As an anatomic structure the iliotibial band (iliotibialis tractus) has been used for more intra- and extraarticular procedures than any other autologous tissue. Physiologically, however, the surgical technique has often violated its anatomy by devascularizing this substantial extension of the tensor fascia latae and gluteus maximus muscles. Biomechanically, the iliotibial band has been shown to be the strongest substitute for the deficient anterior cruciate ligament (ACL) when tested as a free graft. The controversy about its strength arises when unequivalent tests are made with free grafts secured by proximal and distal bone blocks, thus invalidating the comparison.This article describes the subtleties of the surgical technique with the intraarticular transfer of the iliotibial muscle tendon unit that has evolved over ten years. Improvements on an anatomic and physiologic basis require strict attention to detail, which we have demonstrated through our intraoperative photographs.