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Child Orthopedics
Spine - Cervical
Spine - Lumbar
Spine - Thoracic

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I've heard you can have surgery for a chronic iliotibial band syndrome. Please tell me more. I think I may be headed in that direction.

Pain along the outside (lateral) knee is a common symptom with iliotibial band syndrome. The exact cause of the problem isn't clearly understood. The possible factors leading up to the syndrome are currently a hotly debated topic among sports enthusiasts. Researchers are looking for evidence-based treatment protocols. People often end up with ITB syndrome from overdoing their activity. They try to push themselves too far, too fast, and they end up running, walking, or biking more than their body can handle. The repeated strain causes impingement leading to this syndrome. In long distance runners, impingement of the iliotibial band against the lateral femoral condyle causes enough friction to create this condition. As the knee bends 30 degrees and straightens fully (to zero degrees), the iliotibial band slides through an area called the impingement zone. Some experts believe that the problem happens when the knee bows outward. This can happen in runners if their shoes are worn on the outside edge, or if they run on slanted terrain. Others feel that certain foot abnormalities, such as foot pronation, cause ITB syndrome. Pronation of the foot occurs when the arch flattens. An accurate diagnosis and examination is important so that the proper treatment can be applied. For example, impingement versus bursitis versus flat feet would be treated differently from a tendon that is simply too short and too tight. In almost all cases, conservative (nonoperative) care is tried first before considering surgery. If you have pursued a nonoperative approach for at least three months without a change in your symptoms, then you may be a candidate for surgery. Surgery to release the tissue is the treatment of choice. The surgeon may inject the area with cortisone first before surger to see if the procedure will help. Studies show that patients who respond well to the injection tend to have good surgical outcomes. Surgery may be done percutaneously (through the skin without a large incision) but open incision may be required. Using diagrams (drawings), the surgeons show and describe the type of surgical Z-lengthening procedure used to lengthen the iliotibial band. They report being able to increase the stretch of the band by 1.5 centimeters (that's a little more than half an inch). That may not seem like much but combined with a bursectomy (removal of the inflamed or irritated bursa), it is enough to give relief from the painful symptoms. In many cases, the athletes are able to return to full participation in their chosen sport within eight weeks' time after the procedure. To summarize, working with a physical therapist to change posture, form, flexibility, and movement patterns is the first place to start. Only in persistent, chronic cases of inflammation is surgery considered as the preferred treatment method. The goal of all treatment is to return the athlete to pain free full participation in sports and activities.


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