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Objectives and questions: Multiligament knee injuries (MLKIs) frequently compromise the lateral complex of the knee, particularly the lateral collateral ligament (LCL) and the posterolateral corner (PLC). Damage to these structures can produce varus malalignment, rotational instability, and heightened stress on the posterior cruciate ligament (PCL). Numerous surgical strategies have been described for reconstruction of the LCL and PLC. Recently, we started examining the iliotibial band (ITB) as an alternative graft to hamstring autografts. However, the structural integrity of the ITB in the setting of lateral MLKIs have not been investigated. Therefore, this study aimed to evaluate the integrity of the ITB and to delineate its associated injury patterns in patients with lateral MLKIs.

Material and methods: Patients presenting with MLKIs between 2015 and 2025 were retrospectively identified and screened for involvement of the LCL and PLC. Eligibility was confirmed through review of clinical examination findings and operative reports. MRI scans were independently assessed by four readers with varying levels of clinical expertise for injuries to the ACL, PCL, LCL, MCL, PLC, ITB. Interrater and intrarater reliability were calculated for evaluation of ITB integrity (intact vs. injured) and for characterization of injury patterns. Patients were stratified according to the Schenck classification into four subgroups: Schenck I-L with ACL involvement, Schenck I-L with PCL involvement, Schenck III-L, and Schenck IV.

Results: A total of 41 patients were included in the final analysis. Of these, 11 were classified as Schenck I-L with ACL involvement, 10 as Schenck I-L with PCL involvement, 13 as Schenck III-L, and 7 as Schenck IV. Interrater and intrarater reliability for evaluation of ITB integrity were excellent, with ICC values of 0.91 and 0.94, respectively. The ITB remained intact in 73% of Schenck I-L (ACL), 100% of Schenck I-L (PCL), 77% of Schenck III-L, and 86% of Schenck IV cases, without statistically significant differences between groups (p = 0.41). ITB lesions were predominantly partial tears, most commonly located in the midportion or distal segment of the ITB, without a consistent distribution pattern across the different injury subtypes.

Discussion and conclusions: The main finding of this analysis is that the ITB frequently remains intact, even in high-grade MLKIs involving both central and lateral stabilizing structures of the knee. This pattern was consistently observed across all lateral injury subgroups. The ITB is already widely utilized as a graft source for anterolateral extra-articular tenodesis and, in selected cases, for different ligamentous reconstructions. Prior investigations have demonstrated favorable biomechanical characteristics and tensile strength of the ITB. Considering these properties and the high rate of preserved integrity observed in the present cohort, the ITB may represent a viable autograft option for lateral and posterolateral knee reconstruction in patients with MLKIs.