Radiological Identification of Injury to the Kaplan Fibers of the Iliotibial Band in Association With Anterior Cruciate Ligament Injury

Lachlan M Batty; Jerome Murgier; Julian A Feller; Richard O'Sullivan; Kate E Webster; Brian M Devitt

doi:10.1177/0363546520931854

Radiological Identification of Injury to the Kaplan Fibers of the Iliotibial Band in Association With Anterior Cruciate Ligament Injury

Am J Sports Med. 2020 Jul;48(9):2213-2220. doi: 10.1177/0363546520931854. Epub 2020 Jun 24.

Authors

Lachlan M Batty¹, Jerome Murgier^{1

2}, Julian A Feller^{1

3}, Richard O'Sullivan^{4

5}, Kate E Webster³, Brian M Devitt^{1

3}

Affiliations

¹ OrthoSport Victoria Research Unit, Richmond, Australia.
² Aguilera Private Clinic, Ramsey Santé, Orthopedic Department, Biarritz, France.
³ School of Allied Health, La Trobe University, Melbourne, Australia.
⁴ Healthcare Imaging Services, Richmond, Australia.
⁵ Department of Medicine, Monash University, The Alfred Hospital, Melbourne, Australia.

PMID: 32579396
DOI: 10.1177/0363546520931854

Abstract

Background: Recent biomechanical studies have demonstrated that the Kaplan fibers (KFs) of the iliotibial band play a role in the control of anterolateral rotation of the knee. However, controversy exists regarding whether the KFs are injured in conjunction with anterior cruciate ligament (ACL) injury.

Purpose: To establish the prevalence of radiological injury to the KFs in the ACL-injured knee; to evaluate the effect of the time interval between injury and magnetic resonance imaging (MRI) on diagnosis of KF injury; and to assess for any association between KF injury and other qualitative radiological findings.

Study design: Cohort study (diagnosis); Level of evidence, 3.

Methods: Preoperative MRI scans were reviewed for 161 patients with ACL injury. Specific diagnostic criteria were developed and applied to identify KF injury. Chi-square testing was performed to look for associations among KF injury, the time from injury to MRI, and associated radiological knee injuries.

Results: Radiological evidence of KF injury was identified in 30 (18.6%) patients. The diagnosis of KF injury was higher in patients who had MRI scans performed within 90 days of injury as compared with ≥90 days after injury (23.7 vs 6.4%; P = .010). Patients with an MRI diagnosis of KF injury had significantly higher rates of lateral meniscal injury (40% vs 18%; P = .007), posteromedial tibial bone marrow edema (73% vs 44%; P = .003), and injury to the lateral collateral ligament (13% vs 3%; P = .019) or medial collateral ligament (23% vs 8%; P = .019).

Conclusion: The prevalence of injury to the KF in patients with ACL injury as diagnosed by MRI was relatively low (18.6% of patients). However, the time interval from injury to MRI was relevant to diagnosis, with significantly higher rates of injury identification in patients with early (within 90 days) versus delayed (≥90 days) MRI. KF injury was associated with higher rates of injury to the lateral meniscal and collateral ligaments, as well as posteromedial tibial bone bruising.

Keywords: ACL; Kaplan fiber; MRI.

MeSH terms

Anterior Cruciate Ligament Injuries* / diagnostic imaging
Cohort Studies
Humans
Knee Injuries* / diagnostic imaging
Knee Joint
Ligaments / injuries*
Magnetic Resonance Imaging
Radiography