LCF
in 2025 (April):
Kacková, G., Horňák, S., Figurová, M., Vargová, N., & Tauberová, V. (2025). MORPHOMETRIC EVALUATION OF THE HIP JOINT IN DOGS. FOLIA VETERINARIA, 69(1), 1-8. [i] uvlf.sk
Ağlamış, Ö., Akkaya, S. K., Erol, B., & Yılmaz Ergani, S. (2025). Investigating the Impact of Acetabular Dysplasia on Sexual Dysfunction and Psychological Well-Being in Women. Journal of Clinical Medicine, 14(7), 2385. [ii] mdpi.com
Lawler, D., Tangredi, B., Widga, C., Etnier, M., Martin, T., Schulz, K., & Kohn, L. (2025). Reading the carnivoran skeletal story: An acetabular viewpoint, with suggested implications across geological time. Acta Zoologica. 26 March 2025 https://doi.org/10.1111/azo.12542 [iii] onlinelibrary.wiley.com
Hadley, M., Thacker, M. M., & Su, A. W. (2025). Master’s Surgical Technique–One-stage Combined Hip Arthroscopy and Peri-Acetabular Osteotomy. Journal of the Pediatric Orthopaedic Society of North America, 100171. [iv] sciencedirect.com
Monari, R., Pessiquelli, F. L. F., & Machado, E. G. (2025). Painful Borderline Acetabular Dysplasia: What's New?. Revista Brasileira de Ortopedia, 60(1), 1. [v] pmc.ncbi.nlm.nih.gov
Heimann, A. F., Wagner, M., Vavron, P., Brunner, A., Lerch, T. D., Schmaranzer, E., ... & Schmaranzer, F. (2025). Ischiofemoral impingement in joint preserving hip surgery: prevalence and imaging predictors. Insights into Imaging, 16(1), 78. [vi] insightsimaging.springeropen.com
Li, X., Ji, J., Li, P., Yang, D., Yedron, N., Lei, Y., ... & Qu, D. (2025). Plasma Lipidomics Profiling of Developmental Dysplasia of the Hip in Tibet Plateau. Health Care Science. [vii] onlinelibrary.wiley.com
Arkhipov, S. V. (2025).
WHY ACETABULAR LABRUM REPAIR MAY BE INEFFECTIVE?: A NOTE ON THE
MYSTERIOUS" DARK MATTER" OF THE HIP JOINT. [viii] researchgate.net
Davies, M. (2025). Hip dysplasia: time to move from correction to prevention. Hip. [ix] vettimes.com
Wang, Z., Kenmegne, G. R., Zeng, J., & Chen, M. (2025). Clinical analysis of Ganz approach in the treatment of Pipkin type IV fracture: a retrospective review. BMC Musculoskeletal Disorders, 26(1), 1-8. [x] bmcmusculoskeletdisord.biomedcentral.com
Angeli, L. R. A. D., SANTOS, G. B. D., Ferreira, J. R. M., Serafim, B. L. C., Lima, T. Z., Lima, L. G. C. A. D., ... & Guarniero, R. (2025). Local injection of human dental pulp stem cells for treatment of juvenile avascular necrosis of the femoral head: preliminary results in immature pigs. Acta Ortopédica Brasileira, 33(spe1), e283445. [xi] pmc.ncbi.nlm.nih.gov
Johnson, L. G. (2025). Advanced
magnetic resonance imaging and modelling of Legg–Calvé–Perthes disease (Doctoral dissertation, University of British Columbia). [xii] scholar.google.com
Yılmaz, O., Erken, H. Y., Gülen, M. İ., Bağla, A. G., Adalı, Y., & Kuru, T. (2025). The effects of systemic ozone application and hyperbaric oxygen therapy on avascular necrosis of the femoral head: An experimental study in the vascular deprivation of the rat femoral head model. Joint diseases and related surgery, 36(2), 293-303. [xiii] pubmed.ncbi.nlm.nih.gov
Marka, A. W., Meurer, F., Twardy, V., Graf, M., Weiss, K., Makowski, M. R., ... & Foreman, S. C. (2025). Deep learning and conventional hip MRI for the detection of labral and cartilage abnormalities using arthroscopy as standard of reference. European Radiology, 1-14. [xiv] link.springer.com
Zhang, Y., Wang, J., Gu, L., Martin, H. D., & Martin, R. L. (2025). A finite element analysis model to support ligamentum teres function. Journal of Hip Preservation Surgery, hnaf017. [xv] academic.oup.com
Bukowiec, L. G., Kaji, E. S., Koch, J. A., Saniei, S., Girod-Hoffmann, M. M., Sinnwell, J. P., & Wyles, C. C. (2025). Genetics of morphological hip abnormalities and their implications for osteoarthritis: a scoping review. Journal of Hip Preservation Surgery, hnaf020. [xvi] academic.oup.com
Quesada-Jimenez, R. Ligamentum Teres Reconstruction with Tibialis Anterior Allograft: Case Series with 2-Year Follow Up. (2025). American Hip Institute. [xvii] isakos.com
Hegazy, A. A., Hegazy,
M. A., & Hegazy, A. A. (2025). Vascular Anatomy of the Proximal Femur and
the Risk of Avascular Osteonecrosis. Int J Cadaver Stud Ant Var Vol, 6(1), 10. [xviii] researchgate.net
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
[i] The iliac bones fuse with the
sacrum and femur and eventually fuse at the pubic symphysis [18]. It is further
divided into the ventromedial fossa of the acetabulum, where the ligament of
teres, also called the round ligament for ligament of the femoral head, exits.
[ii] Orthopedic
conditions such as femoroacetabular impingement (FAI), hip osteoarthritis,
labral tears, and ligamentum teres injuries were excluded from this study.
[iii] … ‘non-ligamentous fossa bone’ (not
involving the site of ligamentum teres attachment)
[iv] 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.
[v] Nawabi et
al. 36 presented the 2-year clinical outcomes from 55 cases of borderline DDH
treated with arthroscopy and compared with a control group (subjects with hips
undergoing arthroscopy, but with LCEA > 25° and < 40°). The authors
demonstrated that both groups showed significant improvement in the
postoperative quality of life questionnaires, with no difference between the
improvement of one group over the other, and similar hip movement outcomes.
Furthermore, the authors investigated the procedures performed in each group,
and the most frequent in patients with borderline DDH was round ligament
debridement.
36.Nawabi D H, Degen R M, Fields K G et al. Outcomes After Arthroscopic Treatment of Femoroacetabular Impingement for Patients With Borderline Hip Dysplasia. Am J Sports Med. 2016;44(04):1017–1023. doi: 10.1177/0363546515624682. [DOI] [PubMed] [Google Scholar]
Maldonado et al. 43 performed a paired study with patients with
borderline dysplasia undergoing arthroscopy, revealing that those with an intact/healthy
round ligament tended to present better outcomes than patients with round
ligament [ligamento redondo.]
injuries.
43.Maldonado D R, Chen S L, Walker-Santiago R et al. An Intact Ligamentum Teres Predicts a Superior Prognosis in Patients With Borderline Dysplasia: A Matched-Pair Controlled Study With Minimum 5-Year Outcomes After Hip Arthroscopic Surgery. Am J Sports Med. 2020;48(03):673–681. doi: 10.1177/0363546519898716. [DOI] [PubMed] [Google Scholar]
[vi] The presence and extent of
intraarticular degeneration were assessed and compared between groups,
including presence/absence of labral tears, type of labral tear (base tear,
intrasubstance/complex tear), presence/absence of cartilage damage, and
presence/absence of a ligamentum teres lesion [10, 11].
To determine the interobserver
reliability, a fellowship-trained musculoskeletal radiologist with seven years
of experience in hip imaging (F.S.) evaluated the presence/absence of
chondrolabral damage and ligamentum teres lesions on MRA in 100 randomly chosen
patients (100 hips).
[vii] DDH is
characterized by pathological changes in both the skeletal and soft tissues.
These changes include alterations in the osseous structures, such as the
acetabulum, femoral head, femoral neck, and femoral shaft, as well as
modifications in the soft tissues like the labrum, ligamentum teres, and joint
capsule. Additionally, there may be associated dysfunctions in the muscles
surrounding the hip joint.
[ix] In the first two weeks of life the round ligament
seems primarily responsible for maintaining hip joint stability as, if forced
to luxate, the femoral head fractures at the fovea (attachment of the ligament).
[x] The
literature supports that the round ligament is not the primary source of blood
supply to the femoral head [19, 22], therefore, the removal of the remaining
round ligament does not significantly impact the blood supply to the femoral
head.
During the procedure, protecting the deep branches of the medial
circumflex femoral artery is essential. While the round ligament may be
sectioned if needed, excessive tightening of sutures within the joint capsule
should be avoided to prevent compromising femoral head blood perfusion.
19 Sevitt S, Thompson RG, THE DISTRIBUTION AND ANASTOMOSES OF ARTERIES SUPPLYING THE HEAD AND NECK OF THE FEMUR. J Bone Joint Surg Br Volume. 1965;47:560–73. Article CAS Google Scholar
22 Mei J, Quan K, Wang H, Dai Y, Zhang F, Ni M. Total cross-sectional area of the femoral neck nutrient foramina measured to assess arterial vascular beds in the femoral head. J Orthop Surg Res. 2019;14(1):439. Article PubMed PubMed Central Google Scholar
[xi] The surgical
procedure to induce necrosis consisted of performing two intracapsular
ligatures around the neck of the right femur of the animals with absorbable
Vicryl 2-0 sutures (Ethicon INc., Somerville, NJ) and the section of the
ligamentum teres (Figure 1). The procedure aims to interrupt blood flow to the
proximal femoral epiphysis. . After necrosis was inducted, hip reduction and
wound closure in a standard fashion were performed in layers in the control
group.
Figure 1. Photograph of the surgical procedure showing the intracapsular
ligatures in the femoral neck with absorbable sutures after the ligamentum
teres was sectioned. (License СС)
[xii] A ligament called
the ligamentum teres connects the femur to the acetabulum between the capital
fossa and the acetabular fossa.
[xiii] We surgically induced osteonecrosis by
cutting the ligamentum teres and placing a tight ligature around the femoral
neck.
[xiv] Femoral
Zone F corresponds to the attachment site of the ligamentum teres [26].
26 Surowiec RK, Lucas EP, Wilson KJ, Saroki AJ, Ho CP (2014) Clinically relevant subregions of articular cartilage of the hip for analysis and reporting quantitative magnetic resonance imaging: a technical note. Cartilage 5:11–15 Article PubMed PubMed Central Google Scholar
[xv] Abstract
The function of the
ligamentum teres (LT) remains debated, particularly its role in limiting
motion. The aim of this study was to use finite element analysis to assess LT
stress during hip movements, which included external rotation with flexion. A
3D model of the hip joint, including the femoral head and LT, was constructed
from magnetic resonance imaging data using 3D Slicer. The models were imported
into Ansys SpaceClaim 2022R1 for refinement and assembly. The von Mises stress
in the LT was extracted during six hip movements: external rotation, internal
rotation, abduction, adduction, flexion, and extension. LT stress response was
also extracted during external rotation at hip flexion angles of 0°, 30°, 60°,
and 90°. The results found there was a sharper increase in LT stress during
movements involving hip external rotation, internal rotation, abduction, and
adduction when compared to movements in flexion and extension. External
rotation in larger hip flexion angles resulted in greater LT stress, with the
highest stress observed at 90° flexion. These findings help to support the LT’s
role as a rotational stabilizer in the frontal and transverse planes wrapping
around the femoral head to act as a sling. Additionally, the increased stress
during external rotation at greater degrees of hip flexion suggests an enhanced
role for the LT in hip stability as flexion increases. These results add as a
proof of concept in that the LT is under stress during hip movements and has a
potential role in stabilizing the hip joint.
[xvi] In another
study that used snRNA and MiP sequencing to analyse ligamentum teres samples in
six patients undergoing open reduction for DDH, COL1A1 was shown to have a role
in tissue thickening and hypertrophy [66].
66 Zhao Z, Fan
C, Wang S et al.
Single-nucleus RNA and multiomics in situ pairwise sequencing reveals
cellular heterogeneity of the abnormal ligamentum teres in patients with
developmental dysplasia of the hip. Heliyon 2024;10:e27803. doi:
10.1016/j.heliyon.2024.e27803
[xvii] Purpose and Hypothesis
• The literature on outcomes of LT reconstruction is limited. Most
studies report favorable outcomes, with contradictory findings of reoperation
rates.
• This study aims to evaluate the outcomes of LT reconstruction with
tibialis anterior allograft treatment for LT tears, with a minimum 2-year
follow-up.
• Hypothesis: Favorable outcomes with high satisfaction and low revision
rates at 2 years after LT reconstruction
Methods
• Looking at patients from a single surgery center between December 2014
and July 2021
• Included patients had completed preoperative and minimum of 2-year
postoperative questionnaires for the following PROs: mHHS, NAHS, HOS-SSS,
iHOT-12, VAS pain, or had a documented endpoint surgery
• Looking at patient demographics, radiographic findings, intraoperative
findings, procedures, patient reported outcomes (PROs), secondary surgeries,
and complications
• A sub-analysis was also performed comparing outcomes between a comparable group of patients with grade III LT Percentile Domb classifications who underwent hip arthroscopy with LT debridement as treatment.
Conclusion
Arthroscopic LT reconstruction with a tibialis anterior allograft, concomitant with labral repairs and osteoplasties for FAI, have shown favorable outcomes, high patient satisfaction rates, and a high percentage of patients reaching clinically important thresholds, with a low rate of complications and THA conversion at a minimum 2-year follow-up.
[xviii] In addition
to retinacular branches, the head of femur receives another two sources of
blood supply. The first is a branch from obturator artery (OA) travelling along
the ligament of the FH; however, it is not capable of keeping the head alive if
other sources are lost [1].
Interestingly, the artery of ligamentum teres, which is of great importance in children in supplying the FH, can be damaged by hip dislocation [1,2].
1. Barney J, Piuzzi NS, Akhondi H. Femoral head avascular necrosis.
StatPearls Publishing, Treasure Island, Florida, United States. 2023.
2. Lo D, Talkad A, Sharma S. Anatomy, bony pelvis and lower limb, fovea
capitis femoris. StatPearls Publishing, Treasure Island, Florida, United
States. 2023.
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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