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[i] Suspected labral
tears in the hip or shoulder, certain ligamentous evaluation such as UCL tears in the elbow, injuries of the ligamentum teres in the hip, or imaging the postoperative joint are typical indications for
MR arthrography, …
[ii] Conclusions. For the first time, we elucidated the cellular heterogeneity of the abnormal ligamentum teres in patients with DDH at the single-cell and spatial levels using snRNA-Seq and MiP-Seq, which allowed us to construct a single-cell map of the ligamentum teres. We found that receptor-like cells and ligament stem cells are closely associated with the pathogenesis of DDH. Moreover, ligament stem cells appear to be involved in the regulation of ECM metabolism and play an essential role in the pathological changes leading to ligamentum teres thickening and hypertrophy. Eight ligand–receptor pairs related to the ECM–receptor pathway were identified to be closely linked to DDH. Finally, we believe that pericytes in the ligamentum teres could potentially serve as a source of ligament stem cells and fibroblasts.
[iii] All 58 hips showed safe zone improvement and concentric reduction after arthroscopic debridement. Hypertrophic ligamentum teres and thickened pulvinars were detected and resected in all hips. Constrictive capsules preventing reduction were observed in 15 hips, which needed to be further released.
[iv] Of the remaining features, only ligamentum teres tears and paralabral cysts affected more hips at follow-up than baseline (Supplementary information 2%). ... For example, cartilage defects, labral tears, and ligamentum teres tears were not allowed to improve over time.
[v] Osteofyty, labrum, měkké tkáně a zbývající lig. teres jsou nyní odstraněny z acetabula a je vyčištěna fossa acetabuli.
[vi] Korkusuz [6] was the very first surgeon who used ligamentum teres as a stabilizer and repositioned it to the center of the acetabulum with the aid of a button placed on the medial wall of the acetabulum in the late diagnosed patients treated by combined open reduction and pelvic and femoral osteotomies. Korkusuz Z. A new technic in the surgical treatment of congenital hip dislocation. Z Orthop Ihre Grenzgeb. 1986;124:252–5. German. DOI PubMed
[vii] In humans and cats, the femoral capital growth plate can be partially supplied with blood via branches of the artery of the ligament of the femoral head (epiphysis); however, no such blood supply exists in dogs.
[viii] Classically, the hip is considered a constrained joint, with its stability achieved by both osseous congruity between the femoral head and acetabulum as well as nonosseous structures, including the acetabular labrum, ligamentum teres, and hip capsule ligaments.20,29,32 20. Mortensen AJ, Metz AK, Froerer DL, Aoki SK. Hip capsular deficiency: a cause of post-surgical instability in the revision setting following hip arthroscopy for femoroacetabular impingement. Curr Rev Musculoskelet Med. 2021;14(6):351-360. Crossref PubMed Google Scholar 29. Safran MR. Microinstability of the hip: gaining acceptance . J Am Acad Orthop Surg. 2019;27(1):12-22. Crossref PubMed Google Scholar 32. Telleria JM, Lindsey DP, Giori NJ, Safran MR. An anatomic arthroscopic description of the hip capsular ligaments for the hip arthroscopist. Arthroscopy. 2011;27(5):628-636. Crossref PubMed ISI Google Scholar
[ix] Many factors contribute to hip stability. Static stabilizers include the osseous ball-and-socket morphology, capsuloligamentous structures (ie, iliofemoral, ischiofemoral, and pubofemoral ligaments), zona orbicularis, ligamentum teres, and synovial fluid suction seal generated by the femoral head, labrum, and transverse acetabular ligament.7 , 13 , 23 7. Crawford MJ, Dy CJ, Alexander JW, Thompson M, Schroder SJ, Vega CE, et al. The 2007 Frank Stinchfield Award. The biomechanics of the hip labrum and the stability of the hip. Clin Orthop Relat Res. 2007;465:16-22. Crossref PubMed ISI Google Scholar 13. Ito H, Song Y, Lindsey DP, Safran MR, Giori NJ. The proximal hip joint capsule and the zona orbicularis contribute to hip joint stability in distraction. J Orthop Res. 2009;27(8):989-995. Crossref PubMed ISI Google Scholar 23. Van Arkel RJ, Amis AA, Cobb JP, Jeffers JRT. The capsular ligaments provide more hip rotational restraint than the acetabular labrum and the ligamentum teres. Bone Joint J. 2015;97(4):484-491. Crossref PubMed Google Scholar
[x] The femoral head and articular cartilage develop distally. In the meanwhile, autolysis occurs in the intermediate layer, resulting in the formation of ligamentum teres, synovial membrane, and joint space. It is possible to identify the hip joint by the eleventh week. But, during intrauterine growth, an important difference appears: the acetabulum develops more slowly than the femoral head, which leaves the former with inadequate covering. Any break in their communication triggers aberrant growth. An abnormal connection between the acetabulum and femur is caused by prolonged swaddling in an extreme posture, where the hip is stretched, adducted, and immovable, which prevents the hip from developing normally. Interestingly, the acetabulum keeps growing until a child is five years old. Chronic alterations brought on by persistent misalignment include thickening of the ligamentum teres, hypertrophy of the capsule, and development of a neolimbus, or thicker acetabular border.
[xi] An additional study by Maldonado et al 28 also perform a matched-pair controlled study; however, comparison was between patients with and without ligamentum teres tears (LTTs).
[xii] … relaxin in the ligamentum teres of female infants who undergo open reduction for developmental dysplasia …
[xiii] Labral reconstruction is performed using autografts (e.g., ligamentum teres, joint capsule, rectus femoris, fascia lata, iliotibial band, gracilis tendon, quadriceps tendon) or allografts (e.g., anterior and posterior tibialis, semitendinosus, and peroneus brevis tendons, fascia lata) through either an open or arthroscopic approach.
[xiv] Intraoperatively, the lesion depicted in the scans was present from the acetabular fovea and migrating along the ligamentum teres, destroying the femoral head at the insertion of the ligamentum teres towards the middle of the femoral head (Figures 8-10).
[xv] Then the hypertrophied acetabular ligamentum teres and transverse ligament, the contractural soft tissue in the acetabulum were excised via a T-shaped incision to the capsule in cases of subluxated or dislocated hip.
[xvi] According to this technique, a trochanteric osteotomy is performed; the ligamentum teres is transected, retaining the subperiosteal pane with the vascular structures; and after that, the joint is anteriorly dislocated. The femoral head deformity is evaluated and corrected using a subcapital osteotomy, which is fixed afterward.
[xvii] It has been reported that females present a higher prevalence of intra-articular and extra-articular hip injuries, including labral and ligamentum teres pathology, psoas impingement, proximal hamstring and gluteal tendinopathy, ischiofemoral impingement, stress fractures, and nerve entrapment syndromes (15). ... Athletes participating in flexibility sports (FS) demonstrated higher rates of cartilage lesions and tears of the round ligament after FAI surgery compared to athletes in other sports (14). 14. B.R. Saks, P.F. Monahan, D.R. Maldonado, A.E. Jimenez, H.K. Ankem, P.W. Sabetian, et al. Pathologic Findings on Hip Arthroscopy in High-Level Athletes Competing in Flexibility Sports Am J Sports Med, 50 (4) (2022), 10.1177/03635465221077002 Google Scholar 15. K.R. Shibata, S. Matsuda, M.R. Safran Arthroscopic hip surgery in the elite athlete: Comparison of female and male competitive athletes Am J Sports Med, 45 (8) (2017), 10.1177/0363546517697296 Google Scholar
[xviii] They lost or show a strong reduction of the ligamentum teres on their femora.
[xix] … was routinely performed followed by a capsulorrhaphy including removal of the ligamentum teres and transection of the transverse acetabular ligament to create space for the reduction.
[xx] An interesting observation during necropsy was that gross pathological findings were closely associated with joint instability in all investigated horses. In five out of seven horses partial or complete rupture of the Ligamentum capitis ossis femoris could be observed,3-5 suggesting joint instability to be a key pathogenetic factor for OA of the CFJ. Due to the frequent history of trauma, it is more likely that rupture of the ligaments of the head of the femur is rather the trigger than the consequence of OA, although rupture secondary to degeneration of the ligament has to be considered. 3. Paulussen E, Versnaeyen H, Deneut K, Chiers K, van Loon G. Sidewinder syndrome associated with partial rupture of the ligamentum capitis ossis femoris. Vet Rec Case Rep. 2018; 6(1): e000505. https://doi.org/10.1136/vetreccr-2017-000505 Google Scholar 4. Lamb CR, Morris EA. Coxofemoral arthrosis in an aged mare. Equine Vet J. 1987; 19(4): 350–352. https://doi.org/10.1111/j.2042-3306.1987.tb01432.x CAS PubMed Web of Science® Google Scholar 5. Aleman M, Berryhill E, Woolard K, Easton-Jones C, Kozikowski-Nicholas T, Dyson S, et al. Sidewinder gait in horses. J Vet Intern Med. 2020; 34(5): 2122–2131. https://doi.org/10.1111/jvim.15870 PubMed Web of Science® Google Scholar
[xxi] There is no rugosity for the capitate ligament, although this area is damaged in the larger MPC-D 102/12.
[xxii] The surface of the rounded femoral head is rugose. In posterior view, a wide groove for the capital ligament is present on the femoral head.
[xxiii] Conclusion. The ligamentum teres plays a significant role in maintaining the suction seal of the hip, with its effect being most prominent when the hip is in neural alignment or in extension. The findings suggest that ligamentum teres deficiency may be a relevant treatment target in the clinical setting, including reconstruction, to achieve optimal hip joint stability.
[xxiv] Abstract. The ligamentum teres (LT) is known to play a role as a secondary stabilizer of the hip joint. LT tears can be associated with hip instability. In patients with borderline developmental dysplasia of the hip (BDDH), the correlation between LT tears and microinstability is even more pronounced because of the increased mechanical stress placed on the ligament. This relationship may lead certain surgeons to consider new indications for LT reconstructions. However, caution is warranted regarding the potential role of LT reconstruction in these patients, particularly since the primary deficiency in BDDH is bony undercoverage.
[xxv] Conclusions. LT tears and increased combined anteversion at the 3-o’clock level on the acetabular clockface were associated with hip microinstability in patients with BDDH, suggesting that patients with BDDH and LT tears might have a greater prevalence of anterior microinstability.
[xxvi] The hip is a uniquely constrained joint with critical static stability provided by the labrum, capsule and capsular ligaments, and ligamentum teres. … The ligamentum teres is situated between the acetabular notch and the fovea of the femoral head. Initially considered to be inconsequential, recent studies have recognized its role in hip rotational stability. Existing classification systems of ligamentum teres tears account for injury mechanism, arthroscopic findings, and treatment options. Injuries to the labrum, capsule, and ligamentum teres are implicated in symptoms of hip instability. The authors discuss the labrum, capsule, and ligamentum teres, highlighting their anatomy, pathologic conditions, MRI features, and postoperative appearance.
[xxvii] … ligament of the head of the femur, by virtue of its attachments, strongly prevents the hip joint from becoming dislocated posterosuperiorly. However, if the ligament is abnormally long, it will not prevent a posterosuperior dislocation ...
[xxviii] No blood flow was observed in the necrotic femoral head. Following hip dislocation with the release of the ligamentous teres, the epiphysis was trimmed. After the epiphysis was curetted to remove the physeal cartilage, the epiphysis was reduced. The epiphysis was fixed with a 6.5 mm cannulated screw. The capsule was closed.
[xxix] There is hope for patients facing revision arthroscopy as some advanced techniques have the potential to improve patient symptoms and prognosis. Some of these procedures include labral reconstruction/augmentation, capsule reconstruction, ligamentum teres reconstruction, and remplissage of the femoral head-neck junction [49, 50]. 49. Locks R, Bolia I, Utsunomiya H, Briggs K, Philippon MJ. Current concepts in revision hip arthroscopy. HIP International. 2018;28(4):343–351. doi: 10.1177/1120700018771927. PubMed CrossRef Google Scholar 50. Perez-Carro L, Escajadillo NF, Escajadillo LF, Arriaza CR, García MS, Fernandez AA. Simultaneous acetabular labrum reconstruction and remplissage of the femoral head–neck junction. Arthroscopy Techniq. 2019;8(12):e1443–e1443. doi: 10.1016/J.EATS.2019.07.023. PMC free article PubMed CrossRef Google Scholar
[xxx] Physiotherapist-led management involves exercises aimed to optimise movement patterns of the hip and pelvis to prevent impingement from occurring, activity modification and analgesia, whereas surgical management involves arthroscopic resection of the cam/pincer morphology and treatment of concomitant soft tissue pathologies such as labral tears, cartilage lesions or ligamentum teres tears.
[xxxi] The hip joint capsule was incised in a “T" shape and dissected to the sides, exposing the femoral head (Fig. 1b). The round ligament of the femoral head was then severed, and the hip joint was fully dislocated.
[xxxii] Labral and ligamentum teres reconstruction and periacetabular osteotomy.
[xxxiii] Hip arthroscopy surgery can clearly show the acetabular glenoid lip, femur and acetabular cartilage surface, fovea, round ligament, synovium and other structures. Therefore, it can be used to diagnose and treat various hip joint diseases.
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