LCF
in 2025 (January)
Alany, A. M. S., Rasul, D., Berzenji, A. I. H., & Berzenji, A. (2025). Early Outcomes of Arthroscopic Versus Open Reduction for Developmental Dysplasia of the Hip in Children: A Randomized Controlled Trial. Cureus, 17(1). [i] assets.cureus.com
Lovelace, D. M., Kufner, A. M., Fitch, A. J., Curry Rogers, K., Schmitz, M., Schwartz, D. M., ... & Teran, R. (2025). Rethinking dinosaur origins: oldest known equatorial dinosaur-bearing assemblage (mid-late Carnian Popo Agie FM, Wyoming, USA). Zoological Journal of the Linnean Society, 203(1), zlae153. [ii] academic.oup.com
Rashwan, A. S., El-Desouky, M., Elbarbary, H., Madbouly, M. A. E., & Khedr, A. (2025). Arthroscopic-assisted reduction for Developmental Hip Dysplasia (DDH) through the sub-adductor and anterolateral portals; A 24-month follow-up prospective descriptive study. BMC Musculoskeletal Disorders, 26(1), 27. [iii] bmcmusculoskeletdisord.biomedcentral.com
Kellermann, M., Cuesta, E., & Rauhut, O. W. (2025). Re-evaluation of the Bahariya Formation carcharodontosaurid (Dinosauria: Theropoda) and its implications for allosauroid phylogeny. PloS one, 20(1), e0311096. [iv] journals.plos.org
Martonos, C. O., Gudea, A. I., Rawlins, G., Stan, F. G., Lațiu, C., & Dezdrobitu, C. C. (2025). Morphological, Morphometrical and Radiological Features of the Pelvic Limb Skeleton in African Green Monkeys (Chlorocebus sabaeus) from Saint Kitts and Nevis Islands. Animals, 15(2), 209. [v] mdpi.com
Wellauer, H., Heimann, A. F., Stetzelberger, V. M., Schwab, J. M., & Tannast, M. (2025). Joint Preservation Surgeries Utilizing Surgical Dislocation of the Hip. In Osteonecrosis (pp. 443-454). Singapore: Springer Nature Singapore. [vi] link.springer.com
Domb, B. G., Kufta, A. Y., Kingham, Y. E., Sabetian, P. W., Harris, W. T., & Perez-Padilla, P. A. (2025). Sex-Based Differences in the Arthroscopic Treatment of Femoroacetabular Impingement Syndrome: 10-Year Outcomes With a Nested Propensity-Matched Comparison. The American Journal of Sports Medicine, 03635465241302806. [vii] journals.sagepub.com
Marty, E. W., Girardi, N. G., Kraeutler, M. J., Lee, J. H., Keeter, C., Merkle, A. N., & Mei-Dan, O. (2025). Arthroscopic Bone Grafting of Deep Acetabular Cysts in Hip Preservation Surgery: A Matched Case-Control Study. Orthopaedic Journal of Sports Medicine, 13(1), 23259671241310453. [viii] journals.sagepub.com
Wang, L., Luo, Y., Qiu, X., Cheng, L., Ma, K., Guan, J., ... & Zhao, D. (2025). Analysis of Animal Models of Traumatic Osteonecrosis of the Femoral Head Based on Blood Supply: A Literature Review. Orthopaedic Surgery. [ix] onlinelibrary.wiley.com
Yang, J., Zhang, T., Zhu, X., He, Z., Jiang, X., Yu, S., & Gu, H. (2025). MiRNA-223-5p inhibits hypoxia-induced apoptosis of BMSCs and promotes repair in Legg-Calvé-Perthes disease by targeting CHAC2 and activating the Wnt/β-catenin signaling pathway. PloS one, 20(1), e0315230. [x] journals.plos.org
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[i] The arthroscopic reduction procedure is performed using a 4.5 mm arthroscope with both 30° and 70° optics to enhance the identification of anatomical structures. The first stage involves capsular release anteriorly, anterosuperiorly, and anteroinferiorly to relax soft tissues. Obstacles to reduction, such as the pulvinar, hypertrophic ligamentum teres, transverse acetabular ligament, and capsular contractions resulting from hourglass deformity, are removed.
FIGURE 1: Arthroscopic-assisted reduction for developmental dysplasia of the hip. (A) Preoperative marking and positioning: the patient is in the supine position with traction applied to the affected leg to facilitate hip joint access; (B) intraoperative arthroscopic view: the ligamentum teres. This arthroscopic image captures the ligamentum teres (labeled "Lig. teres") prior to its transection. The femoral head ("Head") and transverse acetabular ligament ("TAL") are also visible; (C) arthroscopic portal placement. The image depicts the surgical setup during arthroscopy. Multiple portals are established to accommodate the arthroscope and instruments. (This is an open access article distributed under the terms of the Creative Commons Attribution License CC-BY 4.0.)
The reduced redislocation rate observed with arthroscopic techniques is likely attributable to the meticulous removal of intra-articular obstacles, such as the hypertrophic ligamentum teres and pulvinar, and the ability to observe direct visualization of reduction.
[ii] The proximal end of a left femur (UWGM 7549) possesses several dinosaurian and saurischian features but is too incomplete for a referral beyond Saurischia on its own (). The proximal surface of the femur appears to be slightly abraded revealing trabecular bone and hindering the identification of a transverse groove, such as that seen in UWGM 7407 () and widespread among early-diverging sauropodomorphs and dinosauromorphs more generally. There are also several cracks present in this element, one of which passes through the position that would be occupied by a ligament sulcus between the anteromedial and posteromedial tubera. The posteromedial tuber is small and rounded, and the larger anteromedial tuber is also rounded. The anterolateral tuber forms a broad, rounded profile along the anterolateral surface of the femur in proximal view. The head of the femur is offset from the shaft resulting in a concave emargination just ventral to the head, common among all dinosaurs.
[iii] Using combined anterolateral and sub-adductor portals offers better visualization of the acetabular cavity and instrumentation during addressing pulvinar tissue, ligamentum teres, and transverse acetabular ligament (TAL) [15].
15. Eberhardt O, Fernandez FF, Wirth T. Arthroscopic reduction of the dislocated hip in infants. J Bone Joint Surg Br. 2012;94–B(6):842–7. https://doi.org/10.1302/0301-620x.94b6.28161.
Fig. 3. A: Visualization of ligamentum teres, B: Cutting ligamentum teres from its femoral attachment (This article is licensed under a Creative Commons Attribution 4.0 International License.)
The hip was internally rotated to move the femoral head posteriorly, and a pick-up was used to pull the capsule. We then created the anterolateral portal by making an incision directly into the capsule at the inferomedial aspect of the head and introduced a 2.7-mm, 30-degree scope through it to visualize the femoral head. We used an arthroscopic pump and the pressure was inflated to 30 mmHg. The hypertrophied ligamentum teres was seen by rotating the hip internally and externally and then followed till visualizing the transverse acetabular ligament (TAL) and the acetabulum. A needle was introduced through the incision used for the adductor tenotomy in a cranial and anterior direction to be visualized inside the hip joint. The capsule was pierced by a straight hemostat placed just anterior to the needle to be visualized into the joint, thus developing the sub-adductor portal, which was used for instrumentation.
The ligamnetum teres was followed and visualized as close as possible to its femoral attachment, which may be aided by doing some external and internal rotation of the hip. Another useful maneuver could be performed by the assistant by stabilizing the hip with one hand and doing hip abduction with distraction of the femur to create more working space. The ligamentum teres was then cut using a basket introduced through the sub-adductor portal (Fig. 3).
The hip was internally rotated to move the femoral head posteriorly, and a pick-up was used to pull the capsule. We then created the anterolateral portal by making an incision directly into the capsule at the inferomedial aspect of the head and introduced a 2.7-mm, 30-degree scope through it to visualize the femoral head. We used an arthroscopic pump and the pressure was inflated to 30 mmHg. The hypertrophied ligamentum teres was seen by rotating the hip internally and externally and then followed till visualizing the transverse acetabular ligament (TAL) and the acetabulum.
The ligamentum teres was followed and visualized as close as possible to its femoral attachment, which may be aided by doing some external and internal rotation of the hip. Another useful maneuver could be performed by the assistant by stabilizing the hip with one hand and doing hip abduction with distraction of the femur to create more working space. The ligamentum teres was then cut using a basket introduced through the sub-adductor portal (Fig. 3).
While still using the same portals, an arthroscopic hook was introduced now through the sub-adductor portal. The ligamentum teres was followed proximally to the direction of the acetabulum and used as a guide to the TAL. The TAL was identified by sliding the hook along the acetabulum until it fell into the acetabular notch inferiorly. The basket was then introduced to cut the TAL anterior and posterior to the attachment of the ligamentum teres (Fig. 4). The ligamentum teres with the TAL were extracted by a grasper through the sub-adductor portal out of the hip joint. The hook was introduced once again to confirm that the TAL was adequately released. Now the hook should follow the acetabulum until it falls into the acetabular notch. If the hook was pulled, there should not be any soft tissue resistance, ensuring successful TAL release.
While Eberhardt et al. used the same portals we used, but they didn’t switch portals as they used the sub-adductor portal as a viewing portal while the procedure was performed through the anterolateral portal. In our procedure, we resected the femoral attachment of ligamentum teres through the sub-adductor portal while its acetabular attachment, TAL, and pulvinar tissue were removed through the anterolateral portal [15].
[iv] Furthermore, the femoral head of SNSB-BSPG 1922 X 46 exhibited a notable rounded dorsal expansion which is not present in any of the aforementioned carcharodontosaurids. Stromer described a distinct ligament groove on the posterior medial surface of the femoral head, directly comparing it to the condition in Allosaurus. A groove like this is common in allosauroids and for example present in Concavenator or Mapusaurus [12, 67].
12. Coria RA, Currie PJ. A new carcharodontosaurid (Dinosauria, Theropoda) from the Upper Cretaceous of Argentina. Geodiversitas. 2006;28: 71–118.View Article Google Scholar
67. Cuesta E, Ortega F, Sanz JL. Appendicular osteology of Concavenator corcovatus (Theropoda: Carcharodontosauridae) from the Lower Cretaceous of Spain. J Vert Paleontol. 2018;38: (1)–(24). View Article Google Scholar
[v] In all studied specimens, a small cranial convexity of the shaft could be observed. The femoral head (Caput ossis femuris) (Figure 5) is the articular structure of the proximal end and has a spherical aspect with a medial orientation. This structure articulates with the acetabulum. The Fovea capitis has an elliptical aspect with a transversal diameter smaller than the longitudinal diameter and a ventrocaudal position regarding the center point of the femoral head. Between this structure and the acetabular fossa, the ligament of the head of the femur (Lig. capitis ossis femoris) can be observed in fresh specimens.
Figure 5. Anatomical features of the femur. Cranial aspect (A), Caudal aspect (B), Details of the medial part of proximal extremity (C), Details of the cranial part of distal extremity (D), Details of the caudal part of proximal extremity(E), Femur- details of the caudal part of distal extremity (F) 1. Femoral shaft; 2. Femoral head; 3. Fovea for ligament of head of femur; 4. Neck of femur; 5. Greater trochanter; 6. Lesser trochanter; 7. Intertrochanteric crest; 8. Trochanteric fossa; 9. Intertrochanteric line; 10. Gluteal tuberosity; 11. Linea aspera; 12. Pectineal line of femur; 13. Lateral trochlear lip; 14. Medial trochlear lip; 15. Lateral epicondyle; 16. Medial epicondyle; 17. Medial femoral condyle; 18. Lateral femoral condyle; 19. Medial supracondylar line; 20. Lateral supracondylar line; 21. Articular surface for the medial gastrocnemius sesamoid bone; 22. Articular surface for the lateralsesamoid bone of gastrocnemius; 23. Vascular foramina; Black asterix—Intercondylar fossa; White arrowheads—intercondylar line; Red asterix—popliteal fossa. Dotted circle (D)—ligamentary fossa. (This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
Similar to the black-crested Sumatran langur monkeys and most cercopithecines in C. sabaeus, the fovea capitis has an inferior location reported to the central area of the femoral head [57]. According to [62], the anatomical position of the fovea capitis has a direct relation with the anatomical position of the femur during postural and locomotor activity, and the depth of it can be related to the size of the ligament of the femoral head.
57. Fleagle, J.G. Primate Adaptation and Evolution, 3rd ed.; Academic Press: Cambridge, MA, USA, 2013; pp. 1–423. [Google Scholar] [CrossRef]
62. Jenkins, F.A.; Camazine, S.M. Hip Structure and Locomotion in Ambulatory and Cursorial Carnivores. J. Zool. 2009, 181, 351–370. [Google Scholar] [CrossRef]
[vi] Chapter: «Joint Preservation Surgeries Utilizing Surgical Dislocation of the Hip».
The ligamentum teres is cut and resected to allow dislocation of the hip.
[vii] Villar 22 and Domb 4 classification systems were used to grade ligamentum teres tears. Depending on the extent of damage and anatomic [changes] … tearing of the ligamentum teres was treated with debridement.
[viii] In addition to well-established physical examination findings, radiographic evidence of frank or borderline hip dysplasia (lateral center-edge angle [LCEA] of ≤25°, sourcil angle of ≥10°), excessive acetabular version and/or femoral antetorsion, interruption of the Shenton line on the weightbearing AP pelvic radiograph, and MRI findings of labral hypertrophy and tears, articular cartilage thickening and/or inside-out chondral flaps, or a ligamentum teres tear all aided in establishing a diagnosis of symptomatic hip instability.14,25,26
14. Kraeutler MJ, Garabekyan T, Pascual-Garrido C, Mei-Dan O. Hip instability: a review of hip dysplasia and other contributing factors. Muscles Ligaments Tendons J. 2016;6(3):343-353.
25. Welton KL, Jesse MK, Kraeutler MJ, Garabekyan T, Mei-Dan O. The anteroposterior pelvic radiograph: acetabular and femoral measurements and relation to hip pathologies. J Bone Joint Surg Am. 2018;100(1):76-85.
26. Welton KL, Kraeutler MJ, Garabekyan T, Mei-Dan O. Radiographic parameters of adult hip dysplasia. Orthop J Sports Med. 2023;11(2):23259671231152868.
[ix] Methods of modeling TONFH (traumatic osteonecrosis of the femoral head) include traumatic hip dislocation, dissection of the round ligament and ligature of the femoral neck, femoral neck fracture, reduction and internal fixation after femoral neck fracture, and highly selective disruption of the anterior-superior retinacular vessels (Table 2).
FIGURE 2 | The schematic diagram of TONFH models. (a) Normal femoral head blood supply, (b) traumatic hip dislocation, (c) dissection of the round ligament and ligature of the femoral neck, (d) femoral neck fracture, (e) reduction and internal fixation after femoral neck fracture, and (f) highly selective disruption of the anterior-superior retinacular blood vessels. This figure was created with BioRender.com. (This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.)
3.5 Dissection of the Round Ligament and Ligature of the Femoral Neck
The key to the specific modeling approach involves femoral head dislocation by dissecting the round ligament, followed by electrocoagulation cauterization of the soft tissue surrounding the femoral neck. Alternatively, sutures can be used to ligate the surrounding vessels, effectively interrupting the extramedullary blood supply to the femoral head (Figure 2c). Based on the stage of pathological blood flow changes in ONFH (osteonecrosis of the femoral head (), this TONFH modeling method corresponds to the late stage of blood flow changes (arterial occlusion stage). Cheng et al. [26] successfully established a rat model of TONFH using this method. The findings demonstrated that the expressions of inflammatory cytokines, including IL1-β, IL33, and IL17A, were significantly upregulated. Histopathological analysis revealed significant reductions in the height-to-diameter ratio of the epiphysis (H/D) and the bone volume-to-total volume ratio (BV/TV). Deng et al. [27] utilized a piglet model to induce TONFH. Four weeks post-modeling, deformation of the femoral head was evident. Pathological examination revealed an increased number of empty bone lacunae, while the marrow space showed infiltration of small blood vessels, fibroblasts, and adipocytes around the necrotic femoral head, accompanied by heightened osteoclast activity involved in the absorption of necrotic bone tissue. Park and Him [28] developed a piglet model of TONFH. Four weeks post-modeling, a significant increase in trabecular bone mineralization was observed in the subchondral area of the femoral head, with some specimens exhibiting crescent signs and subchondral fractures. No new bone formation on the ischemic side, while bone formation continued on the normal side, exacerbating discrepancies in trabecular structure between the two regions. This disparity in trabecular structure and mechanical load may contribute to the development of subchondral fractures.
26. J. H. Cheng, S. W. Jhan, C. C. Hsu, H. W. Chiu, and S. L. Hsu, “Extracorporeal Shockwave Therapy Modulates the Expressions of Proinflammatory Cytokines IL33 and IL17A, and Their Receptors ST2 and IL17RA, Within the Articular Cartilage in Early Avascular Necrosis of the Femoral Head in a Rat Model,” Mediators of Inflammation 2021 (2021): 9915877.
27. Z. Deng, Y. Ren, M. S. Park, and H. K. W. Kim, “Damage Associated Molecular Patterns in Necrotic Femoral Head Inhibit Osteogenesis and Promote Fibrogenesis of Mesenchymal Stem Cells,” Bone 154 (2022): 116215.
28. S. S. Park and H. K. Kim, “Subchondral Fracture After Ischemic Osteonecrosis of the Immature Femoral Head in Piglet Model,” Journal of Pediatric Orthopaedics. Part B 20, no. 4 (2011): 227–231.
[x] The rabbit was positioned laterally after being anesthetized with 30 mg/kg sodium pentobarbital (Sigma-Aldrich, USA) administered via an ear vein. The surgical area was disinfected and draped. A 2-cm incision was made, extending from 1 cm above the greater trochanter to the mid-femur on the left side. Blunt dissection of the tensor fascia and gluteus maximus muscle was followed by extreme flexion and internal rotation of the hip to expose the joint capsule. The femoral head was dislocated, and the Ligamentum teres was cut, severing the blood supply. Using a curved clamp, non-absorbable sutures were placed around the femoral neck, severing the vascular supply. The hip was then reduced, and the wound was sutured.
Due to the limitations of space, large-scale rearing of piglets is not feasible; therefore, we established a Perthes disease model using rabbits. Similar to the piglet model of Perthes disease, we cut the ligament of the femoral head and tightly ligated the base of the femoral neck with non-absorbable sutures. This method successfully created a rabbit model of Perthes disease. This model not only replicates the pathological features observed in larger animal models but also introduces a novel approach that enhances feasibility and applicability in experimental research.
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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