髂胫束再探讨：前交叉韧带重建中外侧肌腱固定术的手术解剖与影像学指南
简介
本文是一篇叙述性综述（证据等级V级），更新髂胫束的层次解剖、Kaplan纤维及其与膝关节前外侧稳定结构的关系，并结合MRI/超声影像评估其在ACL重建中Lateral Extra-articular Tenodesis（LET）的应用。作者指出，对于年轻旋转运动运动员、翻修ACL及全身关节松弛等高危患者，髂胫束为基础的LET联合ACL重建可改善旋转稳定性、降…
英文摘要
PURPOSE: To provide an updated, clinically oriented review of the iliotibial band (ITB), emphasizing its surgical anatomy, biomechanical relevance, imaging correlates, and role in knee ligament reconstruction, with a focus on lateral extra-articular tenodesis (LET) and anterior cruciate ligament (ACL) augmentation. METHODS: A structured narrative review was conducted, summarizing anatomical, biomechanical, radiological, clinical, and surgical literature. Key elements included gross and histological anatomy of the ITB, its relationship with Kaplan fibers and anterolateral capsulo-fascial structures, imaging assessment using MRI and ultrasound, and evidence supporting ITB-based procedures in selected ACL reconstruction settings. RESULTS: The ITB functions as both a passive and dynamic stabilizer of the lateral knee and contributes to control of internal tibial rotation, particularly in ACL-deficient or high-risk knees. Its deep capsulo-osseous component, including the Kaplan fibers, forms part of the broader anterolateral restraint system. MRI and ultrasound may support anatomical correlation and evaluation of associated lesions, but imaging findings should be interpreted as complementary to clinical assessment rather than as independent determinants of LET indication. In selected high-risk populations, including young pivoting-sport athletes, revision ACL patients, and patients with generalized laxity, ITB-based LET has been associated with improved rotatory control and reduced graft failure risk when appropriate tensioning principles are respected. CONCLUSION: The ITB is a clinically relevant anatomical and biomechanical structure in contemporary ACL reconstruction. Its layered architecture and relationship with Kaplan fibers help explain the rationale for selective LET augmentation. Current evidence supports ITB-based LET as an adjunct in appropriately risk-stratified patients, while imaging should be viewed as supportive for anatomical correlation and associated pathology rather than as a stand-alone basis for surgical decision-making. LEVEL OF EVIDENCE: V (Narrative review).