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

1902RilkeRM

    Works of art that mention ligamentum capitis femoris (LCF) are extremely rare. One such work is the poem «Der Schauende» ( He Who Visions, The Seer, The Man Watching, The Beholder)  b y Rainer Rilke. Below is the original text in German.   Der Schauende 1. Ich sehe den Bäumen die Stürme an, die aus laugewordenen Tagen an meine ängstlichen Fenster schlagen, und höre die Fernen Dinge sagen, die ich nicht ohne Freund ertragen, nicht ohne Schwester lieben kann. 2. Da geht der Sturm, ein Umgestalter, geht durch den Wald und durch die Zeit, und alles ist wie ohne Alter: die Landschaft, wie ein Vers im Psalter, ist Ernst und Wucht und Ewigkeit. 3. Wie ist das klein, womit wir ringen, was mit uns ringt, wie ist das groß; ließen wir, ähnlicher den Dingen, uns so vom großen Sturm bezwingen, - wir würden weit und namenlos. 4. Was wir besiegen, ist das Kleine, und der Erfolg selbst macht uns klein. Das Ewige und Ungemeine will nicht von uns gebogen sein. Das ist der Enge...

1823CooperA

  According to the author, the ligamentum capitis femoris (LCF) is intended to prevent dislocations in all directions. A. Cooper discusses traumatic obturator dislocation of the hip joint and LCF injury in more detail. Cooper A. Abhandlung über Luxationen und Fracturen der Gelenke des Unterkiefers, der obern Extremitäten und der Knochen des Rumpfes. Aus dem Englischen. Weimar : Landes-Industrie-Comptoir, 1823. [fragments] Quote p. 1 4 8 Das ligamentum teres hat die Bestimmung, Luras tionen nach allen Richtungen hin zu verhindern, besonders aber nach abwärts, denn wenn die Schenkel weit ausein andergespreizt werden, wie z. B. bei'm Fechten, so würde der Kopf des linken Oberschenkelknochens in Gefahr feyn, aus seiner Gelenkhöhle zu schlüpfen, was aber durch dieses Ligament verhindert wird. The ligamentum teres is designed to prevent dislocations in all directions, especially downwards, because when the thighs are widely ab...

LCF in 2026 (May)

LCF in 2026 (May )  (Quotes from articles and books published in May   2026 mentioning the ligamentum capitis femoris)   Kim, P. S., Kang, C., Lee, J. K., & Hwang, J. M. (2026). Hip arthroscopy to treat symptomatic paralabral cysts: a retrospective analysis of clinical outcomes. Arthroscopy and Orthopedic Sports Medicine , 13 (1), 27-34.     [i]     e-aosm.org   Ko, H. Y. (2026). Vascular Anatomy of the Extremities and Lungs. In Practical Functional Anatomy for Spinal Cord Injury Rehabilitation: A Guide for Physiatrists and Rehabilitation Specialists (pp. 191-223). Singapore: Springer Nature Singapore.      [ii] link.springer.com   Aiba, H., Yamaguchi, M., Kimura, H., & Murakami, H. (2026). Advances in limb-salvage surgery and reconstruction for pediatric bone and soft tissue tumors. Frontiers in Pediatrics , 14 , 1817788.      [iii]     pmc.ncbi.nlm.nih.gov   Bajwa, A., Villar, R., ...

A Novel Technique for Proximal Fixation

  Arkhipov SV. A Novel Technique for Proximal Fixation of Ligamentum Capitis Femoris Reconstruction: The Gifts of the Magi for Orthopedic Surgeons. About Round Ligament of Femur. January 14, 2026. DOI: 10.13140/RG.2.2.25269.33763 https://roundligament.blogspot.com/2026/01/the-gifts-of-magi-for-orthopedic.html Abstract Purpose: To describe an experimental technique for proximal fixation in ligamentum capitis femoris (ligamentum teres femoris; LCF) reconstruction using pubic and ischial portions anchored in corresponding pelvic bone tunnels, tested on synthetic hip joint models, and to propose it’s for arthroscopic application with visualization via an inferior portal and femoral tunnel. Methods: Synthetic polyurethane bone analogs (Synbone) of the pelvis and proximal femur were used to fabricate hip joint models. Acetabular cartilage analogs were created from self-curing plastic compound. Femoral tunnels were drilled along the neck axis from the subtrochanteric region below the tub...

1740KulmusJA

Fragments from the book Kulmus JA. Tables anatomiques (1734). The author briefly writes about the anatomy, properties and attachment of the ligamentum capitis femoris (LCF). There are known translations of the treatise into Latin ( 1732KulmusJA ) and French ( 1734KulmusJA ). Quote p. 51 [Deu] Translation [Eng] с . In the upper part of the head there is a recess in which the round ligament is attached. Quote p. 54 [Deu] Translation [Eng] 2.) The round ligament is short but very strong; it arises at the bottom of the acetabulum and joins the fossa at the top of the femoral condyle. External links Kulmus JA. Anatomische Tabellen: Nebst dazu gehörigen Anmerckungen und Kupffern, Daraus des gantzen Menschlichen Cörpers Beschaffenheit und Nutzen deutlich zu ersehen; Welche Den Anfängern der Anatomie zu bequemer Anleitung verfasset hat… Nuremberg, Frankfort, Leipzig: J.A. von Creutz, MDCCXXXX [1740].  [ archive.org ] Authors & Affiliations Johann Adam Kulmus (...

Human Children. Retelling of Chapter 13

  Short retelling of chapter 13 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 13. PROPHETIC DREAMS After his wanderings and battles, Abraham settles in “Mamre’s oaks in Hebron.” Following these events, he experiences a divine “word in a vision” and a dream promising him lands “from Egypt’s river to the great river, Euphrates.” His family relocates to a desert along the Shur road, near the well “Beer-Lahai-Roi,” between Kadesh and Bered. In another divine appearance, Abraham is commanded to circumcise all males’ foreskins, rename Sarai as Sarah, and is told he’ll father a child at 100, despite Sarah’s barrenness at 89. That day, Abraham circumcises his son Ishmael, household males, and, at 99, himself. In Mamre’s oaks, during “daytime heat,” a mirage foretells fatherhood. The dream shifts, showing Sodom and Gomorrah’s destruction and Lot’s miraculous rescue. ...

LCF in 2025 (July)

    LCF in 2025 ( July )   (Quotes from articles and books published in July 2025 mentioning the ligamentum capitis femoris.) Tekcan, D., Bilgin, G., & Güven, Ş. Evaluation of Risk Factors for Developmental Dysplasia of the Hip. HAYDARPAŞA NUMUNE MEDICAL JOURNAL , 65 (2), 99-103.   [i]   jag.journalagent.com   Domb, B. G., & Sabetian, P. W. (2025). Greater Trochanteric Pain Syndrome: Gluteal Tendinopathy, Partial Tear, Complete Tear, Iliotibial Band Syndrome, and Bursitis. In Orthopaedic Sports Medicine (pp. 1-17). Springer, Cham.   [ii]   link.springer.com   Kuhns, B. D., Becker, N., Patel, D., Shah, P. P., & Domb, B. G. (2025). Significant Heterogeneity in Existing Literature Limits Both Indication and Outcome Comparability Between Studies Involving Periacetabular Osteotomy For Acetabular Dysplasia With or Without Arthroscopy Despite Improvement for Both: A Systematic Review. Arthroscopy .   [iii]   ...

1851HyrtlJ

  The author expresses a classic view on the functions of the ligamentum capitis femoris (LCF): a conductor of blood vessels and a limiter of adduction of the femur. J. Hyrtl believed that it was impossible to completely dislocate the hip without tearing the LCF. Hyrtl J. Lehrbuch der Anatomie des Menschen, mit Rücksicht auf physiologische Begründung und praktische Anwendung. Wien: W. Braumüller, 1851. [fragment] Quote p. 265 In der Höhle des Gelenks liegt das runde Band des Schenkelkopfes (Lig. teres), welches an der Incisura acetabuli entspringt, und bei richtiger Neigung des Beckens, senkrecht zur Grube des Schenkelkopfes aufsteigt. Es beschränkt dieses Band die Zuziehung des Schenkels, und schreibt zugleich den durch die Incisura acetabuli eindringenden Blutgefässen den Weg vor, den sie zum Oberschenkelkopfe zu nehmen haben. Da das Band, wenn es in die Höhle des Gelenkes vorragen würde, durch Reibung viel zu leiden hätte, so...

1730CheseldenW

  Fragments from the book Cheselden W. The Anatomy of the Human Body (1730). The author draws attention to the role of ligamentum capitis femoris (LCF) in counteracting hip dislocation and maintaining the femoral head in the joint. The work notes that the LCF is “powerful” and “short” - “about two inches” i.e. approximately 5 cm! This error will be corrected  in a subsequent treatise  ( 1733CheseldenW ) .   Quote pp. 43 - 44 Chap. VII. Of the Ligaments At the upper part of the articulation of the Os Femoris and Os Innominatum, is a strong ligament of great consequence; it contributing very much to preserve that joint from being luxated by the weight of the body. And from the lower edge of the Acetabulum of the Os Innominatum, runs a ligament to the middle of the head of the Os Femoris, about two inches long (which the Motion in this joint requires) called Teres, or Rotundum, whose use is to prevent the Os Femoris from being luxated upwards, but down wards it will le...

Human Children. Retelling of Chapter 14

  Short retelling of chapter 14 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 14. ESAU AND JACOB At 40, Isaac marries Rebekah, his cousin’s daughter. Their marriage is long childless until Rebekah conceives twins, detected prenatally, possibly by her large belly or palpation. Genesis states that at 60, Isaac fathers the twins, born naturally after 20 years of marriage. The first, Esau, emerges “red, all hairy like a cloak,” followed by Jacob, unremarkable but grasping Esau’s heel. Over time, their differences deepen: Esau, a skilled hunter, roams fields; Jacob, gentle, stays in tents. Famine forces the family from “Beer-Lahai-Roi” in the Negev to “Gerar’s Philistine king,” then to “Gerar’s valley,” and finally to Beersheba. At 40, Jacob, urged by Rebekah, deceives blind Isaac to steal Esau’s inheritance, sparking enmity. Rebekah advises Jacob to flee to rela...