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The deep layer of the tractus iliotibialis and its relevance when using the direct anterior approach in total hip arthroplasty: a cadaver study

Authors
  • Putzer, David1
  • Haselbacher, Matthias2
  • Hörmann, Romed3
  • Klima, Günter4
  • Nogler, Michael1
  • 1 Medical University of Innsbruck, Department of Orthopaedic Surgery, Experimental Orthopaedics, Innrain 36, Innsbruck, 6020, Austria , Innsbruck (Austria)
  • 2 Medical University of Innsbruck, Department of Orthopaedic Surgery, Anichstrasse 35, Innsbruck, 6020, Austria , Innsbruck (Austria)
  • 3 Medical University of Innsbruck, Division of Histology and Embryology, Department of Anatomy, Histology and Embryology, Müllerstrasse 59, Innsbruck, 6020, Austria , Innsbruck (Austria)
  • 4 Medical University of Innsbruck, Division of Clinical and Functional Anatomy, Department of Anatomy, Histology and Embryology, Müllerstrasse 59, Innsbruck, 6020, Austria , Innsbruck (Austria)
Type
Published Article
Journal
Archives of Orthopaedic and Trauma Surgery
Publisher
Springer Berlin Heidelberg
Publication Date
Oct 14, 2017
Volume
137
Issue
12
Pages
1755–1760
Identifiers
DOI: 10.1007/s00402-017-2820-x
Source
Springer Nature
Keywords
License
Green

Abstract

IntroductionSurgical approaches through smaller incisions reveal less of the underlying anatomy, and therefore, detailed knowledge of the local anatomy and its variations is important in minimally invasive surgery. The aim of this study was to determine the location, extension, and histomorphology of the deep layer of the iliotibial band during minimally invasive hip surgery using the direct anterior approach (DAA).Materials and methodsThe morphology of the iliotibial tract was determined in this cadaver study on 40 hips with reference to the anterior superior iliac spine and the tibia. The deep layer of the tractus iliotibialis was exposed up to the hip-joint capsule and length and width measurements taken. Sections of the profound iliotibial tract were removed from the hips and the thickness of the sections was determined microscopically after staining.ResultsThe superficial tractus iliotibialis had a length of 50.1 (SD 3.8) cm, while tensor fasciae latae total length was 18 (SD 2) cm [unattached 15 (SD 2.5) cm]. Length and width of the deep layer of the tractus iliotibialis were 10.4 (SD 1.3) × 3.3 (SD 0.6) cm. The deep iliotibial band always extended from the distal part of the tensor fascia latae (TFL) muscle to the lateral part of the hip capsule (mean maximum thickness 584 μm). Tractus iliotibialis deep layer morphology did not correlate to other measurements taken (body length, thigh length, and TFL length).ConclusionsThe length of the deep layer is dependent on the TFL, since the profound part of the iliotibial band reaches from the TFL to the hip-joint capsule. The deep layer covers the hip-joint capsule, rectus, and lateral vastus muscles in the DAA interval. To access the precapsular fat pad and the hip-joint capsule, the deep layer has to be split in all approaches that use the direct anterior interval.

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