LCF in 2026 (July)

 

 LCF in 2026 (July) 

(Quotes from articles and books published in July 2026 mentioning the ligamentum capitis femoris) 

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Çetik, R. M., Bakırcıoğlu, S., Büyükdoğan, K., Çağlar, Ö., Atay, Ö. A., & Atilla, B. (2026). Cam-type femoro-acetabular impingement: Mid-term functional results and joint awareness of arthroscopic, mini-open and surgical dislocation techniques. Acta Medica, 57(2), 123-131.  [i]  actamedica.org

 

Khan, M. Y., Khan, R., Shaikh, H., Persaud, N. A., Rama, S., & Khan, Y. (2026). Evolution of Hip Arthroscopy in Modern Orthopedic Practice. Cureus, 18(6).  [ii]  cureus.com

 

Sanders, W. J., Ji, X. P., & Jablonski, N. G. (2026). New remains of Stegodon zhaotongensis (Proboscidea, Stegodontidae) from the Late Miocene site of Shuitangba, Yunnan Province, China. Journal of Mammalian Evolution, 33(3), 33.  [iii]  link.springer.com

 

Randelli, F. (2026). Hip arthroscopy-separating the evidence from the hype and why we need it. Mentors in Orthopedics, 8(041).  [iv] mentors-in-orthopedics.com

 

Yershov, D. V., Korolkov, O. I., Klymovytskyi, F. V., Chornenkyi, A. V., & Rakhman, P. M. (2026). Surgical management of hip dislocation in children with cerebral palsy: a multicenter retrospective series analysis of 171 patients (part 1). TRAUMA, 27(3), 268-273.  [v]  trauma-journal.com

 

Quesada-Jimenez, R., Patel, D. H., Kahana-Rojkind, A. H., Cohen, M. F., Kuhns, B. D., & Domb, B. G. (2026). Effect of Preoperative Opioid Consumption on Outcomes After Hip Arthroscopy for Femoroacetabular Impingement and Labral Tears: A Minimum 2-Year Follow-up Study. Orthopaedic Journal of Sports Medicine, 14(7), 23259671261431838.  [vi]  journals.sagepub.com

 

Johansson, M. (2026). Prediction of Subject-specific Hip Cartilage Stresses Using Combined Musculoskeletal and Finite Element Modelling. Master’s Thesis in Biomedical Engineering. Lund: Lund University.  [vii]  lup.lub.lu.se

 

Lu, Y., Cabarcas, B., Ahmad, R. A., Kelly, J. J., Lachman, N., Nho, S., ... & Hevesi, M. (2026). Capsular Contributions to Hip Joint Stability: Clinical Anatomy and Implications for Surgical Management. Clinical Anatomy.  [viii]   onlinelibrary.wiley.com

 

Greenhalgh, M. S., & Shah, N. (2026). Management of Hip Dysplasia in Adults: A Review and the Wrightington Philosophy. Journal of Clinical Orthopaedics & Trauma.  [ix]  sciencedirect.com

 

Jokubynas, V. V. (2026). The hip odyssey: exploring anterior, posterior and lateral approaches in hip replacement surgery (Doctoral dissertation, Vilniaus universitetas.).  [x]  scholar.google.com

 

Sarassa, C., Aristizábal, S., García, J. J., Quintero, D., Mejía, R., & Herrera Torres, A. M. (2026). Intraosseous ‘Synthetic Teretization’ in the absence of ligamentum teres: surgical technique and early results. Journal of Pediatric Orthopaedics B. July 13, 2026.  [xi]  ovid.com

 

Miyama, K., Kitamura, K., Fujii, M., Motomura, G., Hamai, S., Kawahara, S., ... & Nakashima, Y. (2026). Artificial Intelligence‐Based Automatic Screening System for Hip Dysplasia. Journal of Orthopaedic Research, 44(7), e70251.  [xii]  pmc.ncbi.nlm.nih.gov

 

Dvorská, D. (2026). Kompenzační cvičení při funkčních poruchách kyčelního kloubu u sportovních gymnastek (Bachelor's thesis, Univerzita Palackého v Olomouci, Fakulta tělesné kultury).  [xiii]  theses.cz

 

Markes, A. R., & Vyas, D. (2026). Hip Microinstability: A Comprehensive Review of Diagnosis and Management. Operative Techniques in Orthopaedics, 101228.  [xiv]  sciencedirect.com

 

Henry, L., Funk, K., & Meredith, S. J. (2026). Traumatic Native Hip Dislocation in the Skeletally Mature Patient. Operative Techniques in Orthopaedics, 101229.  [xv]  sciencedirect.com

 

Qu, R., Liu, T., Wang, W., Li, Z., & Gao, F. (2026). An MRI-Based classification of osteonecrosis of the femoral head based on the spatial relationship between the epiphyseal line and osteonecrotic boundary. European Journal of Radiology, 113086.  [xvi]  sciencedirect.com

 

Stanard I, Almhanna H, Al-Mahmodi AMM, Kilroy D, Kumar AHS. (2026). Comparative Analysis of Vascular Density in the Femoral Head Ligament of the Dog, Sheep, and Goat. BEMS Reports. 12(2):58-64.  [xvii]  bemsreports.org 

Announcement

Full access to our monographs covering various aspects of the history and pathology of LCF is now available:

Архипов С.В. Связка головки бедренной кости. Функция и роль в патогенезе коксартроза. Йоэнсуу: Издание Автора, 2023. [Arkhipov SV. The ligament of the head of femur. Function and role in the pathogenesis of coxarthrosis. Joensuu: Author's Edition, 2023. (In Russian)] GooglePlay  

Архипов С.В. Девятый месяц, одиннадцатый день: Рассуждение о XXXII главе книги Бытие. Йоэнсуу: Издание Автора, 2024. [Arkhipov S.V. The Ninth Month, Eleventh Day: A Reflection on Chapter XXXII of the Book of Genesis. Joensuu: Author’s Edition, 2024. (In Russian)] GooglePlay 

Архипов С.В. Дети человеческие: истоки библейских преданий в обозрении врача. Эссе, снабженное ссылками на интерактивный материал. Йоэнсуу: Издание Автора, 2025. [Arkhipov S.V. Human Children: The Origins of Biblical Legends from a Physician's Perspective. An essay with references to interactive materials. Joensuu: Author's Edition, 2025. (In Russian)]. GooglePlay  

Arkhipov S.V. 50 Tables of Evidence for the Composition of Genesis in Late Second Intermediate Period Egypt: The Protograph Before the Oral Tradition. Joensuu: Author's Edition, 2026. [Архипов С.В. 50 таблиц, подтверждающих составление книги Бытия в конце Второго промежуточного периода в Египте: Протограф до устной традиции. Йоэнсуу: Издание Автора, 2026. (на англ.)] GooglePlay   

[Ru] Дайджест публикаций о ligamentum capitis femoris: 

https://kruglayasvyazka.blogspot.com/2026/07/lcf-2026_0597183046.html

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NB! Fair practice / use: copied for the purposes of criticism, review, comment, research and private study in accordance with Copyright Laws of the US: 17 U.S.C. §107; Copyright Law of the EU: Dir. 2001/29/EC, art.5/3a,d; Copyright Law of the RU: ГК РФ ст.1274/1.1-2,7

LCF in 2026 (January)

LCF in 2026 (February)

LCF in 2026 (March)

LCF in 2026 (April)

LCF in 2026 (May)

LCF in 2026 (June)

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[i] The safe surgical dislocation defined by Ganz et al.[4] in 2001 was previously described as the gold standard, and the short- to mid-term results for this procedure are also favourable for many authors. However, Hip arthroscopy (HA) and anterolateral mini open  (AMO)  techniques  are  more  preferred  today because surgical hip dislocation (SHD) is a technically challenging procedure which requires ligamentum teres detachment, trochanteric osteotomy and refixation, and is more prone to intraarticular adhesions.

 

HA [hip arthroscopy] and AMO [anterolateral mini open techniques] can  be  applied  without  the  need of  trochanteric  osteotomy  and  sacrificing  of  the ligamentum  teres,  compared  to  surgical  dislocation, also  provide  faster  rehabilitation  and  recovery[5,6].

 

Capsulotomy, trochanteric osteotomy, existence of hardware, muscle damage  and  sacrificing  the  ligamentum  teres  all may contribute to a micro-instability and eventually increased joint awareness in the SHD [ surgical hip dislocation] group may be the cause of difference between groups.

  

[ii] Hip joint stability is determined not only by osseous anatomy but also by key soft-tissue structures, including the acetabular labrum, joint capsule, ligamentum teres, and surrounding musculature such as the iliopsoas. These structures function synergistically to maintain the labral suction seal, restrict excessive motion, and provide both static and dynamic stabilization of the hip [32].

32 Ayeni OR, Alradwan H, de Sa D, Philippon MJ: The hip labrum reconstruction: indications and outcomes - a systematic review. Knee Surg Sports Traumatol Arthrosc. 2014, 22:737-43. 10.1007/s00167-013-2804-5

  

[iii] Stegodon zhaotongensis 

The head is large, spherical, and oriented proximomedially, set on a very short neck. There is no fovea capitis femoris on the femoral head. Each femur has a robust, extensive, and low greater trochanter, associated with muscles responsible for deep lateral rotation of the hip, and a narrow, deep intertrochanteric fossa, which also accommodates lateral rotators of the hip. 

  

[iv] The current state of the art is then reviewed, emphasising the broad therapeutic armamentarium now available through the arthroscope: postless hip distraction, femoral and acetabular osteoplasty (including correction of coxa profunda), labral and capsular repair or reconstruction, removal of loose bodies and benign bone tumours, management of aggressive synovitis of the acetabular fossa, gluteal tendon repair, psoas tenotomy, and ligamentum teres reconstruction.

  

[v] Hip reconstruction in children with cerebral palsy and femoral head dislocation was performed according to a standard technique [28] and included adductor tenotomy, arthrotomy, open reduction (OR) with removal of fibrotic tissue, the ligamentum teres, and intra-articular fatty tissue, varus derotation osteotomy (VDRO) with femoral shor-tening of 1–3 cm and fixation using a locking compression plate, as well as capsuloplasty.

  

[vi] Surgical Interventions

Interportal capsulotomy was performed to access the joint. Diagnostic arthroscopy was conducted to initially assess the labrum, intra-articular cartilage, and ligamentum teres. Labral tears were categorized using the Seldes classification system.24 Femoral head chondral injuries were noted using the ALAD (acetabular labrum articular disruption) and Outerbridge classification systems. Tears of the ligamentum teres were defined using the Domb and Villar classification systems.1,3

1. Bardakos NV, Villar RN. The ligamentum teres of the adult hip. J Bone Joint Surg Br. 2009;91-B(1):8-15.

3. Botser IB, Martin DE, Stout CE, Domb BG. Tears of the ligamentum teres: prevalence in hip arthroscopy using 2 classification systems. Am J Sports Med. 2011;39(1 Suppl):117-125.

 

Ligamentum teres tears were treated with debridement if necessary.5

5. Chandrasekaran S, Martin TJ, Close MR, Suarez-Ahedo C, Lodhia P, Domb BG. Arthroscopic reconstruction of the ligamentum teres: a case series in four patients with connective tissue disorders and generalized ligamentous laxity. J Hip Preserv Surg. 2016;3(4):358-367.

  

Table 2 Intraoperative Findingsa

	PO (n = 236)	Control (n = 236)	P Value
Domb classification (ligamentum teres tear)			.41
Grade 0	117 (49.6)	130 (55.1)
Grade 1	63 (26.8)	53 (22.6)
Grade 2	49 (20.9)	42 (17.9)
Grade 3	7 (3.0)	11 (4.7)

  

Table 3 Intraoperative Procedures

	PO (n = 236)	Control (n = 236)	P Value
Ligamentum teres treatment			.21
Debridement	48 (20.3)	58 (24.6)
None	188 (79.7)	178 (75.4)

  

[vii] The hip capsule is primarily composed of the iliofemoral, ischiofemoral, pubofemoral and the teres ligament, see Figure 2.2.

 

The teres ligament couples the peripheral inferior acetabular notch to the fovea of the femoral head, providing structural stability [33], [34] .

 

3.2.4 Ligaments

Ligaments were used in the FE model to provide stabilization and maintain structural integrity of the parts included in the hip joint model. Four ligaments were implemented to mimic the hip joint capsule: the ichiofemoral, iliofemoral, pubofemoral and the teres ligament. The iliofemoral ligament was further divided  into a superior and an inferior branch. The ligaments were represented by spring

elements in the model. For the teres ligament, the location of the springs was selected to reproduce the characteristic star-shaped attachment points inside the acetabulum. Similarly, attachment points of the remaining springs in the model were chosen to replicate the anatomical locations of the respective ligament in the hip joint capsule. The number of spring elements and the corresponding spring stiffness were selected according to Zou et al., which could be seen in Table 3.2 [22].

  

[viii] Secondarily, other pericapsular soft tissue restraints that contribute to hip stability include the ligamentum teres (Jo et al. 2018), the iliocapsularis muscle (Babst et al. 2011), the iliopsoas muscle, the gluteus minimus and medius muscles,  …

Babst, D., S. D. Steppacher, R. Ganz, K. A. Siebenrock, and M. Tannast. 2011. “The Iliocapsularis Muscle: An Important Stabilizer in the Dysplastic Hip.” Clinical Orthopaedics and Related Research 469, no.6:1728–1734.

Jo, S., A. W. Hooke, K. N. An, R. T. Trousdale, and R. J. Sierra. 2018. “Contribution of the Ligamentum Teres to Hip Stability in the Presence of an Intact Capsule: A Cadaveric Study.” Arthroscopy 34, no. 5: 1480–1487.

 

[ix] In severe subluxation or complete dislocation, the true acetabulum becomes functionally abandoned and fills with reactive fibrofatty tissue (the pulvinar), an inverted and hypertrophic labrum, and an abnormally thickened ligamentum teres.

 

[x] The ligamentum teres is a ligament attaching the acetabular notch to the fovea of the femoral head (18,19). Its role in the adult hip is relatively small, but it contains the foetal foveal artery, which supplies the developing head of the femur in foetal life (20,21).

 

[xi] Abstract

Achieving stable, concentric reduction in high-grade developmental dysplasia of the hip (DDH) remains challenging, particularly in older children or when the ligamentum teres is absent. Our previously described teretization technique enhances stability through intraosseous ligamentum teres ligamentodesis, but cannot be applied directly in such cases. We describe a synthetic variation using a button-suture-button construct to replicate ligamentum teres function and report early outcomes. We conducted a prospective case series of pediatric patients with International Hip Dysplasia Institute classification (IHDI) grade III–IV DDH and intraoperatively confirmed absence of the ligamentum teres. Open reduction with intraosseous femoral tunneling and synthetic teretization was performed, combined with femoral and pelvic osteotomies. The construct was tensioned to maintain concentric reduction without overconstraint. Clinical outcomes included hip stability, range of motion, McKay score, pain, and complications. Radiographic assessment included IHDI and Severin classification, acetabular index, and avascular necrosis. Nine hips in eight female patients, with a median age of 24 months, underwent synthetic teretization. At a median 23-month follow-up, all hips remained stable, painless, and without functional limitation. Eight hips achieved postoperative IHDI type I and one type II. Among patients aged 4 years or older at final follow-up, all hips were Severin grade I. No redislocation, infection, growth arrest, avascular necrosis, or hardware-related complications occurred. McKay scores were excellent in seven hips and good in two. Two hips in one patient developed acetabular graft resorption after Dega osteotomy and were successfully revised. Synthetic teretization is a feasible stabilizing option for DDH when the native ligamentum teres is absent.

Level of evidence:

Level IV – Therapeutic case series. This study evaluates a novel surgical technique in a series of patients with congenital hip dislocation without a control group.

[xii] In some hips with markedly deficient anterior coverage, accurate segmentation was challenging owing to a blurred outline of the anterior acetabular wall caused by overlap with the ligamentum teres of the femoral head. Segmentation performance for the anterior wall may be improved by incorporating more training data from multiple centers, particularly from cases with deficient anterior coverage.

 

[xiii] 3.2.5 Ligamentum capitis femoris

Ligamentum capitis femoris (vaz hlavice stehenní kosti) je vaz nacházející se uvnitř kyčelního kloubu. Vaz trojúhelníkovitého tvaru začíná v zářezu acetabula, poté prochází středem kloubní jamky a spojuje ji s hlavicí stehenní kosti.  Na rozdíl od silných vnějších vazů stabilizující kloub mechanicky, má tento vaz specifickou roli v oblasti výživy a propriorecepce. Jeho mechanická pevnost je poměrně malá, přesto má význam zejména během vývoje. Uvnitř vazu probíhají cévy, které přivádějí krev k hlavici stehenní kosti a podílejí se na jejím zásobení.

V hloubce kloubu se nachází ještě zona orbicularis, vazivový prstenec obepínající krček kosti stehenní, který funguje jako mechanická pojistka. Přímo uvnitř kloubu pak najdeme ligamentum capitis femoris, který sice nemá velkou mechanickou sílu, ale vede důležité cévy pro výživu hlavice a informuje mozek o aktuální poloze kloubu (Ross & Pawlina, 2018).

 [Eng]

3.2.5 Ligamentum capitis femoris

The ligamentum capitis femoris (ligament of the femoral head) is a ligament located inside the hip joint. The triangular-shaped ligament begins in the acetabulum notch, then passes through the center of the joint socket and connects it to the femoral head. Unlike the strong external ligaments that stabilize the joint mechanically, this ligament has a specific role in the area of nutrition and proprioception. Its mechanical strength is relatively low, yet it is important especially during development. Inside the ligament run blood vessels that bring blood to the femoral head and participate in its supply.

Deep within the joint is the zona orbicularis, a fibrous ring surrounding the femoral neck that acts as a mechanical lock. Directly inside the joint is the ligamentum capitis femoris, which, although it does not have great mechanical strength, carries important blood vessels for the head and informs the brain about the current position of the joint (Ross & Pawlina, 2018).

Ross, M. H., & Pawlina, W. (2018). Histology: A text and atlas: With correlated cell and molecular biology (8. vyd.). Wolters Kluwer.

  

[xiv] The hip joint relies on both static stabilizers (labrum, capsule, ligamentum teres) and dynamic stabilizers (periarticular musculature) to maintain stability, with greater reliance on soft tissue structures for anterior stability due to asymmetric bony coverage. Hip microinstability is a multifactorial phenomenon that can be broadly categorized into six etiologies: bony abnormalities/dysplasia, connective tissue disorders, post-traumatic, microtraumatic, iatrogenic, and idiopathic.

 

The static structures include the labrum, the ligamentum teres and the 4 capsulolabral ligamentous structures - iliofemoral ligament, pubofemoral ligament, ischiofemoral ligament, and zona orbicularis.

 

Operative Management: Ligamentum Teres Reconstruction

Ligamentum teres reconstruction is indicated for patients with pain and multidirectional instability associated with complete or nearly complete ligamentum teres tears in those who remain symptomatic after previous hip arthroscopy with stabilizing procedure and extensive rehabilitation31. Rosinsky et al. described a technique using tibialis anterior or semitendinosis autograft (7 mm diameter). The graft is prepped on the back table with three to four Krackow stitches placed on both ends of the graft using #2 non-absorbable suture (FiberTape, Arthrex, Naples, FL). The graft is then doubled over, and the looped end is attached to either aa BicepsButton (Arthrex) or RetroButton (Arthrex).31 After addressing all relevant concomitant pathology in the central and peripheral compartments using standard anterolateral and mid-anterior portals, the ligamentum teres stump is cleared using radiofrequency ablation. Under dual fluoroscopic guidance and arthroscopic visualization, a 2.3mm guidewire is inserted from just proximal to the vastus ridge to the fovea. The femoral tunnel is then reamed to size based on the size of the prepared graft.

The acetabular fossa is then prepped through either the predrilled tunnel or a separate established portal. With the leg in 15° of abduction and 15° of internal rotation the guidewire is pass through the femoral tunnel into the posterior footprint of the ligamentum teres at the posteroinferior part of the cotyloid fossa, directly above the transverse acetabular ligament. A 3.2mm drill is then used to perforate the inner table. The graft is inserted through the modified anterior portal and button inserted in the acetabular tunnel and flipped via aid of an instrument in the femoral tunnel. The femoral end of the grade is then passed anterograde through the femoral tunnel and fixed with a Polyether-Ether-Ketone (PEEK) interference anchor with the limb in partial traction placed in 60° to 90° of external rotation.31 Capsular plication with 3 or more stitches is then performed to create an inferior shift and imbrication31.

Rosinsky et al. published outcomes from 9 patients (11 hips) at mean 44-month follow-up and found significant improvements were in mHHS (from 44.1 to 71.8), Non-Arthritic Hip Score (from 47.5 to 78.6), and visual analog scale score (from 7.8 to 3.6). Two patients underwent conversion to total hip arthroplasty at a mean 21 months.31 O'Donnell et al. also evaluated 9 patients who underwent ligamentum teres reconstruction and the mHHS improved from 51.15 to 86.9 with all patients expressing satisfaction with the procedure at minimum 12-month follow-up.32 Further research is needed to develop this technique and confirm the results.

 

Arthroscopic capsular plication remains the most performed procedure while capsular reconstruction and ligamentum teres reconstruction serve as more rare options for more complex cases involving unrepairable capsular defects or complete ligamentum teres tears in revision cases.

 

[xv] The ligamentum teres is an intra-articular, extra-synovial ligament that extends from the acetabular fossa to the fovea capitis on the femoral head. It is composed of two bands that originate from the transverse acetabular ligament and from the pubic bone…

 

Similarly, disruption of static stabilizers such as the labrum, capsule, and ligamentum teres, as well as dynamic muscular stabilizers, plays a critical role in both hip stability immediately post-injury and with long-term recovery.14, 15, 16, 17

[xvi] Throughout the skeletal developmental stages, the blood supply of the proximal femur undergoes dynamic and stage-specific changes. During the first three months of life, the ligamentum teres, together with the lateral epiphyseal arteries, constitutes the principal vascular supply to the developing femoral head. By approximately 18 months of age, this supply progressively shifts to a predominant dependence on the lateral epiphyseal vessels. In adulthood, eventually, the vascular architecture of the proximal femur becomes further differentiated into distinct metaphyseal and epiphyseal circulatory systems. Notably, the metaphyseal circulation is particularly robust, providing essential perfusion to the subphyseal area while terminating at the growth plate [2]. 

  

[xvii] Abstract

Background: The ligament of the head of the femur (ligamentum teres) is an intra-articularstructure that contributes to hip joint stability and serves as a potential conduit for vascular supply to the femoral head. Despite its recognised anatomical presence across mammalian species, its vascular capacity and functional significance remain incompletely understood. This study aimed to comparatively evaluate vascular density within the ligament of the femoral head in adult dog, sheep, and goat, and to determine whether a relationship exists between ligament length and vascular characteristics. Materials and Methods: Nine cadavers (three specimens each of adult dog, sheep, and goat) were examined. Ligament length was measured macroscopically,and selected samples were processed for histological analysis using haematoxylin and eosin staining. High-resolution images were analysed using ImageJ software to quantify blood vessel area and vascular density. Statistical analysis was performed using one-way ANOVA followed by Bonferroni post hoc testing, with significance set at p<0.05. Results: Ligament length ranged from 13-22 mm in dogs and 20-22 mm in both sheep and goats. No correlation was identified between ligament length and blood vessel area. However, significant interspecies differences in vascularity were observed. Goats exhibited a significantly greater mean blood vessel area(47,025.58 μm²) and higher vascular density compared to both dogs (10,289.43 μm²) and sheep(5,806.94 μm²) (p<0.05), while no significant difference was found between dogs and sheep.The ratio of vessel area to density was not significantly different among species. Conclusion:These findings demonstrate that vascular characteristics of the ligament of the femoral head vary between species and are not dependent on ligament length. The increased vascular density observed in goats suggests a potentially greater contribution to femoral head perfusion. This study highlights the importance of vascular density as a relevant parameter in understanding ligament function and may have implications for the pathophysiology and treatment of conditions associated with compromised femoral head blood supply.

 

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Author:

Arkhipov S.V. – candidate of medical sciences, surgeon, traumatologist-orthopedist. 

Keywords

ligamentum capitis femoris, ligamentum teres, ligament of head of femur, history .

 

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