Ligamentum Teres Injuries of the Hip

Woo-Yong Lee; Eui-Chang Kim; Chan Kang; Deuk-Soo Hwang; Ki-Young Lee

doi:10.4055/jkoa.2015.50.6.474

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Lee, Kim, Kang, Hwang, and Lee: Ligamentum Teres Injuries of the Hip

Original Article

Journal of the Korean Orthopaedic Association 2015; 50(6): 474-482.

Published online: 29 December 2015

DOI: https://doi.org/10.4055/jkoa.2015.50.6.474

Ligamentum Teres Injuries of the Hip

Woo-Yong Lee, M.D., Eui-Chang Kim, M.D.^*, Chan Kang, M.D., Deuk-Soo Hwang, M.D., Ki-Young Lee, M.D.

Department of Orthopedic Surgery, Chungnam National University School of Medicine, Daejeon, Korea.

^*Suwon On Orthopaedic Clinic, Suwon, Korea.

Correspondence to: Deuk-Soo Hwang, M.D. Department of Orthopedic Surgery, Chungnam National University School of Medicine, 266 Munwha-ro, Jung-gu, Daejeon 35015, Korea. TEL: +82-42-338-2480, FAX: +82-42-338-2482, dshwang@cnu.ac.kr

Received 15 June 2015 Revised 3 July 2015 Accepted 15 July 2015

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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.

Keywords: hip, round ligament, arthroscopy, magnetic resonance imaging

Figures and Tables

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.

Table 1

Data of Four Cadavers for Analysis of Ligamentum Teres

Table 2

Dermographic Data of Patients with Ligamentum Teres Rupture

MRI, magnetic resonance imaging; VAS, visual analogue scale; mHHS, modified Harris hip score; FU, follow-up.

Table 3

Concomitant Lesions of Patients with Ligamentum Teres Rupture

FAI, femoroacetabular impingement.

Table 4

Comparison between Preoperative and Final Follow-Up Clinical Outcomes

Values are presented as mean±standard deviation. VAS, visual analogue scale; mHHS, modified Harris hip score.

Notes

^{CONFLICTS OF INTEREST} The authors have nothing to disclose.

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