Injury of the Gluteal Aponeurotic Fascia and Proximal Iliotibial Band: Anatomy, Pathologic Conditions, and MR Imaging

The fascia lata, or deep fascia of the thigh, is a complex anatomic structure that has not been emphasized as a potential source of pelvic and hip pain. This structure represents a broad continuum of fibrous tissue about the buttock, hip, and thigh that receives contributions from the posteriorly located aponeurotic fascia covering the gluteus medius muscle and from the more laterally located iliotibial band (ITB). At the pelvis and hip, the ITB consists of three layers that merge at the lower portion of the tensor fasciae latae muscle. The gluteal aponeurotic fascia and ITB merge at the buttock and hip before extending inferiorly to the Gerdy tubercle at the anterolateral tibia. Injuries to these anatomic structures are an underdiagnosed cause of pain and disability and may clinically mimic more common processes affecting the hip and proximal thigh. Categories of disease include overuse injuries, traumatic injuries, degenerative lesions, and inflammatory lesions. Familiarity with the anatomy and pathologic conditions of the fascia lata and its components is important in their recognition as a potential source of symptoms. This article illustrates the anatomy of this complex fascia through anatomic-pathologic correlation and describes the magnetic resonance imaging appearances of the pathologic conditions involving it.