LCF in 2025 (June)
(Quotes from articles and books published in June 2025 mentioning
the ligamentum capitis femoris)
Kuhns, B. D., Kahana-Rojkind, A. H., Quesada-Jimenez, R., McCarroll, T. R., Kingham, Y. E., Strok, M. J., ... & Domb, B. G. (2025). Evaluating a semiquantitative magnetic resonance imaging-based scoring system to predict hip preservation or arthroplasty in patients with an intact preoperative joint space. Journal of Hip Preservation Surgery, hnaf027. [i] academic.oup.com
Iglesias, C. J. B., García, B. E. C., & Valarezo, J. P. P. (2025) CONTROLLED GANZ DISLOCATION. EPRA International Journal of Multidisciplinary Research (IJMR) - Peer Reviewed Journal. 11(5)1410-13. DOI: 10.36713/epra2013 [ii] researchgate.net
Guimarães, J. B., Arruda, P. H., Cerezal, L., Ratti, M. A., Cruz, I. A., Morimoto, L. R., ... & Ormond Filho, A. G. (2025). Hip Microinstability: New Concepts and Comprehensive Imaging Evaluation. RadioGraphics, 45(7), e240134. [iii] pubs.rsna.org
Kelliher, A., Welby, E., Jensen, E., & Seeley, M. (2025). Indications and Techniques for Ultrasonography of the Paediatric Orthopaedic Hip. Journal of Paediatrics and Child Health. https://doi.org/10.1111/jpc.70095 [iv] onlinelibrary.wiley.com
Atzmon, R., Belmont, S., Steen, A., & Ehud, R. (2025). Hip Instability in Sports. In Sports Injuries (pp. 1619-1636). Springer, Cham. [v] link.springer.com
Öhlin, A., Lindman, I., Karlsson, L., & Sansone, M. (2025). Hip Anatomy and Biomechanics. In Sports Injuries (pp. 1573-1580). Springer, Berlin, Heidelberg. [vi] link.springer.com
Shibata, K. R. (2025). Femoral Head Avascular Necrosis. In Orthopaedic Sports Medicine (pp. 1-16). Springer, Cham. [vii] link.springer.com
Pospíšilová, A. (2025). VÝVOJOVÁ DYSPLAZIE KYČELNÍHO KLOUBU: SOUVISLOST S BOLESTÍ BEDERNÍ PÁTEŘE. Bakalářská práce. Univerzita Palackého v Olomouci Fakulta tělesné kultury. Olomouc, 2025. [viii] theses.cz
Cohen, D., Yee, C., Jean, P. O., Duong, A., Simunovic, N., & Ayeni, O. R. (2025). Hip Labral Repair and Reconstruction in Athletes. In Sports Injuries (pp. 1659-1673). Springer, Cham. [ix] link.springer.com
Colonna, S., Tarozzi, R., D'Alessandro, A., & Casacci, F. (2025). Supine Bridge Exercise in Degenerative and Functional Hip Disorders: A Biomechanical and Therapeutic Approach (Part III). Cureus, 17(6): e85678. doi:10.7759/cureus.85678 [x] cureus.com
Akamefula, R., Hines, B., Syed, A., & Bordes, S. J. (2025). The Obturator Artery. In The Clinical Anatomy of the Vascular System (pp. 453-457). Springer, Cham. [xi] books.google
Allen, M. R., & Wallace, J. (2025). Mechanical Properties of Ligament and Tendon. In Skeletal Tissue Mechanics (pp. 293-330). Springer, Cham. [xii] link.springer.com
Manthey, L. V. F. (2025). Prevention of dislocation after total hip arthroplasty through different approaches: surgical considerations (Doctoral dissertation, Vilniaus universitetas.). [xiii] epublications.vu.lt
Fedotchenko, A. (2025). ABS0186 LECTIN HISTOCHEMISTRY OF THE LIGAMENTUM CAPITIS FEMORIS IN THE INTACT HIP JOINT DURING THE POSTNATAL PERIOD. Annals of the Rheumatic Diseases, 84, 1794. [xiv] sciencedirect.com
Ruzbarsky, J. J., Comfort, S. M., Shelton, T. J., Rutledge, J. C., Felan, N. A., Briggs, K. K., ... & Philippon, M. J. (2025). Hip Arthroscopy with Labral Repair and Capsular Closure in Patients with Joint Hypermobility does not Result in Inferior Outcomes Compared to Patients without Joint Hypermobility. Arthroscopy: The Journal of Arthroscopic & Related Surgery. https://doi.org/10.1016/j.arthro.2025.06.007 [xv] arthroscopyjournal.org
Huber, A., Picavet, P., Hamon, M., & Renberg, W. (2025) Canine craniodorsal hip luxation. MEDICINE+SURGERY360. Orthopedics. May/June 2025; dvm360. [xvi] researchgate.net
Kuhns, B. D., Chang, P. S., Brown, J., Stezelberger, V. M., Ruzbarsky, J. J., Godin, J., ... & Philippon, M. J. (2025). Validation of the Ligamentous-Fossa-Foveolar Complex (LFFC) Grading System With Clinical Correlation for Patients Undergoing Hip Arthroscopy. Orthopaedic Journal of Sports Medicine, 13(6), 23259671251340986. [xvii] journals.sagepub.com
Pullen, W. M., & Safran, M. R. (2025). Hip Instability. Orthopaedic Sports Medicine: An Encyclopedic Review of Diagnosis, Prevention, and Management, 1-14. [xviii] link.springer.com
Kodra, J. D., Healey, R., Keener, K., Papatheofanis, C., & Muldoon, M. P. (2025). Postless Hip Arthroscopy in the Lateral Decubitus Position is Safe and Associated with Low Rates of Traction-Related Complications. Arthroscopy, Sports Medicine, and Rehabilitation, 101205. [xix] arthroscopysportsmedicineandrehabilitation.org
Maidment, S. C., & Barrett, P. M. (2025). Enigmacursor mollyborthwickae, a neornithischian dinosaur from the Upper Jurassic Morrison Formation of the western USA. Royal Society Open Science, 12(6), 242195. [xx] royalsocietypublishing.org
Kahana-Rojkind, A. H., Rana, K., Kingham, Y. E., Hapa, O., Quesada-Jimenez, R., & Domb, B. G. (2025). Revision Hip Labral Reconstruction after Primary Repair Demonstrates Inferior Outcomes Compared to Matched Primary Reconstruction at Minimum 2-Year Follow-Up. Arthroscopy: The Journal of Arthroscopic & Related Surgery. https://doi.org/10.1016/j.arthro.2025.06.022 [xxi] arthroscopyjournal.org
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[i] This scoring system evaluates MRI findings of osteoarthritis (articular cartilage damage, subchondral cystic change, subchondral edema, labral pathology, intra-articular loose bodies, ligamentum teres damage, and joint effusion) according to discrete geographic zones that are then combined to form a total score. This grading system was subsequently validated on longitudinal MRI studies as well as visually through hip arthroscopy, but has not currently been utilized to compare patients receiving either hip preservation or arthroplasty surgery
Developed by Lee et al, the SHOMRI grading scale evaluates eight features of osteoarthritis that can be assessed on advanced imaging (Table 1) [9]. These features include articular cartilage, bone marrow edema, subchondral cysts, labral pathology, ligamentum teres pathology, paralabral cysts, intra-articular loose bodies, and joint effusion. Of these features, articular cartilage loss, bone marrow edema patterns, and subchondral cysts were all individually graded on 10 femoral and acetabular subregions. The femoral head was divided into six subregions (anterior, lateral, superolateral, superomedial, inferior, posterior), and the acetabulum was into four subregions (anterior, superolateral, superomedial, posterior; Fig. 4). Labral abnormalities were scored within four distinct geographic regions (anterior, posterior, anterosuperior, superior). A score is calculated for each of the above-named features separately and then added to the globally graded features (intra-articular loose bodies, ligamentum teres damage, paralabral cysts) to generate a total score.
Table 3. Reliability analysis showing ICC scoring for SHOMRI features between four reviewers.
Ligamentum teres ICC value 0.81 95% CI 0.71–0.88
Twelve subjects in the hip preservation group (44%) had evidence of subchondral cysts that were located primarily in the anterior acetabulum (9/12; 75%) and femoral head–neck junction (3/12; 25%). Differences in labral pathology, ligamentum teres damage, or loose bodies were not significant between the groups (P > 0.05). All subjects in the THA cohort had evidence of labral pathology on SHOMRI scoring (11.5 ± 3.7; range 5–18).
Table 4. Differences in SHOMRI scores between patients undergoing hip preservation and hip arthroplasty.
Ligamentum teres
Hip preservation 1.3 ± 0.7 (0–2)
Hip arthroplasty 1.4 ± 0.8 (0–2)
P. <. 6
[ii] The incision begins at the anterior edge of the acetabulum and curves posteriorly along the acetabular rim, proximal to the labrum. At this point, the joint is exposed. The round ligament is cut and, using a combined external rotation and flexion maneuver, controlled dislocation of the hip is performed. A hook may be used to facilitate dislocation of the femoral head.
[iii] Ligamentum Teres. — The LT is a pyramidal soft-tissue structure that originates from the transverse cetabular ligament and posterior inferior acetabular fossa and inserts into the femoral head at the foveal capitis. The LT works as a secondary static stabilizer of the hip by acting as a sling to prevent subluxation of the femoral head …
… hip flexion, adduction, and external rotation, which results in less soft-tissue constraint in a more stable position, with an additional contribution from ligamentum teres …
[iv] [ultrasound examination.] In this view, the anatomic features that can be identified include the acetabular cartilage, the gluteus muscles, the greater trochanter, the cartilaginous femoral head, the ischium, labrum, the ligamentum teres, femoral metaphysis, pubis, …
[v] Once thought to be a redundant structure in the adult hip, the ligamentum teres (LT) is now thought to play an important role in hip joint stability. The ligamentum teres moves synchronously with the femoral head’s range of motion. It coils around the femoral head …
[vi] Between the apex of the acetabular notch and the fovea capitis femoris runs an intra-articular ligament an intra-articular ligament called the ligamentum teres. The role of the ligamentum teres as a stabilizer has been discussed, and recent research has suggested a more prominent role in hip joint stability than earlier thought of, …
Ligamentum teres carries a small branch of the obturator artery, which supplies the femoral head …
[vii] The blood supply of the femoral head derives primarily from the medial femoral circumflex artery with secondary contributions from the foveal ligament (ligamentum teres), lateral femoral circumflex, and inferior gluteal arteries.
[viii] Na labrum navazují ligamentum (lig.) transversum acetabuli, které je v podstatě součástí labra přemosťující incisuru acetabuli a lig. capitis femoris – intraartikulární vaz, který odstupuje z lig. transversum acetabuli a upíná se do fovea capitis femoris. V oblasti incisury tvoří tato ligamenta téměř jednotnou strukturu, což má velký význam při rozvoji patologických změn limbu u VDK.
[ix] …, semitendinosus allograft or gracilis autograft was used in 12.5% of hips, ligamentum capitis femoris graft in 5% of hips, peroneus brevis allograft in 4% of hips, labrum allograft in 3% of hips, and indirect head of rectus femoris autograft in 3% of …
[x] An intact hip joint possesses a high degree of intrinsic multiplanar mobility. Stabilizing structures include the acetabular labrum, ligamentum teres, iliofemoral, ischiofemoral, and pubofemoral ligaments, the joint capsule [24,25], the iliopsoas tendon [26], the rectus femoris tendon [27], and the iliocapsularis muscle [28].
25. Bolia I, Chahla J, Locks R, Briggs K, Philippon MJ: Microinstability of the hip: a previously unrecognized pathology. Muscles Ligaments Tendons J. 2016, 6:354-60.
26. Philippon MJ: The role of arthroscopic thermal capsulorrhaphy in the hip. Clin Sports Med. 2001, 20:817-30. 10.1016/S0278-5919(05)70287-8
27. Mechó S, Iriarte I, Pruna R, Pérez-Andrés R, Rodríguez-Baeza A: A newly discovered membrane at the origin of the proximal tendinous complex of the rectus femoris. Surg Radiol Anat. 2022, 44:835-43. 10.1007/s00276-022-02954-3
28. Babst D, Steppacher SD, Ganz R, Siebenrock KA, Tannast M: The iliocapsularis muscle: an important stabilizer in the dysplastic hip. Clin Orthop Relat Res. 2011, 469:1728-34. 10.1007/s11999-010-1705-x
[xi] Posterior Branch [obturator artery] (Extrapelvic)
This branch courses alongside the posterior margin of the obturator canal. It then deviates as it reaches the inferior ramus of the ischium to anastomose with the anterior division of the obturator artery. Although this branch typically is not the main blood supply for any dedicated musculature, the posterior branch of the obturator artery has been seen to partially perfuse muscles that attach to the ischial tuberosity, such as the ischiocavernosus and the ligamentum teres. This branch has been seen as anastomosing with the inferior gluteal artery.
[xii] … femoral head tethered to the socket-shaped acetabulum of the pelvis by a short ligament, … , the residual force in the acetabulum pops the femoral head partially back out of the joint.
Elastic modulus values reported for tendon and ligament range between 1.0 and 2.0 GPa;
[xiii] Within the joint, the so-called ligamentum teres connects the head of the cotyloid notch to the fovea of the femoral head. Its vascular contribution is minimal in adults but carries the foveal artery a branch of the posterior division of the obturator artery that is essential for the blood supply of the femoral head in infants and children.
„Injuries to the ligamentum teres can occur in dislocations, which can cause lesions of the foveal artery, resulting in osteonecrosis of the femoral head” (13).
13. Gold M MA, Varacallo MA. Anatomy, Bony Pelvis and Lower Limb, Hip Joint. StatPearls. Updated 2023 Jul 25.
[xiv] The ligamentum capitis femoris (LCF) is an important hip joint structure.
Objectives:
This study aimed to examine the distribution of lectin receptors in the normal LCF during the postnatal period.
Conclusion:
The distribution of lectin receptors in the LCF is similar to the joint capsule. The lectin histochemistry of the marginal cartilaginous zone (MCZ) directly contacting the LCF, in turn, is similar to the marginal cartilage of the hip joint marginal transitional zone. The phenomenon of “pale areas” and the subsequent hyperexpression of lectins at the point of attachment of the LCF to the articular cartilage, by analogy with the marginal cartilage (Figure 1C, E, F), apparently plays the role of an innate non-specific lectin-mediated immunobiological barrier that would prevent excessive invasion of the LCF into the cartilage and might be relevant in immunoinflammatory diseases of the hip joint.
[Lectin receptors are a family of proteins that play a crucial role in the immune system and other biological processes by binding to specific carbohydrates on cell surfaces. They are involved in both innate and adaptive immunity, recognizing both foreign and endogenous molecules. Lectin receptors can be found on various immune cells and are crucial for processes like pathogen recognition, cell adhesion, and immune response regulation.]
[xv] Additional procedures were performed including, but not limited to; capsular treatment, bursectomy, ligamentum teres debridement, synovectomy, microfracture, and chondral treatment
[xvi] Hip luxation occurs when the femoral head moves from its position in the acetabulum to a resting position that is either craniodorsal or caudoventral. To prevent this from occurring, the ligament of the head of the femur, the dorsal acetabular rim, and the joint capsule act as major stabilizers of the hip. (1)
1. Harper T. Coxofemoral luxation: tips for closed reductions. University of Illinois Urbana-Champaign College of Veterinary Medicine. April 13, 2021. Accessed May 15, 2025. https://vetmed.illinois.edu/2021/04/13/coxofemoral-luxation-tips-for-closed-reductions/
[xvii] While the primary diagnostic and therapeutic focus for central compartment lesions has been the treatment of chondrolabral injury, there is frequently concomitant damage to the structures within the acetabular fossa, including the ligamentum teres (LT), pulvinar tissue within the cotyloid fossa, and perifoveal cartilage, all of which are also possible pain generators.
Multiple classification systems exist describing LT pathology, but they are limited in scope as well as by reproducibility with inter- and intraobserver agreement (kappa) values ranging from 0.39 to 0.74. (1,4,9,16,18) To address this, a recent study by Stetzelberger et al (21) proposed a comprehensive grading system for the LFFC [ligamentous-fossa-foveolar complex] that was validated for patients undergoing open hip preservation with surgical hip dislocation. The authors evaluated the LT, cotyloid fossa, and perifoveolar cartilage, grading lesions on a scale of 0 (normal) to 4 (complete defect) (Appendix Table A1) reporting excellent intraobserver and interobserver reliability.
4. Devitt BM, Smith B, Stapf R, Jo S, O’Donnell JM. The reliability of commonly used arthroscopic classifications of ligamentum teres pathology. J Hip Preserv Surg. 2017;4(2):187-193.
9. Gray AJR, Villar RN. The ligamentum teres of the hip: an arthroscopic classification of its pathology. Arthroscopy. 1997;13(5):575-578.
16. O’Donnell JM, Arora M. A novel and simple classification for ligamentum teres pathology based on joint hypermobility. J Hip Preserv Surg. 2017;5(2):113-118.
18. Salas AP, O’Donnell JM. Ligamentum teres injuries—an observational study of a proposed new arthroscopic classification. J Hip Preserv Surg. 2015;2(3):258-264.
21. Stetzelberger VM, Zurmühle CA, Hanauer M, et al. Reliability and reproducibility of a novel grading system for lesions of the ligamentous-fossa-foveolar complex in young patients undergoing open hip preservation surgery. Orthop J Sports Med. 2022;10(6):23259671221098750.
LFFC Imaging
During the diagnostic portion of the procedure, the central compartment was visualized through a 70° arthroscope (4K; Smith & Nephew) through the traditional anterolateral and midanterior portals with the lower extremity in internal rotation. The lower extremity was then externally rotated to tension the LT allowing for improved visualization and further evaluation of related pathology. An arthroscopic probe was used to evaluate perifoveal cartilage quality and LT integrity. Viewing from the midanterior portal, 3 separate images used for grading were obtained focusing on the LT, perifoveal cartilage, and cotyloid fossa, respectively.
[xviii] The ligamentum teres is a noncapsular ligament within the hip articulation, originating from the transverse acetabular ligament within the acetabular notch and inserts into the femoral fovea, posterior and inferior to the central portion …
[xix] All surgical procedures were performed with patients positioned in lateral decubitus while using a Stryker Guardian postless hip distractor (Kalamazoo, MI). Conditions addressed included labral pathology, femoroacetabular impingement syndrome (FAIS), chondral injuries, ligamentum teres pathology, and intra-articular adhesions. No additional intra-articular pathologies were treated beyond those listed. Adequate distraction was ensured prior to initiation of hip arthroscopy and intraoperative force and duration of traction were measured. Postoperative complaints were monitored over the course of three months during clinic visits at 2 weeks, 6 weeks, and 12 weeks status post arthroscopy.
Hip arthroscopy included various combinations of femoroplasty, acetabuloplasty, and labral repair (Table 3). These procedures treated labral pathology, FAIS, chondral injuries, ligamentum teres pathology, and intra-articular adhesions.
Table 3
Hip Arthroscopy Traction Time and Complication Rates by Primary Procedure(s) Performed
Additional central compartment procedures included labral debridement, chondroplasty, ligamentum teres debridement, lysis of adhesions, and loose body removal
[xx] Diagnosis — Enigmacursor mollyborthwickae differs from all other ornithischian dinosaurs in possessing the following unique combination of features and one potential autapomorphy (the latter marked with an asterisk): … (5) absence of a ligament sulcus on the posterior surface of the femoral head…
The possession of character 3 is a feature generally considered to be a neornithischian synapomorphy [28], but other early diverging neornithischians, such as Jeholosaurus shangyuanensis, Haya griva and Hypsilophodon foxii, lack character 4, as the anterior trochanter commonly projects much further dorsally in these taxa (figure 1h,k), and character 5, as a deep and well-developed ligament sulcus is present (figure 1g,j) [29–31].
Figure 1. (a,d,g,j) The proximal end of the femur in posterior view showing the presence of a trochanteric fossa, tf, in all but Lesothosaurus, and the presence of a ligament sulcus, ls, in Hypsilophodon and Dysalotosaurus that is absent in Enigmacursor and Lesothosaurus.
[xxi] Surgical Technique:
All surgical procedures were performed by the senior author (B.G.D). Each patient was positioned in a modified supine position without a traction post. For each arthroscopy, a minimum of two portals were used (the anterolateral and mid-anterior portal). Other portals were used on a case-by-case basis. Interportal capsulotomy using a blade was used to access the joint. While in the joint, diagnostic arthroscopy was used to initially assess the labrum, intra-articular cartilage, and ligamentum teres. Labral tears were classified using the Seldes classification system. 19 Femoral-head chondral pathologies were noted with the acetabular labrum articular disruption (ALAD) and Outerbridge classifications.20,21 Tears of the ligamentum teres were defined using the Domb and Villar classifications.22,23
22. Botser, I.B. Martin, D.E. Stout, C.E. ... Tears of the Ligamentum Teres: Prevalence in Hip Arthroscopy Using 2 Classification Systems Am J Sports Med. 2011; 39:117-125
23. O’Donnell, J.M. Arora, M. A novel and simple classification for ligamentum teres pathology based on joint hypermobility J Hip Preserv Surg. 2018; 5:113-118
[Revision Hip Labral Reconstruction after Primary Repair]
Table 3. Intraoperative Findings and Procedures
LT Treatment
Debridement:
Primary Reconstruction 15 (20.0%)
Revision Reconstruction 8 (10.7%)
p 0.11
Reconstruction:
Primary Reconstruction 2 (2.7%)
Revision Reconstruction 2 (2.7%)
p >0.99
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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