The Musculoskeletal Advanced Transillumination Technique (MATT): A Descriptive Proof-of-Concept Study of a New Method for the Study of the Iliotibial Tract Tested on Fresh Cadaveric Specimens.

Background

The iliotibial band (ITB) is an anatomically complex structure with multiple proximal and distal attachments, making its mechanical behavior difficult to interpret. In the study of iliotibial band syndrome (ITBS), prior research has often considered the underlying lateral femoral epicondyle (LFE) as a fixed reference to describe ITB movement during knee flexion, potentially misrepresenting true tissue dynamics. This proof-of-concept study introduces the musculoskeletal advanced transillumination technique (MATT) to visualize and measure LFE displacement relative to the ITB and the tubercule of the ITB (tITB) on the tibia during passive knee flexion.

Methods

Un-embalmed donor knees (n = 8) were dissected to expose the ITB and positioned on a device allowing standardized passive motion from 0° to 30°. A trocar was inserted between the femoral epicondyles, and a 300-watt xenon light source illuminated the LFE. Video was recorded with an iPhone 15, and key frames were analyzed using ImageJ Version 1.54i, and a custom Python (Version 3.12.5) script to quantify LFE displacement relative to the ITB and to the tITB.

Results

Median absolute LFE displacement from 0° to 30° was 9.18 mm (IQR 7.23-10.95). Between 0° and 30°, the LFE shifted anteriorly by -1.76 mm (IQR -10.28 to -8.72) relative to the anterior border of the ITB, and by 11.26 mm (IQR 8.27 to 26.33) relative to its posterior border. The LFE-tITB distance increased from 51.98 mm (IQR 49.13-52.36) at 0° to 53.66 mm (IQR 50.08-60.11) at 30°, with a median displacement of 3.92 mm (IQR: 2.48-5.73).

Conclusions

Musculoskeletal Advance Transillumination Technique (MATT) is a straightforward and reproducible technique that offers direct visualization of the dynamic relationship between a skeletal landmark and myofascial structures, such as the LFE and the ITB. By challenging the assumption that the LFE is a fixed reference point, MATT opens new perspectives for investigating the biomechanical mechanisms underlying conditions like iliotibial band syndrome.