LCF in 2025 (March): Quotes from articles and books published in March 2025 mentioning the ligamentum capitis femoris.
Matsushita, Y., Sugiyama, H., Hayama, T., Sato, R., & Saito, M. (2025). Long-term Outcome of Pediatric Arthroscopic Surgery for Avulsion Fracture of the Ligamentum Teres: A Case Report. JBJS Case Connector, 15(1), e25. [i] journals.lww.com
Arkhipov, S. V. (2025). Inferior Portal for Hip Arthroscopy: A Pilot Experimental Study. Pt. 2. Inferior Portal Prototypes. About Round Ligament of Femur. February 26, 2025. [ii] researchgate.net
Pfirrmann, C. W., & Kim, Y. J. (2025). Advanced Imaging. In Surgical Hip Dislocation: A Comprehensive Approach to Modern Hip Surgery (pp. 29-42). Cham: Springer Nature Switzerland. [iii] link.springer.com
Singh, R., & Yadav, N. (2025). Morphometry and Morphology of the Fovea Capitis of the Femoral Head and its Associated Implications. Cureus, 17(3). [iv] cureus.com , assets.cureus.com
de Moura Vallim, F. C., de Angeli, L. R. A., Serafim, B. L. C., & Manca, A. (2025). Do we need to dislocate the femoral head? A retrospective comparison of unstable slipped capital femoral epiphysis (SCFE) cohorts treated by two variations of the modified Dunn procedure. European Journal of Orthopaedic Surgery & Traumatology, 35(1), 86. [v] link.springer.com
Kitamura, K., Fujii, M., Hamai, S., Hara, D., Yoshimoto, K., Kawashima, I., ... & Banks, S. A. (2025). Periacetabular Osteotomy Improves Hip Microinstability Between Supine and Standing Radiographs in Symptomatic Hip Dysplasia. Orthopaedic Journal of Sports Medicine, 13(3), 23259671251319994. [vi] journals.sagepub.com
Quesada-Jimenez, R., Schab, A. R., Cohen, M. F., Kuhns, B. D., Kahana-Rojkind, A. H., & Domb, B. G. (2025). Periacetabular Osteotomy with Concomitant Hip Arthroscopy Shows Comparable Outcomes Compared to Isolated Hip Arthroscopy with Capsular Plication in Borderline Dysplastic Hips: A Propensity-Matched Study. Arthroscopy. March 06, 2025. [vii] arthroscopyjournal.org
Hadley, M., Thacker, M. M., & Su, A. W. One-stage Combined Hip Arthroscopy and Periacetabular Osteotomy. Journal of the Pediatric Orthopaedic Society of North America. . [viii]
Mehta, A. V., Sangrigoli, R. M., Galos, D. K., & Rehman, S. (2025). Open Reduction and Internal Fixation of Femoral Head Fracture After Firearm Injury: A Case Report. JBJS Case Connector, 15(1), e24. [ix] journals.lww.com
Aggarwal, A., Behera, P., Sahoo, D. R., Prakash, V., Santoshi, J. A., & Singh, K. (2025). Neglected Chronically Dislocated Hip in a Prader-Willi Child: A Case Report and Literature Review. Journal of Orthopaedic Case Reports, 15(3), 70. [x] jocr.co.in
Maidment, S., Ouarhache, D., Butler, R. J., Boumir, K., Oussou, A., Ech-Charay, K., ... & Barrett, P. M. (2025). The world’s oldest cerapodan ornithischian dinosaur from the Middle Jurassic of Morocco. Royal Society Open Science, 12(3), 241624. [xi] royalsocietypublishing.org
Kraeutler, M. J.,
Nguyen, B. Q., Keeter, C., Jamar, K. S., Samuelsson, K., Lee, J. H., & Mei-Dan,
O. (2025). Sitting Pain is More Common Than Standing Hip Pain Regardless of
Diagnosis of Femoroacetabular Impingement Syndrome versus Hip Dysplasia: A
Prospective Comparative Study. Arthroscopy, Sports Medicine, and
Rehabilitation, 101116. [xii]
sciencedirect.com , arthroscopysportsmedicineandrehabilitation.org
Dhillon, J., Hernandez, E. J., Keeter, C., & Kraeutler, M. J. (2025). The Sensitivity and Specificity for Physical Examination Tests in Diagnosing Pre-Arthritic Intra-Articular Hip Pathology Are Highly Variable: A Systematic Review. Arthroscopy, Sports Medicine, and Rehabilitation, 101117. [xiii] arthroscopysportsmedicineandrehabilitation.org , sciencedirect.com
Burnei, G., Dragomir, M., Banculescu, M., Popescu, R. C., Leopa, N., & Iordache, I. E. (2025). Cephalobturator Neoacetabuloplasty: A Therapeutic Solution in Vicious Ankylosis After Developmental Dislocation of the Operated Hip—Case Study. JAAOS Global Research & Reviews, 9(3), e24. [xiv] journals.lww.com
Kang, S., Batri, A., Danssaert, Z., Rakesh, N., & Gulati, A. (2025). Hip Joint Injection. Practical Atlas of Ultrasound for Anesthesia in Chronic Pain, 160-167. [xv] books.google
Pharis, H., DeGenova, D. T., Manes, T. J., Anderson, M., Seebacher, T., Turnow, M., ... & Wissman, R. Magnetic resonance imaging findings of intra-articular hip pathology in collegiate american football players. 2024; 1(5): 1050. [xvi] annscri.org
Hapa, O., Aydemir, S., Sunay, F. B., Acan, A. E., Akkaya, P. N., Celtik, M., ... & Salin, M. (2025). In Vitro Ovine Cam Impingement Model and Its Effect on Acetabular Cartilage. Orthopaedic Journal of Sports Medicine, 13(3), 23259671251322757. [xvii] journals.sagepub.com
BLOCK, J. L., GEIGER, J. E., MITCHELL, A., PAVLESEN, S., MOGERMAN, J. F., BINKLEY, A. S., & FERRICK, M. R. (2025). The Prevalence of Infantile Hip Dislocation Before and During the COVID-19 Pandemic and Associated Short-Term Treatment Outcomes–Retrospective Case-Series. Journal of Orthopaedic Reports, 100655. [xviii] sciencedirect.com
Kebeh, M., Hall, C., Madhuri, V., & Sankar, W. N. (2025). Idiopathic Chondrolysis of the Hip in Adolescents: Updated Evidence for Clinical Management. Journal of the Pediatric Orthopaedic Society of North America, 100187. [xix] sciencedirect.com
Hatano, M., Ishikura,
H., Terao, T., Kasai, T., Yamagami, R., Higuchi, J., ... & Saito, T.
(2025). Intra-articular administration of autologous adipose-derived stem cells
in hip osteoarthritis: Longitudinal treatment trajectories and prognostic
factors. Regenerative Therapy, 29, 217-226.
[xx] sciencedirect.com
Martin, R., Wang, J., & Gu, L. (2025). EP2. 27 A Finite Element Analysis Model to Support Ligamentum Teres Function. Journal of Hip Preservation Surgery, 12(Supplement_1), i63-i63. [xxi] scholar.google
Changil, A. (2025). To determine morphometric analysis, vertical head diameter, foveal diameter, fovea transverse diameter, and foveal longitudinal diameter of the proximal femur in individuals from Central India. International Journal of Pharmacy Research & Technology (IJPRT), 15(1), 110-115. [xxii] ijprt.org
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[i] Abstract
Case:
An 8-year-old boy experienced a traffic accident
resulting in avulsion fracture of the ligamentum teres, preventing maintenance
of hip joint congruity. Hip arthroscopy was performed to remove the teres and
bone fragments. Three months postoperatively, he could walk without a cane.
Fourteen years postoperatively, the patient remains well, and his International
Hip Outcome Tool (iHOT-12, short version) score improved from 23 points preoperatively
to 100.
Conclusion:
We performed arthroscopic hip surgery for managing a ligamentum teres avulsion fracture. This is the first report of the long-term results of arthroscopic treatment of this type of fracture in a pediatric patient.
[ii] Abstract: The article presents, theoretically and graphically substantiates the technique of a new arthroscopic approach to the central compartment of the hip joint. It is proposed to introduce the optical system of the arthroscope from below through the acetabular notch without traction. Similar approaches were used for puncture, arthroscopy, arthrography, and arthrotomy of the hip joint. Diagnostics using the described lower portal will exclude complications caused by distraction of the leg and compression of the perineal support during surgery.
[iii] Ligamentum teres tears are a possible source of hip pain. At arthroscopy of the hip tears of the ligamentum teres are often observed (up to 50% of cases) [28]
MR arthrography in a patient with a high-grade tear (white arrow) of the ligamentum capitis femoris at its foveal attachment …
[iv] Introduction
The fovea capitis is a depressed space postero-inferior to the center of the head of the femur [1]. It provides attachment to the ligament of the head of the femur, also known as the ligamentum teres femoris, which forms a channel for the passage of vessels irrigating the femoral head. There is a disruption of blood supply to the femoral head if the ligamentum teres femoris, through which blood vessels are passing to the femoral head, is injured in cases of hip fractures and dislocations, culminating in avascular necrosis of the femoral head [2].
Therefore, the gross appearance of the fovea capitis may provide important clues for assessing hip joint osteoarthritis and the ligament of the head of the femur. In addition, if there is a fracture in the neck of the femur, then the position of the fovea capitis changes with respect to the normal position; thus, the knowledge of the precise location of the fovea capitis is useful in establishing the rotational position of the head of the femur in fractures of the neck of the femur [7].
The ligament of the head of the femur has been designated various names, such as the round ligament or ligamentum teres, as it is ovoid or rounded in configuration at its attachment to the fovea capitis [16]. Different shapes of the fovea capitis have been observed in studies in the literature, which are elaborated on in the succeeding paragraphs.
Figure 1: Various morphological forms of fovea capitis A) Horizontal oval-shaped; B) Vertical oval-shaped; C) Circularshaped; D) Triangular-shaped; E) Irregularly shaped. FC: fovea capitis; HOF: head of femur (This is an open access article distributed under the terms of the Creative Commons Attribution License CC-BY 4.0)
Clinical implications
Conclusion: The information provided in this study will be of utmost use in dealing with hip joint pathologies like dysplasia and osteoarthritis, reconstructing injured ligaments of the head of the femur, proximal femur measurements, radiological interpretation, arthroscopic procedures, and other surgical interventions involving the hip joint.
[v] This
paper describes a variation of the modified Dunn procedure [for unstable
slipped capital femoral epiphysis] where the ligamentum teres remains intact,
and the femoral head is … the maintenance of the ligamentum teres could play a
role in augmenting the stability in … its preservation might be of interest in such
a challenging condition.
[vi] While the congruent bony architecture of the hip is important to its stability, recent studies have shown that the surrounding soft tissues involving the acetabular labrum, ligamentum teres, and capsular structures are also important.
[vii] While in the joint, diagnostic arthroscopy was used to initially assess the labrum, intra-articular cartilage, and ligamentum teres. … Tears of the ligamentum teres were defined using the Domb and Villar classifications. … Acetabular Outerbridge grades, femoral-head Outerbridge grades, and Ligamentum Teres tear were observed at similar rates (p > 0.05).
[viii] A diagnostic
hip scope is performed in the central compartment, focusing on assessing labral
integrity, cartilage injury, the presence of loose bodies, and the ligamentum
teres.
d) Avoid damage to ligamentum teres, which contributes to hip stability.
[ix] The hip was
then dislocated anteriorly with external rotation, and release of the
ligamentum teres was performed using a curved Mayo scissor.
[x] Following “T” shaped capsulotomy, the femoral head was visualized and found to be malformed and appeared as if it had shrunk. The ligamentum teres was elongated but was thin and was excised after tracing it to the depths of the acetabular cavity. We excised the transverse acetabular ligament and fatty tissue from the floor of the acetabular fossa.
[xi] The
posterior surface of the head bears a distinct, ‘U’-shaped ligament sulcus in
proximal view (figure 1C, ls). More laterally, the head is distinctly separated
from the greater trochanter by a second, more pronounced ‘U’-shaped depression
(figure 1C, u). The lateral margin of the greater trochanter is laterally
convex and abraded dorsally.
In posterior view, the ligament sulcus (figure 1B, ls) occupies most of the posterior surface of the femoral head and is broad and shallow. It extends from the dorsal margin of the head posteroventrally towards the shaft and merges into the medial margin of the shaft ventrally.
Figure 1. USMBA 001, proximal left femur of a cerapodan dinosaur in A, anterior; B, posterior; C, proximal (dorsal); D, lateral and E, medial views. ar, ridge on the anterior surface; gt, greater trochanter; hd, head; ls, ligament sulcus; tr, trough separating head from greater trochanter; u, u-shaped sulcus; ur, ridges bordering u-shaped sulcus. Scale bar equal to 2 cm. (Published by the Royal Society under the terms of the Creative Commons Attribution License http://creativecommons.org/licenses/by/4.0/, which permits unrestricted use, provided the original author and source are credited.)
The presence of a ligament sulcus on the posterior surface of the femoral head indicates that the specimen is an early diverging cerapodan, early diverging iguanodontian or early diverging ceratopsian, but excludes it from being a non-cerapodan neornithischian, hadrosauroid or ceratopsid because the ligament sulcus was not present in these taxa (see description, above).
[xii] History of hip pain, positive findings on provocative hip tests indicating labral tear, radiographic evidence of hip dysplasia, excessive acetabular version and/or femoral antetorsion, interruption of Shenton’s line on the AP pelvis radiograph, the presence of an upsloping lateral sourcil, and MRI findings of labral hypertrophy, articular cartilage thickening or ligamentum teres tear all aided in establishing a diagnosis of symptomatic hip instability.24-27
[xiii] Nine studies19,20,21,22,23-25,26,27 evaluated physical examination tests for a
labral tear, 5 studies22,28,29,31,32 evaluated for FAI, 1 study32 evaluated microinstability, and 1 study33 evaluated for a ligamentum teres tear.
33 O’Donnell, J., Economopoulos, K.,
Singh, P., Bates, D., & Pritchard, M. (2014). The ligamentum teres test: a
novel and effective test in diagnosing tears of the ligamentum teres. The American journal of sports medicine, 42(1), 138-143.
For diagnosis of a ligamentum teres
tear, O’Donnell et al.25 used the ligamentum teres test.
Ligamentum teres
Patient lies supine. The knee is flexed to 90 degrees and the hip to 70 degrees without tilting the pelvis. The hip is abducted as far as tolerated, then adducted until 30 degrees short of full abduction. The hip is fully internally and externally rotated until a firm end point is observed. Pain provocation in either rotation is a positive test result. (Ligamentum teres tear)
[xiv] The round
ligament is a landmark for individualizing acetabular incisions.
[xv] The ligamentum
teres femoris is an intra-articular ligament that attaches the center
of the femoral head to the acetabulum, which can further stabilize the hip
joint, especially in the setting of labral dysplasia. (25)
The posterior division of the obturator artery also contributes a major
branch, traversing the ligamentum teres and supplying the femoral head (25).
[xvi] Tears of the LT (ligamentum teres) was noted in 3/14 (21.4%) of our patients. Recently, there has been increased discussion in the literature regarding LT injuries and the role of repair and debridement. Multiple reports have linked LI rupture to hip micro instability, which can present as acute or chronic hip pain [4,12,24]. The proposed mechanism of LT’ rupture is a posteriorly directed force on a flexed and adducted knee, or sudden external rotation of the hip [3,19]. As such, IT injury has been noted American Football players as well as hockey players and skiers [3]. Despite LT injury commonly presenting during traumatic hip injuries, it is uncommon for surgeons to perform IT reconstruction during hip arthroscopy. A study by Bodendorfer et al. compared outcomes in patients with labral tears and concomitant LT tears to patients with isolated labral tears [2]. After labral repair in both groups, no significant difference in outcomes were noted [2]. LT reconstruction may still be indicated for patients with persistent pain or instability after primary hip arthroscopy, as patients have shown symptomatic improvement with revision arthroscopy and LT repair [13,21].
[xvii] After dissection of the muscular tissues around the hip, the capsule was completely excised by separating it from the femoral attachment site without damaging the labrum. The labrum, transverse acetabular ligament, and ligatmentum teres were preserved. Specimens underwent meticulous screening and were excluded if they exhibited macroscopic signs of degeneration, any evidence of trauma-related injury, or osteoarthritis.
Figure 2. Type 3 acetabular labrum articular disruption ‘‘chondral flap’’ lesion (white arrows).
Figure 3. Left: Cam deformity with an aspherical femoral head-neck junction. Right: Post-excision view following cam resection, demonstrating a restored femoral headneck contour.
[xviii] Older, untreated infants with DDH may also develop an inverted labrum that mechanically blocks concentric hip reduction. Closed reduction of a dislocated hip with an inverted labrum may be associated with an increased incidence of avascular necrosis (AVN) of the femoral head. Furthermore, persistent dislocation causes lengthening of the ligamentum teres and may also block concentric reduction of the femoral head in the acetabulum.
[xix] Osteoarthritic
changes, pannus arising from thickening of the ligamentum teres, and
full-thickness cartilage defects, especially over the central aspect of the
femoral head, may be observed with surgical dislocation.2
2 Madhuri V, Walter NM, Panwar J. Idiopathic Chondrolysis of the Hip. The Pediatric and Adolescent Hip. 2019:375-390:chap Chapter 14.
Figure 4. Preoperative, intraoperative, and postoperative findings in a 13-year-old female patient who presented with two months of right hip pain and limitations in flexion and rotation of the affected hip. The patient underwent surgical hip dislocation with osteochondral autograft transfer (OATS) approximately 7 months after her initial presentation. (A and B) Initial radiographs and magnetic resonance imaging showing joint space narrowing and geographic enhancement (indicated by the white arrow), respectively. (C) Intraoperative findings reveal characteristic parafoveal chondral degeneration and hyperemia of the ligamentum teres. (D) Intraoperative image depicting OATS preparation. (E) Radiograph taken approximately 1 year postoperatively (after hardware removal) shows reconstitution of the affected joint space. https://ars.els-cdn.com/content/image/1-s2.0-S2768276525000318-gr4.jpg
[xx] Intra-articular ASC (intra-articular administration of
autologous adipose-derived stem cells ) treatment enhanced
patient-reported outcomes over 6 months, with differences observed across hip
OA severities. Female sex and moderate hip OA were positive prognostic factors,
whereas ligamentum teres abnormalities were negative prognostic factors for
patient-reported outcomes after ASC treatment.
[xxi] Abstract
Background: The function of the ligamentum teres (LT) continues to be an
area of debate and interest. A cadaver study found the LT to be a rotational stabilizer
in all hip positions.(1) Hip external rotation (ER) may be of particular
interest as it relates to microinstability and focal rotational laxity of the
iliofemoral ligament.(2) The purpose of this study was to use finite element
analysis (FEA) modeling to support the function of the LT as a structure that
stabilizes the hip by limiting ER. It was hypothesized the stress on the LT
would increase as hip ER values increased.
Methods: Onshape was first used to recreate the hip anatomy. FEA
modeling during hip movement simulation was then performed with Ansys. These
movements were segregated into two sequential steps: flexion in the first step
and ER in the second step. Three flexion angles (0°, 30°, and 60°) were
considered, with adduction set at 0°. The simulation captured the maximum
von-Mises stress during various degrees of ER.
Results: The von Mises stress on the LT remained low until ER range of
motion approached end range. Stress on the LT then increased exponentially as
ER range of motion approached a maximum value. The increase in stress varied by
flexion angle, with the stress starting to increase exponentially at approximately
28°, 37°, and 42° of ER when the flexion angle was at 0°, 30°, and 60°,
respectively. The von-mises stress was allied with the LT limiting ER range of
motion.
Discussion: This FEA modeling study supports the function of the LT in
restraining hip ER range of motion. It also supports a ball and string
model to describe the function of the LT. ER was found to cause the LT to
tighten with an associated increase in stress. The LT therefore may act as a
sling, wrapping around the femoral head during ER. A tightening of the LT was
associated with an exponential increase in stress as it pulls the femoral head
into the acetabulum to increase stability at the end range of hip ER range of
motion.
(1) Martin HD, Hatem MA, Kivlan BR, Martin RL. Function of the ligamentum teres in limiting hip rotation: a cadaveric study. Arthroscopy. 2014;30:1085-1091
(2) Martin RL, McDonough C, Enseki K, Kohreiser D, Kivlan BR. CLINICAL RELEVANCE of the LIGAMENTUM TERES: A LITERATURE REVIEW. Int J Sports Phys Ther. 2019;14:459-467.
[xxii] The fovea capitis femoris is responsible for the stability of the hip joint and serves as the attachment site for the ligamentum teres. Morphometric parameters of the fovea, including depth, transverse diameter, and longitudinal diameter, are subject to change.
In our study, the vertical head diameter was observed to be 40.60 ±3.36 mm. The mean foveal depth in the present study was 2.86 ± 0.86 mm. The mean transverse and longitudinal diameters of the fovea were 12.49 ± 2.46 mm and 16.05 ± 4.48 mm, respectively, according to the same study. We did not observe significant differences in mean and standard deviation between the age and gender in terms with vertical head diameter, foveal diameter, fovea transverse diameter, and foveal longitudinal diameter.
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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