Publications about the LCF in August 2024
Caliesch, R., Beckwée, D., Taeymans, J., Schwab, J. M., Renaud, T., Brossard, Q., & Hilfiker, R. (2024). Hip microinstability and its association with femoroacetabular impingement: A scoping review. Archives of Physiotherapy,14, 29-46. [i] journals.aboutscience.eu
Delbrück, H., Gehlen, Y., Hildebrand, F., & Brunner, R. (2024). Redisplacement rate after bony hip reconstructive surgery in nonambulatory patients with cerebral palsy: a systematic review and meta-analysis. EFORT Open Reviews, 9(8), 773-784. [ii] eor.bioscientifica.com
Patwa, R., Bishnoi, P., Palecha, S., Bishnoi, A. K., Diwedi, S., Singh, N., ... & Bishnoi, S. INCIDENCE OF PELVIS AND HIP JOINT DISORDERS IN DOGS-A CLINICAL STUDY IN 74 DOGS. Veterinary Practitioner, 25;1:61-65 [iii] www.vetpract.in
Vidal Leão, R., Fernandes Batista Pereira, R., Omena Martins, R., Sayuri Yamachira, V., Tokechi Amaral, D., Ejnisman, L., ... & Partezani Helito, P. V. (2024). Imaging evaluation of hip capsule disorders: a comprehensive review. Skeletal radiology, 1-20. [iv] link.springer.com
Flores, D. V., Foster, R. C., Sampaio, M. L., & Rakhra, K. S. (2024). Hip Capsulolabral Complex: Anatomy, Disease, MRI Features, and Postoperative Appearance. RadioGraphics, 44(2), e230144. [v] pubs.rsna.org
Yi-Sheng, C. H. A. N. (2024) Hip arthroscopic surgery: surgical indications, clinical application and related research. 日本臨床整形外科学会雑誌, 49;1:171-175. [vi] jstage.jst.go.jp
Heerey, J. J., Kemp, J. L., Rotstein, A., Su, S., Li, J., Roebert, J., ... & Crossley, K. M. (2024). Are hip joint imaging findings associated with symptoms and early hip osteoarthritis features in elite male Australian Football League draftees?. Science and Medicine in Football, 1-8. [vii] tandfonline.com
Sobhanian, P., Karami, S., Saffar, H., Shafizad, M., Baradaran, M., & Shahbaznejad, L. (2024). Investigating Legg-calve-perthes Disease: A Comprehensive Review of Diagnosis, Management and Current Treatment Options. Journal of Pediatrics Review, 12(2), 171-182. [viii] jpr.mazums.ac.ir
Girardi, N. G., Malin, S., Zielenski, C., Lee, J. H., Henry, K., Kraeutler, M. J., & Mei-Dan, O. (2024). Association Between Low-Dose Ketamine After Periacetabular and/or Femoral Osteotomy and Postoperative Opioid Requirements. Orthopaedic Journal of Sports Medicine, 12(8), 23259671241257260. [ix] journals.sagepub.com
Hoffer, A. J., St George, S. A., Lanting, B. A., Degen, R. M., & Ng, K. G. (2024). A Hip Circumferential Labral Reconstruction Provides Similar Distractive Stability to a Labral Repair After Cam Over-Resection in a Biomechanical Model. Arthroscopy: The Journal of Arthroscopic & Related Surgery. [x] arthroscopyjournal.org
Cargill, J.C., Thorpe-Vargas, S. Canine Hip Dysplasia Part II-Causative Factors of Canine Hip Dysplasia. [xi] molosserdogs.com
Shah, S. M. A., & Fatima, S. N. (2024) GENERAL AND COMPARATIVE ANATOMY OF FEMUR. KNOWLEDGE EVOLUTION ACROSS DISCIPLINES - CONTEMPORARY TRENDS AND FORWARD THINKING INNOVATIONS. 696-702. [xii] researchgate.net
Mandal, M. A. B. (2024) Assessing the efficacy of abduction orthoses in treating developmental hip dysplasia. International Journal of Life Sciences Biotechnology and Pharma Research. 13(4) [xiii] ijlbpr.com
Bateman, M., Rassie, M. (2024) Annual scientific meeting of the Australasian Musculoskeletal Imaging Group (AMSIG) 2024, Queensland, Australia. Skeletal Radiol. [xiv] link.springer.com
Gorczyca, J. T. (2024) Orthopaedic Emergencies: A Manual for Medical Students, Physicians, PAs and NPs. Springer Nature. [xv] books.google
Hung, N. N. (2024). Long-Term Result After Operative Hung Zigzag Osteotomy Combined Fibular Allograft for Develop-mental Dysplasia of the Hip, and Coxa Magna in Children. EC Paediatrics, 13, 01-27. [xvi] ecronicon.net
Felix, S. U., Pauline, C. N., Afolabi, M. S., Darma, B. M., Lushaikyaa, A., & Njideka, A. (2024). Downer‐cow Syndrome. Periparturient Diseases of Cattle, 121-133. [xvii] onlinelibrary.wiley.com
Tomé, I., Costa, L., Alves-Pimenta, S., Sargo, R., Pereira, J., Colaço, B., & Ginja, M. (2024). Morphometric Assessment of the Hip Joint in a Functional Dysplastic Rabbit Model. Veterinary Sciences, 11(8), 387. [xviii] mdpi.com
Akkaya, Z., Giesler, P. J., Roach, K. E., Joseph, G. B., McCulloch, C. E., Bharadwaj, U. U., ... & Link, T. M. (2024). Ligamentum teres lesions are associated with compositional and structural hip cartilage degenerative change: region-specific cartilage degeneration. European Radiology, 1-12. [xix] link.springer.com
Sarkar, R., Sarkar, S., & Sarkar, S. (2024). Management and Outcome of Pipkin Type I and Type II Femoral Head Fractures by Ganz Surgical Dislocation of the Hip. Cureus, 16(8). [xx] assets.cureus.com
Jekinakatti, K. M., Manjunatha, D. R., Vilas, D., Nagaraju, N., Mulage, K. P., & Ramya, N. M. (2024). Treatment of coxofemoral dislocation and short oblique mid shaft tibial fracture by modified toggle pin technique with locking compression plate method in a dog. Indian J Anim Health, doi: https://doi. org/10.36062/ijah. [xxi] ijah.in 2ijah.in
Putko, R. M., & Safran, M. R. (2024). Managing the Hip in Supraphysiologic Motion Athletes. Operative Techniques in Sports Medicine, 151107. [xxii] sciencedirect.com
Noorzad, A. S., & Philippon, M. J. (2024). Arthroscopic Labral Management: Ignore, Debride, Repair or Reconstruct. Operative Techniques in Sports Medicine, 151106. [xxiii] sciencedirect.com
Zhang, J., Li, Z., Wu, Y., Yu, K., Gan, L., Liu, Y., ... & Li, C. (2024). Borderline Developmental Dysplasia of the Hip With Osseous Impingement as Distinct From Femoroacetabular Impingement and Developmental Dysplasia of the Hip. Orthopaedic Journal of Sports Medicine, 12(8), 23259671241249948. [xxiv] journals.sagepub.com
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[i] At the International Hip-related Pain Research Network meeting in Zürich, Switzerland, in 2018 (4), three categories for hip-related pain were proposed: (1) FAI syndrome, (2) acetabular dysplasia and/or hip instability, and (3) other conditions causing hip-related pain (including labrum, cartilage, and ligamentum teres lesions without a specific bony morphology). However, there is no consensus on the diagnostic criteria for hip microinstability (4,5). 3. Packer JD, Cowan JB, Rebolledo BJ, et al. The Cliff Sign: a new radiographic sign of hip instability. Orthop J Sports Med. 2018;6(11):2325967118807176. CrossRef PubMed
[ii] Redisplacement rate after bony hip reconstructive surgery in nonambulatory patients with cerebral palsy … In the study by Koch et al. (48) with 81 patients and 115 hips, the following were reported: bilateral release of the adductors, psoas and hamstrings distal lengthening; neurectomy of the anterior branch of the obturator nerve on the side of the dislocation; exposing the hip by using the Watson–Jones lateral approach; detaching of gluteal muscles and capsular attachment of the rectus femoris; opening of the hip capsule; removing of the ligamentum teres, the transverse ligament and connective tissue within the joint; defining the shortening of the femur by the distance between the upper edge of the acetabulum and the most proximally positioned part of the femoral head; performing the VDRO with femoral shortening; reducing the hip; Dega osteotomy and immobilization in a spica cast for 4–6 weeks. 48. Koch A, Jozwiak M, Idzior M, Molinska-Glura M, & Szulc A. Avascular necrosis as a complication of the treatment of dislocation of the hip in children with cerebral palsy. Bone and Joint Journal, 2015. 97–B:270–276. https://doi.org/10.1302/0301-620X.97B2.34280
[iii] The joint is stabilized by normal conformation, surrounding musculature, suction like effect of the synovial fluid, and ligament of the femoral head (Hayashi et al., 2019). Hayashi K, Schulz KS and Fossum TW (2019) Small Animal Surgery Textbook-E-Book, 5th ed., Elsevier Health Sciences, Philadelphia. pp. 1036-1133.
[iv] The
ligamentum teres is a tubular ligament composed of two bands (ischial and pubic
bands) that inserts into the inferior acetabular notch emerging from the
transverse acetabular ligament and attaches proximally to the fovea of the
femoral head [15] (Fig. 7). It helps in hip stability and also provides a
conduit for the … 15. Flores DV,
et al. Hip capsulolabral complex: anatomy, disease, MRI features, and
postoperative appearance. Radiographics. 2024;44(2):e230144. Article
PubMed Google Scholar
[v] The labrum, capsule, and ligamentum teres are important static stabilizers of the hip, and understanding the anatomy, patterns of injury, MRI features, treatment, and postoperative appearance allows precise diagnosis and timely management.
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.
[vi] MRI best with gadolinium picks up labral tears, ligamentum teres tears, subtle DJD, synovial diseases and loose bodies.
[vii] The Scoring Hip Osteoarthritis with MRI (SHOMRI) scoring system was used to assesses eight different intra-articular features, including: the severity of articular cartilage (scored 0–2), bone marrow edema pattern (BMEP) (scored 0–3), subchondral cysts (scored 0–2), labrum (scored 0–5), and ligamentum teres (scored 0–3), and the presence or absence of paralabral cysts, intra-articular bodies, and effusion-synovitis (Lee et al. 2015).
Paralabral cysts were present in 10% of hips. Increased signal intensity
or fraying was evident in the ligamentum teres in 10% of hips. Subchondral
cysts were found in 4% of hips.
[viii] In addition, the foveal artery, which passes
through the ligamentum teres, supplies blood to the FH (femoral head), which is
especially significant in children.
[ix] The
following aided in establishing a diagnosis of symptomatic hip instability:
history of hip pain; positive findings on provocative hip tests indicating
intra-articular hip pain; radiographic evidence of hip dysplasia (lateral
center-edge angle of ≤25°, sourcil angle of ≥10°); excessive acetabular version
and/or femoral antetorsion; interruption of the Shenton line on the
weightbearing anteroposterior pelvic radiograph; and magnetic resonance imaging
(MRI) findings of labral hypertrophy and tears, articular cartilage thickening
and/or inside-out chondral flaps, or a ligamentum teres tear.8,15,17,18
[x] The ligamentum teres was left intact connecting the acetabulum and femoral head.
 |
| Figure 3 Six soft tissue conditions were tested: (A) intact capsule (Ca) and labrum with femoral fixture (FF) superior and acetabular fixture (AF) inferior, (B) capsulectomy with pre-existing labral repair (LR), femoral head (FH) within femoral fixture (FF) on right, and acetabulum (Ac) within acetabular fixture (AF) on the left, (C) capsulectomy, 5-mm cam over-resection (COR) at femoral head (FH)-neck junction, and labral repair (LR), acetabulum (Ac) within acetabular fixture (AF) inferior, (D) capsulectomy, 5-mm cam over-resection (COR) at femoral head (FH)-neck junction and labral tear (LT), acetabulum (Ac) within acetabular fixture (AF) inferior, (E) capsulectomy, 5-mm cam over-resection (COR) at femoral head (FH)-neck junction within femoral fixture (FF) superior and labrectomy at rim of acetabulum (Ac) within the acetabular fixture (AF), and (F) capsulectomy, 5-mm cam over-resection (COR) at the femoral head-neck (FN) junction, with 6- or 10-mm ITB labral reconstruction (Lrec), femoral fixture (FF) visualized superior and acetabular fixture (AF) visualized inferior. (CC BY-NC-ND 4.0, no change) |
[xi] Other changes that can precede either clinical signs, like pain and gait abnormalities, or radiographic evidence of hip dysplasia include thickening of the joint capsule and swelling of the round ligament. Subtle and early changes in articular cartilage structure also precede clinical signs.
[xii] 3. Bone Markings in Femur: Head: The smooth process articulating with the acetabulum of the os coxae, forming the hip joint. It has a depression (fovea) (h) for the round ligament of the femur. The neck (a) joins the head to the body of femur.
4. Anatomy of Femur of Different Classes: 1. Anatomy of Femur of Equine: Head: The femur features a wedge-shaped, notched femoral head that opens to the medial side. Fovea: The apex of the fovea on the femoral head serves as the point of attachment for the ligament of the head of the femur.
3. Anatomy of Femur of Canine: Head: The head of the femur is covered in cartilage except for a small central portion called the fovea capitis, where the femoral head ligament is attached. Fovea capitis: The ligament connects to the acetabulum via the acetabular fossa.
[xiii] The
acetabulum, formed by the ischium, ilium, and pubis, contains essential
components, including the round ligament and the acetabular labrum, which
contribute to articular stability.
[xiv] Ligamentum
teres can be a source of hip pain and is an important stabiliser.
[xv] Of note, the
artery of the ligamentum teres provides perfusion to the developing femoral
head in children, but this artery provides minimal if any perfusion to the
femoral head in adults.
[xvi] The
ligamentum teres and the transverse acetabular ligament are excised, removal of
any fibrofatty tissue from the acetabulum, and plication of the capsule.
[xvii] Hemorrhages
around the hip joint, sometimes accompanied by rupture of the ligamentum teres,
are also commonly seen.
[xviii] The present study investigates the morphometric changes in the hip joint in a surgically induced rabbit model of hip dysplasia through the sectioning of the ligamentum capitis femoris and pelvic limb immobilization.
The medical bandage applied in the
ISHI group promoted the knee joint in an extended position and tightened the
hamstring, resulting in the hip capsule being stretched, which was amplified by
the absence of the ligamentum capitis femoris and led to subluxation or
dislocation [22]. As a result, the ligamentum capitis femoris appears to be
crucial as a head of the femur–acetabulum stabilizer, especially when the limb
has been immobilized in extension [22,23].
Conclusions This study demonstrated the critical role of the ligamentum capitis femoris
sectioning in joint development, where its absence led to the subluxation or
dislocation of the head of the femur and the consequent joint overload. The
resulting contact between the cranial portion of the head of the femur and the
acetabulum promotes femoral anteversion and the shortening of the cranial edge
of the acetabulum. These findings highlight the value of this rabbit model for
studying HD and its potential translational relevance to other species,
including humans and dogs.
[xix] Objectives
To investigate the association between magnetic resonance imaging (MRI)-based ligamentum teres lesions (LTL) and structural hip degeneration.
The ligamentum teres (LT) supports the capsular ligaments of the hip, preventing femoral head subluxation at the extremes of the range of motion. Its tears are associated with hip microinstability and pain, especially in a traumatic setting…
Conclusion
MRI abnormalities of LT are associated with worse SHOMRI-sc/BML scores,
indicative of hip osteoarthritis and higher T1ρ and T2 that differ by region. Pulvinar effusion-synovitis and changes in femoral head morphology are
associated with LTL.
Clinical relevance statement
Abnormal ligamentum teres
findings identified via MRI are associated with structural degenerative changes
of the hip joint and alterations in acetabular and femoral cartilage
compositions show spatial differences in relation to LTL.
Key Points
The clinical significance of
common ligamentum teres lesions (LTL) on MRI is not well understood.
LTL identified by an
MRI-based scoring system is associated with worse biomarkers, indicating more
advanced degenerative hip changes.
Effusion-synovitis signal at pulvinar, shallow fovea capitis, and foveal osteophytes are associated with LTL on imaging.
[xx] If the ligamentum teres was not torn as found in two of our cases, it was cut with long sharp curved scissors with great care to protect the medial retinaculum, attached to inferior fragment. The limb was put in a sterile side bag (Figure 8)
[xxi] Orthopaedic and radiographic examinations revealed cranio-dorsal hip dislocation and complete, short oblique, mid diaphyseal tibial fracture of right limb. Under general anaesthesia, coxofemoral dislocation was corrected using toggle pin (1.5 mm K-wire) and nylon thread (1 mm diameter) via caudo-dorsal approach.
Placement of toggle pins was quicker due to removal of debris, blood
clots and remnants of ligamentum teres in the acetabulum and femoral head. [see
fig.4. Immediate postoperative radiographs with appropriate placement of toggle
pin and appropriate reduction of tibial fractured fragments with 10 hole 3.5 mm
locking compression plate; fig. 6. 30th day postoperative radiographs showing
no reluxation, normal coxofemoral joint with no arthritic changes and adequate
reduction of fractured fragments of tibia]
[xxii] However, with microinstability, or excessive femoral head motion within the acetabulum, joint damage may include stretching of the capsuloligamentous structures, labral tears, articular chondral injury as well as ligamentum teres tears …
[xxiii] Within this cohort, investigators found that the best predictor of failed nonsurgical management was presence of a concomitant ligamentum teres tear in the setting of acetabular labral tear.
[xxiv] Our findings indicate that patients with BDDH have significantly greater labral size, capsule thickness, and percentage of ligamentum teres tear compared to patients with FAI. The reason may be related to the compensatory reaction of soft tissue with acetabulum undercoverage.
Borderline developmental dysplasia of
the hip (BDDH)
Femoroacetabular impingement (FAI)
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