J Korean Orthop Assoc.  2015 Dec;50(6):474-482. 10.4055/jkoa.2015.50.6.474.

Ligamentum Teres Injuries of the Hip

• Lee WY
• Kim EC
• Kang C
• Hwang DS
• Lee KY

• KMID: 2185088
• DOI: http://doi.org/10.4055/jkoa.2015.50.6.474

Abstract

PURPOSE
The purpose of this study is to identify functions of ligamentum teres during multi-planar movement of the hip joint and to evaluate the correlation between arthroscopic findings and preoperative magnetic resonance imaging (MRI) of ligamentum teres rupture.
MATERIALS AND METHODS
With four fresh-frozen cadavers that were dissected for removal of all soft tissue from around the hip, leaving only the ligamentum teres intact, tension of ligamentum teres at each position of the hip during multiplanar movement of the hip joint was identified. Among patients who underwent arthroscopic treatment for hip joint lesion from June 2006 to December 2012, arthroscopic findings of 26 patients who showed ligamentum teres rupture on arthroscopy were compared retrospectively with finding of preoperative MRI and visual analogue scale pain score and modified Harris hip score preoperatively and at final follow-up were evaluated.
RESULTS
The ligamentum teres was maximal taut at flexion with external rotation. Ligamentum teres rupture was suspected according to preoperative MRI in 20 cases (76.9%). All cases underwent arthroscopic debridement and thermal shrinkage for the ruptured ligamentum teres. At final follow-up, visual analogue scale pain score and modified Harris hip score had improved from 6.1 (4-9) and 63.7 (36.3-86.9) to 2.0 (0-5) and 88.4 (72.6-100), respectively (all p<0.001).
CONCLUSION
The ligamentum teres is maximal taut at flexion with external rotation and contributes to internal stability. Ruptured ligamentum teres should be treated by arthroscopic debridement and thermal shrinkage.

Keyword

hip; round ligament; arthroscopy; magnetic resonance imaging

MeSH Terms

Arthroscopy
Cadaver
Debridement
Follow-Up Studies
Hip Joint
Hip*
Humans
Magnetic Resonance Imaging
Retrospective Studies
Round Ligament of Uterus
Rupture

Figure

• 

  Figure 1 Arthroscopic views show the ruptured ligamentum teres rupture (white arrows) and femoral head (asterisks). (A) Complete tear. (B) Partial tear. (C) Degenerative tear.

• 

  Figure 2 Arthroscopic views show the femoral head (asterisks) and treatments for ruptured ligamentum teres (white arrows). (A) Arthroscopic debridement of ligamentum teres. (B) Arthroscopic shrinkage of ligamentum teres.

• 

  Figure 3 Cadaveric photographs show the femoral head (asterisks) and tension of the ligamentum teres (white arrows) at multiplanar movement of the hip joint. (A) The ligamentum teres was maximal taut during flexion with external rotation. (B) The ligamentum teres was slightly taut during flexion with internal rotation and extension with external rotation. (C) The ligamentum teres was slightly lax during extension with internal rotation.

Reference

1. Savory WS. The use of the ligamentum teres of the hip-joint. J Anat Physiol. 1874; 8:291–296.

2. Bardakos NV, Villar RN. The ligamentum teres of the adult hip. J Bone Joint Surg Br. 2009; 91:8–15.

3. Guanche CA, Sikka RS. Acetabular labral tears with underlying chondromalacia: a possible association with high-level running. Arthroscopy. 2005; 21:580–585.

4. Martin HD, Savage A, Braly BA, Palmer IJ, Beall DP, Kelly B. The function of the hip capsular ligaments: a quantitative report. Arthroscopy. 2008; 24:188–195.

5. Leunig M, Beck M, Stauffer E, Hertel R, Ganz R. Free nerve endings in the ligamentum capitis femoris. Acta Orthop Scand. 2000; 71:452–454.

6. Byrd JW, Jones KS. Traumatic rupture of the ligamentum teres as a source of hip pain. Arthroscopy. 2004; 20:385–391.

7. Rao J, Zhou YX, Villar RN. Injury to the ligamentum teres. Mechanism, findings, and results of treatment. Clin Sports Med. 2001; 20:791–799.

8. Martin RL, Kivlan BR, Clemente FR. A cadaveric model for ligamentum teres function: a pilot study. Knee Surg Sports Traumatol Arthrosc. 2013; 21:1689–1693.

9. Cerezal L, Kassarjian A, Canga A, et al. Anatomy, biomechanics, imaging, and management of ligamentum teres injuries. Radiographics. 2010; 30:1637–1651.

10. Delcamp DD, Klaaren HE, Pompe van Meerdervoort HF. Traumatic avulsion of the ligamentum teres without dislocation of the hip. Two case reports. J Bone Joint Surg Am. 1988; 70:933–935.

11. Martin HD, Hatem MA, Kivlan BR, Martin RL. Function of the ligamentum teres in limiting hip rotation: a cadaveric study. Arthroscopy. 2014; 30:1085–1091.

12. Walker JM. Growth characteristics of the fetal ligament of the head of femur: significance in congenital hip disease. Yale J Biol Med. 1980; 53:307–316.

13. Gray AJ, Villar RN. The ligamentum teres of the hip: an arthroscopic classification of its pathology. Arthroscopy. 1997; 13:575–578.

14. Glick JM, Sampson TG, Gordon RB, Behr JT, Schmidt E. Hip arthroscopy by the lateral approach. Arthroscopy. 1987; 3:4–12.

15. Ide T, Akamatsu N, Nakajima I. Arthroscopic surgery of the hip joint. Arthroscopy. 1991; 7:204–211.

16. Philippon M, Schenker M, Briggs K, Kuppersmith D. Femoroacetabular impingement in 45 professional athletes: associated pathologies and return to sport following arthroscopic decompression. Knee Surg Sports Traumatol Arthrosc. 2007; 15:908–914.

17. Keene GS, Villar RN. Arthroscopic anatomy of the hip: an in vivo study. Arthroscopy. 1994; 10:392–399.

18. Armfield DR, Towers JD, Robertson DD. Radiographic and MR imaging of the athletic hip. Clin Sports Med. 2006; 25:211–239.

19. Sampatchalit S, Barbosa D, Gentili A, Haghighi P, Trudell D, Resnick D. Degenerative changes in the ligamentum teres of the hip: cadaveric study with magnetic resonance arthrography, anatomical inspection, and histologic examination. J Comput Assist Tomogr. 2009; 33:927–933.

20. Blankenbaker DG, Tuite MJ. The painful hip: new concepts. Skeletal Radiol. 2006; 35:352–370.

21. Chen HH, Li AF, Li KC, Wu JJ, Chen TS, Lee MC. Adaptations of ligamentum teres in ischemic necrosis of human femoral head. Clin Orthop Relat Res. 1996; 328:268–275.

22. Martin RL, Palmer I, Martin HD. Ligamentum teres: a functional description and potential clinical relevance. Knee Surg Sports Traumatol Arthrosc. 2012; 20:1209–1214.

23. Wenger D, Miyanji F, Mahar A, Oka R. The mechanical properties of the ligamentum teres: a pilot study to assess its potential for improving stability in children's hip surgery. J Pediatr Orthop. 2007; 27:408–410.

24. Kivlan BR, Richard Clemente F, Martin RL, Martin HD. Function of the ligamentum teres during multi-planar movement of the hip joint. Knee Surg Sports Traumatol Arthrosc. 2013; 21:1664–1668.

25. Beck M, Kalhor M, Leunig M, Ganz R. Hip morphology influences the pattern of damage to the acetabular cartilage: femoroacetabular impingement as a cause of early osteoarthritis of the hip. J Bone Joint Surg Br. 2005; 87:1012–1018.