Knee > Iliotibial Band Friction Syndrome > Treatments

   Surgical Release

Preparing for Surgery

If iliotibial band (ITB) friction syndrome does not respond to rest and physical therapy, a surgical release, in which the surgeon cuts into the ITB to relieve pressure, may be recommended. While you are preparing to undergo knee surgery, the decisions you make and the actions you take can be as important as the procedure itself in ensuring a healthy recovery. Most insurance companies require a second opinion before agreeing to reimburse a patient for a surgical procedure. Getting a second opinion from a surgeon who is as qualified as the surgeon who gave the initial diagnosis is advisable in any case.

   Make sure you have received any equipment you will need when you get home from the hospital. This may include a knee brace, crutches, ice packs or coolers, or a continuous passive motion (CPM) machine. You should receive prescriptions for any of these from your doctor when your surgery is scheduled.

   Understand the potential risks and benefits of the surgery, and ask your surgeon any questions that will help you better understand the procedure. It can also help to talk to someone else who has undergone the same surgery.

   Any physical problems, such as a fever or infection, should be reported to your surgeon, and you should notify your surgeon of any medication you are taking.

   Discontinue the use of any anti-inflammatory medicine a week prior to surgery, to prevent excessive bleeding during the surgical procedure.

   To reduce the risk of infection, try to refrain from smoking for at least a week prior to surgery.

   If possible, practice walking with your crutches in case you need to use them after surgery.

   Make sure the orthopedist performing the surgery is board-certified, which can be determined by calling the American Board of Orthopaedic Surgery at 919-929-7103.

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At most medical centers, you will go to "patient admissions" to check in for your iliotibial band (ITB) surgical release. If your surgery is going to be inpatient, there may be a separate department, so be sure to ask your physician. After you have checked in to the hospital or clinic, you will go to a holding area where the final preparations are made. The paperwork is completed and your knee area may be shaved (this is not always necessary). You will wear a hospital gown and remove all of your jewelry. You will meet the anesthesiologist or anesthetist (a nurse who has done graduate training to provide anesthesia under the supervision of an anesthesiologist). Then, you will walk or ride on a stretcher to the operating room. Most patients are not sedated until they go into the operating room. Here are some important steps to remember for the day of your surgery:

   You will probably be told not to eat or drink anything after midnight on the night before your surgery. This will reduce the risk of vomiting while you are under general anesthesia, which can lead to pneumonia.

   Since you will most likely be able to go home within a few hours of surgery, and because the anesthetic and pain medications may make you drowsy, arrange for someone to drive you home when you are released.

   Wear a loose pair of pants or other clothing that will fit comfortably over your knee bandage when you leave the hospital.

   Take it easy. Keeping a good frame of mind can help ease any nerves or anxiety about undergoing surgery. Distractions such as reading, watching television, chatting with visitors, or talking on the telephone can also help.

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Surgical release of the iliotibial band (ITB) involves cutting out a small portion of the back inside part of the band that rubs against the leg bone (lateral femoral epicondyle) when the knee is flexed. This surgery takes about 30 to 45 minutes and is outpatient.

   General anesthesia is typically used for this type of surgery, though in some cases a spinal or epidural anesthetic is used. The anesthesiologist will administer the anesthesia once you are in the operating room.

   A small incision is made over the outside part of your knee. Only a small section of the ITB is released to relieve the pressure.

   Incisions are usually closed with stitches and the patient is taken to the recovery room.

After your iliotibial band (ITB) surgical release, you will remain in the recovery room until you have recovered from the effects of anesthesia, which may include drowsiness. It normally takes about an hour for a general anesthetic to wear off, and about two hours for a spinal anesthetic. Depending on the degree of your pain, you may be given a narcotic pain reliever such as vicodin or codeine. Your knee will be bandaged and wrapped, usually with an ace bandage wrapped over layers of gauze and cotton, and your knee will be elevated. Ice may be used to reduce swelling, and a brace may be used to keep the knee stabilized. Your surgeon may suggest you use crutches or a cane initially, though you probably will be able to walk without them. Physicians may recommend that older patients continue using crutches or a cane for a longer period of time. Your temperature, blood pressure, and heartbeat will be monitored by a nurse who, with the assistance of the doctor, will determine when you can prepare to go home. You will normally be able to leave the hospital or clinic within a few hours after surgery. Make sure to have someone available to drive you home, as you may not be able to drive a car. Surgical release of an iliotibial band (ITB) is outpatient, and does not require an overnight stay in the hospital or clinic.

Following surgical release of your iliotibial band (ITB), you will follow a course of rest, anti-inflammatories, physical therapy, and stretching and strengthening exercises. The severity of your symptoms will dictate the course of action your physician recommends. ITB friction syndrome is a chronic condition, and usually is not severe enough that you will need to immobilize your knee or use crutches. However, you should probably try to avoid squatting, or walking or running up hills or stairs, since these movements place added stress on your knees. You will most likely have to curtail your exercising routine if you participate in activities that place strain on the ITB, like running or cycling.

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You usually are able to begin rehab exercises soon after your iliotibial band (ITB) surgical release, possibly as soon as the following day. Physical therapy for ITB friction syndrome includes stretching the ITB and strengthening exercises for the muscles around the knee. You probably will begin with mild stretching and slow movements to restore range of motion, and gradually work your way up to strengthening exercises focusing on the quadriceps and hamstrings. Strengthening exercises require dedication because results often take weeks and pain may recur. Heat applied to the affected area of your knee can aid in loosening up the muscles and tendons before you stretch. Depending on the severity of the irritation, pain from ITB friction syndrome usually subsides over a period of four to six weeks.

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   ITB stretching exercises

The ITB rubs against the outside of the knee as part of the knee's normal motion. The goal is to prevent this motion from causing irritation and pain. Following are some steps you can take to prevent ITB friction syndrome:

   Make sure to stretch and strengthen the muscles around your knees, particularly the quadriceps and hamstrings.

   Stretch and warm up before you exercise, and stretch after you are done.

   Have your physician check to see if your feet turn inward excessively (over-pronation), and if they do, make sure to wear running shoes with proper support and cushioning.

   If you do a lot of cycling, adjust your seat height so that you are not stretching too far at the bottom of the down stroke.

   If you run frequently at a track, alternate direction (clockwise and counter-clockwise) to avoid excessive ITB strain on your outside leg.

   Do not suddenly increase your training duration or intensity; try to progress in small increments.