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LCF in 2025 (April)

 

LCF in 2025 (April): Quotes from articles and books published in April 2025 mentioning the ligamentum capitis femoris.


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.

  

[viii] A cause of poor outcomes after labral surgery may lie in changes to the ligamentum capitis femoris (LCF).

  

[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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