## 4 Discussion
In contrast, an increased Doppler signal is often associated with tendinopathy or inflammatory changes [23]. There are a few studies that evaluated patients after ACLR and LET procedures, mainly using MRI rather than other imaging techniques. For instance, [PERSON] et al. presented the ITB strip's appearance after a modified Lemaire technique on the coronal and axial planes. On the coronal plane, the ITB strip coursed obliquely, and on both planes a gap in the central portion of the ITB was observed that was secondary to graft harvesting. They also included imaging findings of the attachment of the ITB strip using the interference screw in the lateral femoral epicondyle [17]. However, the number of studies evaluating ITB strip morphology assessed using MRI or other imaging techniques is limited. Researchers primarily focus on radiological assessment of results of ACLR and LET procedures. For instance, some authors presented postoperative complications of the LET procedure, such as LET graft failure, hematoma, infection, tunnel convergence, etc., seen in X-ray, computed tomography, and MRI [24]. Other scientists who investigated the LET graft using MRI suggested that it absorbs a portion of the forces acting on the knee, thereby reducing the load on the ACL graft, which may hasten its regeneration [25]. For instance, [PERSON] et al. presented that the addition of LET to ACLR improves the maturation of the ACL graft and its incorporation as assessed using MRI at the 12-month follow-up. However, there were no differences in clinical outcomes between ACLR alone and ACLR+LET groups [26]. On the other hand, [PERSON] et al. showed that the application of the LET procedure during primary ACLR may slow the healing hamstring ACL graft at 10 months postoperatively, as observed via MRI [27]. There were also studies using quantitative MRI aimed at assessing accelerated osteoarthritis after the ACLR + LET procedure, but it was not proven [28]. As there are cadaveric studies that investigated biomechanical properties of LET depending on the location of its attachment to the lateral femoral epicondyle, we decided to divide localization of the ITB strip under LCL as seen in ultrasound into three zones: at the level of femur, between the femur and the tibia, and at the level of the tibia. For instance, biomechanical studies show that LET insertion proximal to the LCF may present a steady length change pattern and lower the total strain range compared to situations when its insertion is localized anteriorly and distally to the LCF [29]. Moreover, apart from localization of the LET attachment, graft behaviour may be influenced by its course, which finally may affect knee joint kinematics and cause overconstraint in internal rotation [30]. Therefore, we designated the aforementioned three zones, as they could reflect the fibre route and the location of the ITB strip attachment. However, we did not find any relationship between the ITB strip area and clinical outcomes. This may suggest that our zones do not accurately reflect the location of LET attachment; that the postoperative healing process of knee tissues is complex and ultimately affects knee biomechanics that cannot be predicted on cadavers; or that different factors during surgery, such as graft size, graft tension, the fixation method, and knee angle during ITB strip attachment, affect the final result. This pilot study provides initial insight into the utility of ultrasonography for the detection and evaluation of the ITB strip after the modified Lemaire technique. Based on these preliminary findings, future research should focus on larger, multicentre cohorts to validate the observed results and further expand the prognostic value of ultrasound-detected effusion. Additionally, long-term studies may enhance understanding of graft integration and postoperative knee function. This study had several limitations. Firstly, the sample size was relatively small and consisted of the local population with complex knee injuries.