Iliotibial Band Thickness: Sonographic
Measurements in Asymptomatic Volunteers
Lesley-Ann Goh, FRCR,1 Rethy K. Chhem, MD,2 Shih-chang Wang, FRACR,2 Thomas Chee, FRCR1
1
Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore 308433
2
National University Hospital, 5 Lower Kent Ridge Road, Singapore 119074
Received 4 January 2002; accepted 2 January 2003
ABSTRACT: Purpose. The aims of this study were to
measure the thickness of the iliotibial band (ITB) in
asymptomatic adult volunteers and to determine
whether there was any correlation between these
measurements and the subjects age, weight, or
height.
Methods. Sonography was used to measure the
ITB thickness in 31 asymptomatic volunteers (13 men
and 18 women) ranging from 25 to 68 years old. Two
radiologists obtained the sonographic measurements
of each volunteer at the levels of the femoral condyle
and the tibial condyle of both knees. Findings of fluid
or bursae adjacent to the ITB were recorded.
Results. The mean ITB thickness was 1.95 mm 0.3
mm ( standard deviation) at the level of the femoral
condyle and 3.4 mm 0.5 mm at the level of the tibial
condyle. There was a statistically significant negative
correlation between ITB thickness and subject age.
There was no significant correlation between ITB
thickness and subject weight or height. Joint fluid was
present in the lateral recess of both knees in 29 volun-
teers (93.5%) and 1 knee joint in 2 volunteers (6.5%).
Bursae were present in 3 volunteers (9.7%).
Conclusions. The mean sonographic values of nor-
mal ITB thickness established using sonography may
be helpful in diagnosing ITB pathology. There is no
significant correlation between ITB thickness and sub-
ject weight or height, but there is a negative correla-
tion between ITB thickness and subject age. Joint fluid
in the lateral recess is present in most asymptomatic
individuals, but bursae are rare. 2003 Wiley Periodi-
cals, Inc. J Clin Ultrasound 31:239244, 2003;
Published online in Wiley InterScience (www.inter-
science.wiley.com). DOI: 10.1002/jcu.10168
Keywords: iliotibial band; measurements; bursa; ul-
trasonography; magnetic resonance imaging
Correspondence to: L.-A. Goh
2003 Wiley Periodicals, Inc.
VOL. 31, NO. 5, JUNE 2003
T he iliotibial band (ITB) is a continuation of
the fascia lata at the lateral aspect of the
thigh. Distally, this fibrous band is attached to a
smooth, triangular, anterolateral facet on the lat-
eral tibial condyle. Part of the ITB inserts distally
on the fibular head and the patella.1
Thickening of the ITB is associated with ITB
friction syndrome,2 which is caused by repetitive
friction of the ITB across the lateral femoral con-
dyle and is most commonly seen in long-distance
runners.3 Although sonography has been used to
evaluate patients with symptoms of ITB friction
syndrome,2 sonographic measurements of normal
ITB thickness have not, to our knowledge, been
reported. The purposes of our study were to es-
tablish normal mean sonographic measurements
of ITB thickness in asymptomatic subjects; to as-
sess for correlations between ITB thickness and
subject age, weight, and height; and to determine
the incidences of fluid or bursae located adjacent
to the ITB.
SUBJECTS AND METHODS
Thirty-one asymptomatic volunteers (13 men and
18 women) ranging in age from 25 to 68 years
participated in the study. Each patient under-
went sonographic examination of both knees by 1
of 2 radiologists (L. G. and R. C.). The study de-
sign was approved by the ethics committees of the
National University Hospital and Tan Tock Seng
Hospital in Singapore. Verbal consent was ob-
tained from all participants. The volunteers
completed a questionnaire, providing their age,
weight, and height. Subjects with a history of
pain in the region of the ITB were excluded from
the study.
239
 GOH ET AL
Sonography was performed using a Sequoia
512 ultrasound scanner (Acuson, Mountain View,
CA) equipped with an 815-MHz linear-array
transducer and a Powervision 6000 ultrasound
scanner (Toshiba, Tokyo, Japan) equipped with
an 814-MHz linear-array transducer. During the
examinations, the subjects were in a supine posi-
tion with their knees comfortably extended. The
ITB was visualized on its long axis, and the thick-
ness was measured in both knees at the level of
the lateral femoral condyle and the lateral tibial
condyle (Figures 1 and 2). For each knee exam-
ined, assessment for fluid or bursae adjacent to
the ITB was routinely performed.
Statistical analysis was performed using SPSS
8.0 software for Windows (SPSS Inc., Chicago,
IL). The selected sample size of 31 subjects al-
lowed the mean ITB thickness to be estimated
within error boundaries of 0.3 mm with a prob-
ability greater than 99%.4 The 95% confidence in-
FIGURE 1. Diagram of the knee joint illustrates the normal iliotibial
band and the locations of the lateral femoral condyle (arrow) and the
lateral tibial condyle (arrowhead).
240
terval was calculated using Stata version 7.0 soft-
ware (Stata Corporation, College Station, TX).
We used the Wilcoxon signed rank test to as-
sess for a statistically significant difference in
ITB thickness between the left and right knees5
and the Mann-Whitney test to assess for a signifi-
cant difference in ITB thickness between men and
women.6 Correlation of ITB thickness with the
age, height, and weight of the volunteers was as-
sessed using the Pearson product moment corre-
lation.7 A p value of less than 0.05 was considered
significant.
RESULTS
At the level of the lateral femoral condyle, the
thickness of the ITB ranged from 1.3 to 2.6 mm on
the left side and from 1.3 to 2.5 mm on the right
side, with an overall mean of 1.95 0.3 mm
( standard deviation) (Figure 3). At the level of
the lateral tibial condyle, the ITB thickness
ranged from 2.0 to 4.5 mm on the left side and
from 2.3 to 4.8 mm on the right side, with an
overall mean of 3.4 0.5 mm (Figure 4). There
was no significant difference in ITB thickness be-
tween the left and right sides or between men and
women.
Correlation of ITB thicknesses with subject
age, weight, and height revealed a significant
negative correlation between the ITB thickness
on both sides at the level of the femoral condyle
and increasing subject age, ie, there was a trend
toward decreasing ITB thickness with increasing
subject age (Table 1, Figure 5). However, there
was no significant correlation between ITB thick-
ness measured at the level of the tibial condyle on
either side and subject age. No significant corre-
lation was found between ITB thickness and sub-
ject height, weight, or sex.
Joint fluid located deep to the ITB and super-
ficial to the lateral femoral condyle was present in
both knees in 29 subjects (93.5%) and in only 1
knee in the other 2 subjects (6.5%) (Figure 6).
This fluid dispersed when gently compressed with
the transducer. We also identified a bursa located
deep to the ITB in 1 knee in 3 subjects (9.7%)
(Figure 7). Unlike the joint fluid located superfi-
cial to the lateral femoral condyle, the fluid in the
bursae was not dispersed when compressed with
the transducer. No fluid was present in the sub-
cutaneous tissue located superficial to the bursa
in any subject.
DISCUSSION
To our knowledge, normal sonographic values for
the thickness of the ITB have not been previously
JOURNAL OF CLINICAL ULTRASOUND
 NORMAL ILIOTIBIAL BAND THICKNESS

FIGURE 2. Longitudinal sonogram of the iliotibial band in the coronal plane shows the measurement of the
iliotibial band (arrows) at the lateral femoral condyle (F) (calipers).

FIGURE 3. Graph shows the frequency of the given mean thicknesses FIGURE 4. Graph shows the frequency of the given mean thicknesses
of the left and right iliotibial bands (ITB) at the lateral femoral con- of the left and right iliotibial bands (ITB) at the level of the lateral tibial
dyles (FC). SD, standard deviation. condyles (TC). SD, standard deviation.

TABLE 1
Mean Iliotibial Band Thickness Measured at the Lateral Femoral and Tibial Condyles: Correlation with Subject Age, Height,
and Weight

Subject Characteristic (n = 31)

Statistical Value* Age Height Weight

Left femoral condyle
r 0.505 0.312 0.076
95% CI 0.732 to 0.177 0.055 to 0.604 0.292 to 0.425
Right femoral condyle
r 0.421 0.112 0.101
95% CI 0.678 to 0.071 0.259 to 0.454 0.269 to 0.445
Left tibial condyle
r 0.122 0.066 0.064
95% CI 0.462 to 0.249 0.301 to 0.416 0.303 to 0.415
Right tibial condyle
r 0.156 0.034 0.172
95% CI 0.217 to 0.489 0.331 to 0.389 0.200 to 0.502

Abbreviations: r, correlation coefficient; CI, confidence interval.

*Calculated using the Pearson product moment correlation.

VOL. 31, NO. 5, JUNE 2003 241

 GOH ET AL

published. The mean values of sonographically

FIGURE 5. Graph shows the correlation of the mean thickness of the
left and right iliotibial bands (ITB) at the level of the femoral condyle
(FC) with subject age, as determined by the Pearson product moment
correlation.
measured ITB thickness in our study1.9 0.3
mm at the level of the femoral condyle and 3.4
0.5 mm at the level of the lateral tibial condyle
are consistent with previously published MRI
data.8
Our mean value for the ITB thickness at the
level of the femoral condyle is comparable to re-
ported values obtained using MRI. In a study of 7
patients with ITB friction syndrome and 10 age-
and sex-matched control subjects, Ekman et al9
found a mean ITB thickness of 2.5 1.6 mm at the
level of the femoral condyle for the control group.
Using MRI to examine the knees of 16 patients
with ITB friction syndrome, 20 asymptomatic
control subjects, and 6 cadavers, Muhle et al8 re-
ported that the control subjects had an ITB thick-
ness of 2.0 0.5 mm at the level of the femoral
condyle. These findings suggest that sonography
has a potentially important role in the diagnosis
and follow-up of ITB friction syndrome.

FIGURE 6. (A) Sonogram in the coronal plane shows fluid () in the lateral recess of the knee joint deep to the
iliotibial band (arrows) and superficial to the lateral femoral condyle (F). (B) Sonogram in the coronal plane
shows dispersion of joint fluid deep to iliotibial band (arrows) with gentle compression with the transducer.

242 JOURNAL OF CLINICAL ULTRASOUND

 NORMAL ILIOTIBIAL BAND THICKNESS

FIGURE 7. (A) Sonogram in the coronal plane shows the left iliotibial band (arrows) at the tibial condyle (T).
No bursa is present. (B) Longitudinal sonogram in the coronal plane shows a bursa () located deep to the
right iliotibial band (arrows) at its insertion into the tibial condyle (T).

Sonographic features such as ITB thickening,
focal intrasubstance hypoechoic changes, the
presence of fluid deep to the ITB, and tenderness
on graded compression of the tendon with the
transducer are suggestive of ITB friction syn-
drome.2 In a previous study, Bonaldi et al2 stated
that sonography showed moderate thickening of
the ITB, which measured 13 mm at the level of
the lateral femoral condyle, in a patient with ITB
friction syndrome, but the authors did not give a
value for normal ITB thickness.
The values of normal ITB thickness obtained
using sonography in our study are likely to be
useful in evaluating symptomatic patients, espe-
cially since increased band thickness is a sono-
graphic feature of ITB friction syndrome.2 Al-
though such measurements can be performed
using MRI, the relatively low cost and widespread
availability of sonography are major advantages
that allow for repeated follow-up examinations to
assess progress. For patients undergoing conser-
VOL. 31, NO. 5, JUNE 2003
vative treatment, such follow-up imaging may
help in determining when the patient can safely
resume certain sporting activities,2 information
that is especially important for competitive ath-
letes.3
In addition, we have demonstrated a statisti-
cally significant negative correlation between ITB
thickness measured at the level of the femoral
condyle and subject age. This association may
owe to progressive atrophy of the ITB. Further
study is needed to determine whether the normal
mean value for ITB thickness at the level of the
lateral femoral condyle should be adjusted on the
basis of subject age in evaluating symptomatic
cases.
Fluid located deep to the ITB and superficial to
the lateral femoral condyle was present in virtu-
ally all of our subjects. The fluid dispersed on
gentle compression with the transducer in all
cases, a sign consistent with the presence of free
fluid in the lateral recess of the knee joint.10
243
 GOH ET AL
We also detected focal collections of fluid deep
to the ITB at its insertion on the tibial tubercle in
1 knee in 3 subjects. Because these fluid collec-
tions did not disperse with compression, we con-
cluded that they were probably bursae that were
separate from the joint fluid. In 1 of the cadaveric
dissections described by Ekman et al,9 a potential
space, ie, a bursa, was found between the ITB and
the knee capsule on MRI, whereas others found
no primary bursa on MRI.8 The bursa Ekman et
al9 described was much more proximal in location
than were the bursae we detected using sonogra-
phy. No bursal fluid was detected in asymptom-
atic or cadaveric knees.8,9
In previous MRI and sonographic studies of pa-
tients with ITB friction syndrome, fluid was
found deep to the ITB and was interpreted as bur-
sitis and a sign of ITB friction syndrome.2,8,9,11 In
those studies, the bursal fluid in the affected
knees was located deep to the ITB and superficial
to the lateral femoral condyle. In contrast, the
bursal fluid was located at the distal insertion in
the asymptomatic subjects in our study.
Limitations of our study are its small sample
size and the lack of anatomic verification of the
sonographic findings. The finding of fluid in the
knee joints of our asymptomatic volunteers sug-
gests that the presence of such fluid does not nec-
essarily indicate ITB friction syndrome or other
pathology.
In conclusion, we have reported sonographi-
cally measured mean values of ITB thickness. We
found no significant correlation between ITB
thickness and the weight or height of volunteers
but did find a negative correlation with subject
age. Fluid is present in the lateral recess of the
knee joint in most asymptomatic individuals, but
bursae are rare.
ACKNOWLEDGMENTS
We thank Ms. Heok Soh Chang of Tan Tock Seng
Hospital in Singapore and Professor Truong
Young Kinh-Nhue of the National University of
Singapore for their contributions in statistical
244
analysis. We also thank Dr. Haryanto Alimsard-
jono and Professor Bambang Prijambodo of Air-
langga University in Surabaya, Indonesia, for
drawing Figure 1.
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