Skip to main content

2024MiglioriniF_MaffulliN

  

Abstract and table 4 (overview of LCF tear classification) of the article Migliorini F et al. The ligamentum teres and its role in hip arthroscopy for femoroacetabular impingement: a systematic review.  (2024). Translation into Russian is available at the link: 2024MiglioriniF_MaffulliN.


Systematic Review / Open access / Published: 20 December 2024

The ligamentum teres and its role in hip arthroscopy for femoroacetabular impingement: a systematic review

Filippo Migliorini, Federico Cocconi, Tommaso Bardazzi, Virginia Masoni, Virginia Gardino, Gennaro Pipino, Nicola Maffulli 

Journal of Orthopaedics and Traumatology volume 25, Article number: 68 (2024)  

Abstract

Background

The ligamentum teres (LT) has received attention in patients undergoing hip arthroscopy (HA) for femoroacetabular impingement (FAI). Indeed, a better understanding of the function of the LT and its implications for clinical outcomes in the presence of a torn LT is required. This systematic review analyses the patient-reported outcome measures (PROMs) and the complication rate when an intact or torn LT is encountered during HA for FAI.

Methods

Studies that compared patients with an intact to those with a torn LT managed with debridement during hip arthroscopy for FAI were identified from the Web of Science, PubMed, and Embase. The minimum follow-up for inclusion was 24 months. The Risk of Bias in Non-randomised Studies of Interventions (ROBINS-I) tool was used to assess the risk of bias. Patient characteristics and PROMs were assessed at the baseline and last follow-up.

Results

The systematic review identified two studies comprising 611 patients. No statistically significant difference was found in pain, Harris Hip Score, and the activities of daily living and sports subscales of the Hip Outcome Score between patients with an intact LT and those with a torn LT treated with debridement, both of whom underwent HA for FAI.

Conclusions

In patients undergoing arthroscopic management for FAI, an intact or torn ligamentum teres managed with debridement does not influence postoperative PROMs. Given the importance of the LT as a structure of the hip joint and the increasing interest in HA for FAI, further standardised studies will be a valuable source for surgeons encountering this pathology.

Table 4 Overview of LT tear classification 

Author classification group

LT pathological alteration and grade

Domb classification [68]

I: normal

II: partial tears (< 50%)

III: partial tears (> 50%)

IV: complete tears

Gray and Villar [13]

I: complete rupture (major trauma)

II: partial rupture (minor trauma)

III: degenerative—partial or complete (attritional)

Salas and O’Donnell [89]

I: LT synovitis

II: LT synovitis with impingement

III: partial LT tear—low grade

IV: partial LT tear—high grade (50%)

V: partial LT tears with hip osteoarthritis

VIa: complete LT tear—acquired

VIb: complete LT tear—avulsion fracture

VIc: complete LT tear—congenital absence

O’Donnell and Arora [30]

0: normal

I: synovitis

II: partial tear

III: complete tear

References

13. Gray AJ, Villar RN (1997) The ligamentum teres of the hip: an arthroscopic classification of its pathology. Arthroscopy 13(5):575–578. https://doi.org/10.1016/s0749-8063(97)90182-1 Article CAS PubMed Google Scholar 

30. O’Donnell JM, Arora M (2018) A novel and simple classification for ligamentum teres pathology based on joint hypermobility. J Hip Preserv Surg 5(2):113–118. https://doi.org/10.1093/jhps/hnx039 Article PubMed Google Scholar 

68. Botser IB, Martin DE, Stout CE, Domb BG (2011) Tears of the ligamentum teres: prevalence in hip arthroscopy using 2 classification systems. Am J Sports Med 39(Suppl):117s–125s. https://doi.org/10.1177/0363546511413865 Article PubMed Google Scholar  

89. Porthos Salas A, O’Donnell JM (2015) Ligamentum teres injuries—an observational study of a proposed new arthroscopic classification. J Hip Preserv Surg 2(3):258–264. https://doi.org/10.1093/jhps/hnv045 Article Pub

 

Open Access This article is licensed under a Creative Commons Attribution 4.0 http://creativecommons.org/licenses/by/4.0/.

 

External links

MiglioriniF., CocconiF., BardazziT., MasoniV., GardinoV., PipinoG., & MaffulliN. (2024). The ligamentum teres and its role in hip arthroscopy for femoroacetabular impingement: a systematic review. Journal of Orthopaedics and Traumatology: Official Journal of the Italian Society of Orthopaedics and Traumatology25, 68. jorthoptraumatol.springeropen.com.

Authors & Affiliations

Department of Orthopaedic and Trauma Surgery, Academic Hospital of Bolzano (SABES-ASDAA), 39100, Bolzano, Italy

Filippo Migliorini, Federico Cocconi & Tommaso Bardazzi

Department of Life Sciences, Health, and Health Professions, Link Campus University, 00165, Rome, Italy

Filippo Migliorini

Department of Orthopaedics and Traumatology, University of Turin, Via Zuretti, 29, 10126, Turin, Italy

Virginia Masoni

Department of Orthopaedics and Traumatology, University of Bologna, Via G. Cesare Pupilli, 1, 40136, Bologna, Italy

Virginia Gardino

Department of Orthopaedics, Villa Erbosa Hospital, San Raffaele University, Milan, Italy

Gennaro Pipino

Department of Trauma and Orthopaedic Surgery, Faculty of Medicine and Psychology, University La Sapienza, 00185, Rome, Italy

Nicola Maffulli

Faculty of Medicine, School of Pharmacy and Bioengineering, Keele University, Stoke on Trent, ST4 7QB, UK

Nicola Maffulli

Centre for Sports and Exercise Medicine, Barts and the London School of Medicine and Dentistry, Mile End Hospital, Queen Mary University of London, London, E1 4DG, UK

Nicola Maffulli

Keywords

ligamentum capitis femoris, ligamentum teres, ligament of head of femur, role, classification, pathology, review

                                                                    

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


Comments

Popular posts from this blog

Catalog. LCF of Extinct Species

Discussion of the LCF and morphological signs of its existence in extinct species.   Funston, G. F. (2024). Osteology of the two-fingered oviraptorid Oksoko avarsan (Theropoda: Oviraptorosauria). Zoological Journal of the Linnean Society, zlae011. [ academic.oup.com ] Hafed, A. B., Koretsky, I. A., Nance, J. R., Koper, L., & Rahmat, S. J. (2024). New Neogene fossil phocid postcranial material from the Atlantic (USA). Historical Biology, 1-20. [ tandfonline.com ] Kuznetsov, A. N., & Sennikov, A. G. (2000). On the function of a perforated acetabulum in archosaurs and birds. PALEONTOLOGICAL JOURNAL C/C OF PALEONTOLOGICHESKII ZHURNAL, 34(4), 439-448. [ researchgate.net ] Romer, A. S. (1922). The locomotor apparatus of certain primitive and mammal-like reptiles. Bulletin of the AMNH; v. 46, article 10. [ digitallibrary.amnh.org  ,  digitallibrary.amnh.org(PDF) ]    Słowiak, J., Brusatte, S. L., & Szczygielski, T. (2024). Reassessment of the enigmati...

LCF in 2025 (November)

  LCF in 2025 ( November )   (Quotes from articles and books published in  October  2025 mentioning the ligamentum capitis femoris)   Awad, A., Rizk, A., ElAlfy, M., Hamed, M., Abdelghany, A. M., Mosbah, E., ... & Karrouf, G. (2025). Synergistic Effects of Hydroxyapatite Nanoparticles and Platelet Rich Fibrin on Femoral Head Avascular Necrosis Repair in a Rat Model.  Journal of Biomedical Materials Research Part B: Applied Biomaterials ,  113 (11), e35672.    [i]    onlinelibrary.wiley.com   Loughzail, M. R., Aguenaou, O., Fekhaoui, M. R., Mekkaoui, J., Bassir, R. A., Boufettal, M., ... & Lamrani, M. O. (2025). Posterior Fracture–Dislocation of the Femoral Head: A Case Report and Review of the Literature.  Sch J Med Case Rep ,  10 , 2483-2486.     [ii]    saspublishers.com  ,  saspublishers.com   Vertesich, K., Noebauer-Huhmann, I. M., Schreiner, M., Schneider, E., Willegger,...

2025ChenJH_AcklandD

  The article by Chen JH, Al’Khafaji I, Ernstbrunner L, O’Donnell J, Ackland D. Joint contact behavior in the native, ligamentum teres deficient and surgically reconstructed hip: A biomechanics study on the anatomically normal hip (2025). The authors experimentally demonstrated the role of the ligamentum capitis femoris (LCF) in unloading the upper sector of the acetabulum and the femoral head. The text in Russian is available at the following link: 2025ChenJH_AcklandD . Joint contact behavior in the native, ligamentum teres deficient and surgically reconstructed hip: A biomechanics study on the anatomically normal hip By  Chen JH, Al’Khafaji I, Ernstbrunner L, O’Donnell J, Ackland D.     CONTENT [i]   Abstract [ii]   Introduction [iii]   Materials and methods [iv]   Results [v]   Discussion and Conclusion [vi]   References [vii]   Application [i]   Abstract Background The ligamentum teres is known to contribute to hip joint st...

The First Scientific Mention

  European science has known the LCF for about 2500 years. It is the most important functional connection of the hip joint. The first person to describe the LCF was Hippocrates (c. 460-370 BCE). A written mention of the LCF is found in §1 of his treatise "On the Instrument of redactions". In our opinion, a book created in the library of the Asclepeion of the island of Kos. Hippocrates did not dissection of the human body, did not operate on the hip joint, did not have a CT scan and MRI. How he could discover the LCF? In our view, it is possible that Hippocrates treated a patient with an open hip dislocation. Track Music:  Blue Dot Sessions ,  Vittoro  (CC BY-NC 4.0 DEED / fragment) keywords: ligamentum capitis femoris, ligament of head of femur, ligamentum teres, hip dislocation .                                                     ...

1534Biblia

  Biblia, engraving, Jacob wrestling with the angel (1534).  Depicting the circumstances and mechanism of the ligamentum capitis femoris (LCF) injury based on the description in the Book of Genesis: 25 And Ja cob was left alone; and there wrestled a man with him until the breaking of the day. 26 And when he saw that he could not pre vail against him, he struck against the hollow of his thigh ; and the hollow of Jacob's thigh was put out of joint, as he was wrestling with him. … 33 Therefore do the children of Israel not eat the sinew which shrank, which is upon the hollow of the thigh, unto this day; because he struck against the hollow of Jacob's thigh on the sinew that shrank.  ( 1922LeeserI , Genesis (Bereshit) 32:25-26,33) More about the plot in our work:  Ninth month, eleventh day   ( 2024 АрхиповСВ. Девятый месяц, одиннадцатый день ).     Bible illustration – Jacob Wrestling with the Angel (1534); original in the  europeana.eu  collecti...

The Birth of the Earth

  The Birth of the Earth The solar system arose 4.5682-4.567 billion years ago (2013HazenRM). It has been found with an accuracy of 1% that the substance of the "Earth-Moon-meteorite" complex is 4.55-4.51 billion years old (2001DalrympleGB). The outlined segment is the immediate beginning of the arrangement of our Home in the Universe. One of the most important conditions for the emergence of life is liquid water (2002ChybaCF_PhillipsCB). Analysis of lithosphere particles aged 4406 (+14/-17) million years showed that they crystallized under conditions of increased water pressure (2012O'NeilJ_FrancisD). Accordingly, moisture was present no later than 160 million years after the "establishment" of the planet. The explanation for this is the proven presence of water in the accretion disk of the newborn Sun, which the Earth could have received in a volume equivalent to one to three oceans (2005DrakeMJ). According to a conservative estimate, half of the Earth's w...

1898AshhurstJ

    Report Ashhurst J. Tuberculosis of the hip joint (1898). The author discusses the function of the LCF as a supporting element of the body, its role in the development of deformity of the hip joint, reducing pressure and stress in the femoral head. The most notable quotes:  «Of course, the whole weight of the body is not sustained by this ligament, but mostly by the head of the femur in more or less close contact with the cotyloid cavity; but this ligament, I believe, serves to diminish the pressure of the pelvis upon the head of the bone, and to lessen strain. The position of the ligamentum teres is like that of the old-fasioned leather springs which used to be found in stage- coaches, the body of the coach being balanced upon two broad strong bands of leather. The pelvis is to a certain extent similarly balanced upon these ligaments on either side, which are attached to the heads of the thigh- bones, and then pass down to the lower edges of the cotyloid cavities. I b...

1996(d)ArkhipovSV

  The endoprosthesis of the femoral head ( Эндопротез головки бедренной кости ) Patent Application RU96118782A Inventor Сергей Васильевич Архипов Original Assignee Sergey Vasilyevich Arkhipov Application RU96118782/14A events 1996-09-20 Application filed by С.В. Архипов 1998-12-27 Publication of RU96118782A Claims The endoprosthesis of the femoral head, comprising a head connected to the intraosseous rod, characterized in that the head is formed as a hollow spherical segment, is provided with a through hole, and intramedullary rod has a longitudinal bore there through and the stiffeners, and connected to lateral extramedullary plate provided with through-cone holes which set screws with conical head connected to the extramedullary medial plate, and through the die opening intraosseous rod channel omitted flexible member of dynes end connected to the extramedullary lateral plate and the other with a fastening member. Description of the invention Description in Russian is...

Human Children. Retelling of Chapter 8

  Short retelling of chapter 1 of the essay: Arkhipov S.V. Human Children: The Origins of Biblical Legends from a Physician's Perspective. Joensuu: Author's Edition, 2025. [In Russian]  Chapter 8. THE LAND OF NOD Cain’s family settled in the land of "Nod," where they established a "city." We propose this tribal group followed a route later known as the Great Khorasan Road, leading Cain, son of Adam, to the Kermanshah Valley in the central Zagros Mountains. There, we believe he founded the settlement of "Enoch," its remnants linked to the archaeological site of Sheikh-e Abad (34°36'42"N, 47°16'11"E). In this village, the newcomers mastered musical instruments, developed metalworking techniques, and some adopted nomadic herding, living in "tents with flocks." As a farmer, Cain likely preserved knowledge of agriculture. Favorable conditions, division of labor, and acquired skills probably fueled population growth among thes...

1190Rambam

  Fragment from the book Rambam . Guide for the Perplexed (1190). The treatise is philosophical work and an explanation of the Biblical account of creation, was written in Egypt ( sefaria.org ). The author mentions a variant of the pathology ligamentum capitis femoris (LCF, גיד) in humans.  See our commentary at the link:   1190Rambam [Rus]. Quote. [Heb] Part 3.48:6 «:וטעם 'גיד הנשה' כתוב» (original source: sefaria.org ). Translation Quote. [Eng] Part 3, Chapter 48.6 The reason why the sinew that shrank is prohibited is stated in the Law (Gen. xxxii.33).  (trans. M. Friedländer ; original source: 1956MaimonidesM, p. 371) External links Rambam . Guide for the Perplexed. Egypt, 1190. [ sefaria.org ] Maimonides M. The Guide for the Perplexed by Moses Maimonides. Transl. M. Friedländer London: Routledge & Kegan Paul Ltd. [1904] [ sacred-texts.com ] Maimonides M. The Guide for the Perplexed by Moses Maimonides. Transl. M. Friedländer London: G. Routledge & Sons...