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Fragment from the article: Groves EH. Some contribution to the reconstruction surgery of the hip (1927). The author describes fixation of the femoral head by creating a ligamentum capitis femoris (LCF) from the joint capsule during reduction of congenital hip dislocation. The text in Russian is available at the following link: 1927HeyGrovesEH.
Quote, pp. 511-513.
In the one method stability is secured by gouging out a deep acetabulum, but with a great sacrifice of the mobility of the joint; in the other free movement is retained in a loose joint, the stability of which is uncertain by constructing a new acetabular shelf. I still believe that by further improvement in the technique we shall be able to attain both mobility and stability at the same time. The deepening of the socket is clearly an essential step in securing stability and will always be more efficient than building up a new acetabular rim. How, then, can the fibrous union between the head of the femur and the new socket be prevented? I am trying to effect this by the following method (Fig. 352). After exposing the head of the femur lying inside the capsule, the latter is not slit open, but its attachment to the rim of the acetabulum is cut away and the constricted part of the capsule is sewn together by a stout ligature so as to enclose the head of the femur by a bag which has an exuberant margin beyond the ligature. The new socket is then made by gouging out of the acetabulum freely. The floor of this new socket is perforated by a twist-drill, the point of which is controlled by the finger inserted under Poupart’s ligament and the iliacus muscle. By means of a suitably curved aneurysm needle a stout tendinous ligature is passed over the pelvic brim, through the hole in the acetabulum, and out into the thigh. The ligature is tied to the free margin of the capsule, the whole femoral head inside the capsule is placed in the new socket, and the free margin of capsule is firmly anchored to the brim of the pelvis or to Poupart’s ligament. Thus, although the new socket has been deprived of its cartilage lining, it is now lined by capsule and the head of the bone is still surrounded by its original synovial sac; and, further, the strong capsular ligament with its new attachment will serve to anchor the femur to its socket instead of allowing it to wander away (Figs. 353, 354).
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| Fig. 352. — Diagram showing deepened acetabulum with the whole capsule detached from the rim of the socket and used to anchor the heed in its new bed. A, New acetabulum; B, Capsule; C, Synovial cavity; D, Sutures fixing capsule round the head and brought through the floor of the acetabulum. |
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| Fig. 353. — Diagram of operation for transplanting capsule inside the acetabulum. A, New acetabulum ; B. Cut edges of capsule being sewn together by sutures, which are left long and then taken through a hole in floor of the acetabulum. |
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| Fig. 354. — Shows sutures drawing the capsule into its now position lining the acetabulum. |
Hey Groves EW. Some contribution to the reconstructive surgery of the hip. Brit. J. Surg. 1927;14(55)486-517. academic.oup.com
Ernest William Hey Grove (1872–1944) was a MSc, FRCS, Professor of Surgery at the University of Bristol. wikipedia.org
ligamentum capitis femoris, ligamentum teres, ligament of head of femur, plastic surgery, reconstruction, congenital dislocation, pathology
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