Ultrasound-Guided Cutting Wire Release of the Posterior Iliotibial Band: A Feasibility Study

Distal iliotibial band friction syndrome (ITBFS) is a common cause of knee pain in endurance athletes. Nonsurgical treatment is usually successful, but surgery is occasionally required for recalcitrant cases. No published studies to date have evaluated the feasibility of an ultrasound-guided (USG) partial iliotibial band (ITB) release.

To determine the feasibility of an USG partial ITB release using a cutting wire. A secondary aim was to assess whether adjacent structures were damaged. We hypothesized that the posterior distal ITB could be partially transected with a cutting wire under USG with no injury to adjacent structures.

Cadaveric study.

Quaternary-care academic institute.

Ten cadaveric knees ranging from 76-89 years old with a mean body mass index of 21.9 kg/m² .

One physician sonographer performed USG releases of the posterior ITBs at the level of the lateral femoral epicondyle with a cutting wire. Dissection was carried out by an independent second physician to assess for primary and secondary outcomes.

(1) Release of the posterior border of the ITB; (2) width of the release; (3) evaluation for any injury to adjacent structures; (4) technical difficulty of the procedure (0 = no difficulty, 10 = most difficult procedure possible); (5) duration of time it took to complete the procedure.

All 10 knees had the posterior border of the ITB transected. Mean release length was 16 mm (range 15-17), which was within 1 mm of the target release length of 15 mm. No adjacent structures were damaged.

A USG release of the posterior ITB utilizing a cutting wire is feasible and safe in a cadaveric model. Translational research is warranted to determine how these results apply to the clinical setting.