, 4-mm section thickness) demonstrates soft-tissue edema (arrows) between the ITT (arrowheads) and the femur.

View larger version (183K): [in a new window]   Figure 5b. Patient 10. Images obtained in a 17-year-old soccer player with lateral knee pain for 6 weeks. (a) Coronal T2-weighted fat-saturated fast spin-echo MR image (4,400/108, 4-mm section thickness) reveals poorly defined high-signal-intensity alterations (straight arrows) medial to the ITT (arrowheads) that extend into the fatty layer distal to the vastus lateralis muscle (curved arrow). (b) Corresponding axial T2-weighted fat-saturated fast spin-echo MR image (4,400/108, 4-mm section thickness) demonstrates soft-tissue edema (arrows) between the ITT (arrowheads) and the femur.

View larger version (156K): [in a new window]   Figure 6a. Patient 9. Images obtained in a 20-year-old freehand rock climber with tenderness and pain over the lateral femoral epicondyle. (a) Coronal T1-weighted spin-echo MR image (550/18, 4-mm section thickness) shows poorly defined low-signal-intensity changes (straight arrows) medial to the ITT (arrowheads) and distal to the vastus lateralis muscle (curved arrow). (b) Corresponding coronal two-dimensional multiplanar gradient-recalled-echo image (600/15, 4-mm section thickness, 30° flip angle) shows high-signal-intensity alterations (arrows) that correspond to the low-signal-intensity changes in a. Arrowheads = ITT. (c) Axial T2-weighted fat-saturated fast spin-echo MR image (4,400/108, 4-mm section thickness) shows abnormal signal intensity alterations (white arrow) lateral to the lateral femoral epicondyle (black arrow). Arrowhead = ITT. (d) Axial T2-weighted fat-saturated fast spin-echo MR image (4,400/108, 4-mm section thickness) shows abnormal signal intensity alterations (solid arrows) medial to the ITT (arrowhead), adjacent to the biceps femoris muscle (open arrow) and femur.

View larger version (179K): [in a new window]   Figure 6c. Patient 9. Images obtained in a 20-year-old freehand rock climber with tenderness and pain over the lateral femoral epicondyle. (a) Coronal T1-weighted spin-echo MR image (550/18, 4-mm section thickness) shows poorly defined low-signal-intensity changes (straight arrows) medial to the ITT (arrowheads) and distal to the vastus lateralis muscle (curved arrow). (b) Corresponding coronal two-dimensional multiplanar gradient-recalled-echo image (600/15, 4-mm section thickness, 30° flip angle) shows high-signal-intensity alterations (arrows) that correspond to the low-signal-intensity changes in a. Arrowheads = ITT. (c) Axial T2-weighted fat-saturated fast spin-echo MR image (4,400/108, 4-mm section thickness) shows abnormal signal intensity alterations (white arrow) lateral to the lateral femoral epicondyle (black arrow). Arrowhead = ITT. (d) Axial T2-weighted fat-saturated fast spin-echo MR image (4,400/108, 4-mm section thickness) shows abnormal signal intensity alterations (solid arrows) medial to the ITT (arrowhead), adjacent to the biceps femoris muscle (open arrow) and femur.

View larger version (194K): [in a new window]   Figure 6b. Patient 9. Images obtained in a 20-year-old freehand rock climber with tenderness and pain over the lateral femoral epicondyle. (a) Coronal T1-weighted spin-echo MR image (550/18, 4-mm section thickness) shows poorly defined low-signal-intensity changes (straight arrows) medial to the ITT (arrowheads) and distal to the vastus lateralis muscle (curved arrow). (b) Corresponding coronal two-dimensional multiplanar gradient-recalled-echo image (600/15, 4-mm section thickness, 30° flip angle) shows high-signal-intensity alterations (arrows) that correspond to the low-signal-intensity changes in a. Arrowheads = ITT. (c) Axial T2-weighted fat-saturated fast spin-echo MR image (4,400/108, 4-mm section thickness) shows abnormal signal intensity alterations (white arrow) lateral to the lateral femoral epicondyle (black arrow). Arrowhead = ITT. (d) Axial T2-weighted fat-saturated fast spin-echo MR image (4,400/108, 4-mm section thickness) shows abnormal signal intensity alterations (solid arrows) medial to the ITT (arrowhead), adjacent to the biceps femoris muscle (open arrow) and femur.

View larger version (190K): [in a new window]   Figure 6d. Patient 9. Images obtained in a 20-year-old freehand rock climber with tenderness and pain over the lateral femoral epicondyle. (a) Coronal T1-weighted spin-echo MR image (550/18, 4-mm section thickness) shows poorly defined low-signal-intensity changes (straight arrows) medial to the ITT (arrowheads) and distal to the vastus lateralis muscle (curved arrow). (b) Corresponding coronal two-dimensional multiplanar gradient-recalled-echo image (600/15, 4-mm section thickness, 30° flip angle) shows high-signal-intensity alterations (arrows) that correspond to the low-signal-intensity changes in a. Arrowheads = ITT. (c) Axial T2-weighted fat-saturated fast spin-echo MR image (4,400/108, 4-mm section thickness) shows abnormal signal intensity alterations (white arrow) lateral to the lateral femoral epicondyle (black arrow). Arrowhead = ITT. (d) Axial T2-weighted fat-saturated fast spin-echo MR image (4,400/108, 4-mm section thickness) shows abnormal signal intensity alterations (solid arrows) medial to the ITT (arrowhead), adjacent to the biceps femoris muscle (open arrow) and femur.

View larger version (156K): [in a new window]   Figure 7a. Patient 13. Images obtained in a 40-year-old jogger with anterolateral knee pain, swelling, and tenderness. (a) Coronal T2-weighted fat-saturated fast spin-echo MR image (4,400/108, 4-mm section thickness) demonstrates a high-signal-intensity large cystic fluid collection (straight arrows) medial to the ITT and extending to the tibial plateau. The lesion extends proximal to the lateral femoral epicondyle with soft-tissue edema (open arrow) adjacent to the vastus lateralis muscle (curved arrow). (b) Axial three-dimensional double-echo steady state MR image (27/9, 1.6-mm section thickness, 40° flip angle) shows a well-circumscribed fluid collection (arrow) medial to the ITT.

View larger version (147K): [in a new window]   Figure 7b. Patient 13. Images obtained in a 40-year-old jogger with anterolateral knee pain, swelling, and tenderness. (a) Coronal T2-weighted fat-saturated fast spin-echo MR image (4,400/108, 4-mm section thickness) demonstrates a high-signal-intensity large cystic fluid collection (straight arrows) medial to the ITT and extending to the tibial plateau. The lesion extends proximal to the lateral femoral epicondyle with soft-tissue edema (open arrow) adjacent to the vastus lateralis muscle (curved arrow). (b) Axial three-dimensional double-echo steady state MR image (27/9, 1.6-mm section thickness, 40° flip angle) shows a well-circumscribed fluid collection (arrow) medial to the ITT.

View larger version (174K): [in a new window]   Figure 8a. Patient 15. Images obtained in a 40-year-old marathon runner with persistent bilateral knee pain and tenderness. (a) Coronal T2-weighted fat-saturated fast spin-echo MR image (4,400/108, 4-mm section thickness) demonstrates small cystic fluid collections (arrow), which are 1.5 x 1.0 cm, on the right side medial to the ITT (arrowheads) adjacent to the lateral femoral epicondyle. (b) Coronal T2-weighted fat-saturated fast spin-echo MR image (4,400/108, 4-mm section thickness) shows a similar cystic lesion (arrow), which is 1.0 x 0.5 cm, on the left side. The ITT (arrowheads) shows no signal intensity alterations or thickening.

View larger version (169K): [in a new window]   Figure 8b. Patient 15. Images obtained in a 40-year-old marathon runner with persistent bilateral knee pain and tenderness. (a) Coronal T2-weighted fat-saturated fast spin-echo MR image (4,400/108, 4-mm section thickness) demonstrates small cystic fluid collections (arrow), which are 1.5 x 1.0 cm, on the right side medial to the ITT (arrowheads) adjacent to the lateral femoral epicondyle. (b) Coronal T2-weighted fat-saturated fast spin-echo MR image (4,400/108, 4-mm section thickness) shows a similar cystic lesion (arrow), which is 1.0 x 0.5 cm, on the left side. The ITT (arrowheads) shows no signal intensity alterations or thickening.