Distal Iliotibial Band Z-lengthening for Iliotibial Band Syndrome

This technique video reviews an iliotibial band Z-lengthening procedure for iliotibial band (ITB) syndrome using a patient case example.

Indications for considering surgical intervention include a diagnosis of iliotibial band syndrome, ruling out other possible etiologies of knee pain, and a minimum of 6 months of failed conservative treatment.

There are several surgical techniques described in the literature, although the ITB Z-lengthening procedure is preferred at our institution. This technique uses a "Z"-type incision through the distal ITB to allow lengthening of the ITB and to allow access for surgical debridement of the underlying inflamed bursa. Nonabsorbable suture is then used for a side-to-side repair of the ITB in the elongated position.

Complications from this technique are uncommon, and the few published outcomes from this procedure show good clinical results and return to preactivity levels.

Preoperative planning should include analysis of lower extremity alignment and can include advanced imaging to rule out intra-articular pathology. Diagnostic arthroscopy is typically used at the start of the case for completeness. Distal iliotibial band Z-lenghtening can be a successful surgical option for patients who have failed extensive conservative treatment for iliotibial band syndrome.