Content
Abstract of the article: Englert G et al. Open Reduction With Ligamentum
Teres Reconstruction—Preliminary Results of a Novel Technique for the
Management of Pediatric Developmental Dysplasia of Hip). The article describes
the ligamentum capitis femoris (LCF) reconstruction through the femoral tunnel
for hip dysplasia. The text in Russian is available at the following link:
Abstract
Background:
The primary goal in the
management of developmental dysplasia of the hip (DDH) is to obtain and
maintain a stable, concentrically reduced hip via closed or open techniques
while limiting iatrogenic risk. Recent studies suggest a 7% risk of recurrent
instability following open reduction (OR) of idiopathic DDH and even higher
rates of recurrent instability and complications with the management of
neuromuscular or syndromic DDH. This study describes a novel technique of
ligamentum teres reconstruction (LTR) performed during OR of idiopathic and
nonidiopathic DDH.
Methods:
This is a prospective cohort
study of 49 consecutive patients (61 hips) who underwent LTR with OR as an index
procedure via a single surgeon from 2020 to 2024. The procedure combines an
anterior and limited lateral approach with the use of a suture button device
passed through a femoral tunnel and flipped along the inner table of the
pelvis, inferior and posterior to the triradiate physis. Demographics,
radiographic severity, and short-term outcomes were analyzed. Exclusion
criteria included surgery performed in a revision setting (4 patients/4 hips),
nonstandard implant (2 patients/2 hips), and <1 year follow-up (10
patients/14 hips).
Results:
A total of 33 patients (41
hips) met inclusion criteria—18 patients (21 hips) with idiopathic DDH and 15
patients (20 hips) with nonidiopathic DDH. Average follow-up was 27.6 months
for idiopathic and 21.9 months for nonidiopathic patients. In the idiopathic
cohort, all patients exhibited grade III or IV DDH. No loss of reduction or
hardware failure occurred, and 5% of patients sustained minor complications. In
the nonidiopathic cohort, only one loss of reduction was noted (5%).
Discussion:
The addition of LTR via a
suture button device to OR demonstrates excellent short-term outcomes,
including maintenance of reduction and low complication rates. Further studies
are warranted to investigate the long-term effect on acetabular remodeling,
range of motion, need for postoperative immobilization, and risk of iatrogenic
avascular necrosis and future growth disturbance.
Taylor IK, Burlile
JF, Schaeffer EK, et al. Developmental dysplasia of the hip: an examination of
care practices of pediatric orthopaedic surgeons in North America. J Pediatr
Orthop. 2020;40:e248–e255.
Yang S, Zusman N,
Lieberman E, et al. Developmental dysplasia of the hip. Pediatrics.
2019;143:e20181147.
Sankar WN,
Gornitzky AL, Clarke NMP, et al. Closed reduction for developmental dysplasia
of the hip: early-term results from a prospective, multicenter cohort. J
Pediatr Orthop. 2019;39:111–118.
Davids JR.
Management of neuromuscular hip dysplasia in children with cerebral palsy:
lessons and challenges. J Pediatr Orthop. 2018;38(suppl 1):S21–S27.
Maranho DA, Fuchs
K, Kim YJ, et al. Hip instability in patients with down syndrome. J Am Acad
Orthop Surg. 2018;26:455–462.
Kiani SN, Gornitzky
AL, Matheney TH, et al. A prospective, multicenter study of developmental
dysplasia of the hip: what can patients expect after open reduction? J Pediatr
Orthop. 2023;43:279–285.
Wenger DR, Mubarak
SJ, Henderson PC, et al. Ligamentum teres maintenance and transfer as a
stabilizer in open reduction for pediatric hip dislocation: surgical technique
and early clinical results. J Child Orthop. 2008;2:177–185.
Magister SJ, Liu
RW. Use of a suture anchor technique to replace the tethering effect of the
ligamentum teres in the treatment of complex hip dysplasia. Orthopedics.
2020;43:e480–e485.
Castañeda P,
Tejerina P, Nualart L, et al. The safety and efficacy of a transarticular pin
for maintaining reduction in patients with developmental dislocation of the hip
undergoing an open reduction. J Pediatr Orthop. 2015;35:358–362.
Doski J, Mosa L,
Hassawi Q. An upgrade of the international hip dysplasia institute
classification for developmental dysplasia of the hip. Clin Orthop Surg.
2022;14:141–147.
Yagmurlu MF, Bayhan
IA, Tuhanioglu U, et al. Clinical and radiological outcomes are correlated with
the age of the child in single-stage surgical treatment of developmental
dysplasia of the hip. Acta Orthop Belg. 2013;79:159–165.
Kim HT, Kim JI, Yoo
CI. Acetabular development after closed reduction of developmental dislocation
of the hip. J Pediatr Orthop. 2000;20:701–708.
Chen IH, Kuo KN,
Lubicky JP. Prognosticating factors in acetabular development following
reduction of developmental dysplasia of the hip. J Pediatr Orthop. 1994;14:3–8.
Akagi S, Tanabe T,
Ogawa R. Acetabular development after open reduction for developmental
dislocation of the hip. 15-year follow-up of 22 hips without additional
surgery. Acta Orthop Scand. 1998;69:17–20.
Abousamra O,
Deliberato D, Singh S, et al. Closed vs open reduction in developmental
dysplasia of the hip: The short-term effect on acetabular remodeling. J Clin
Orthop Trauma. 2020;11:213–216.
Bache CE, Graham
HK, Dickens DR, et al. Ligamentum teres tenodesis in medial approach open
reduction for developmental dislocation of the hip. J Pediatr Orthop.
2008;28:607–613.
DiFazio R, Vessey
J, Zurakowski D, et al. Incidence of skin complications and associated charges
in children treated with hip spica casts for femur fractures. J Pediatr Orthop.
2011;31:17–22.
Kocher MS, Ciarlo
ML, Feroe AG, et al. Impact on family functioning of immediate spica casting
for pediatric femur fractures: an ecological study. J Pediatr Orthop Soc North
Am. 2022;4:389.
Heffernan MJ,
Barnett SA, Nungesser ME, et al. The impact of cast immobilization on return to
daycare. J Pediatr Orthop. 2021;41:571–575.
Hughes JL, Bomar
JD, Wenger DR, et al. Treatment of hip instability in children with down
syndrome: keys to managing a challenging problem. J Pediatr Orthop.
2022;42:e174–e180.
Desai VM,
DeFrancesco CJ, Cardin S, et al. Outcomes of open reduction for hip
dislocations in children with connective tissue disorders. J Child Orthop.
2024;18:583–589.
Wada A, Nakamura T,
Yamaguchi T, et al. Surgical treatment of hip dislocation in Kabuki syndrome:
use of incomplete periacetabular osteotomy for posterior acetabular wall
deficiency. J Child Orthop. 2012;6:261–267.
Benedick A, Bazar
B, Zirkle LG, et al. Retrograde intramedullary nailing of pediatric femoral
shaft fractures does not result in growth arrest at the distal femoral physis-a
retrospective cases series. J Orthop Trauma. 2021;35:e405–e410.
Yoo WJ, Kocher MS,
Micheli LJ. Growth plate disturbance after transphyseal reconstruction of the
anterior cruciate ligament in skeletally immature adolescent patients: an MR
imaging study. J Pediatr Orthop. 2011;31:691–696.
Weinstein SL, Dolan
LA. Proximal femoral growth disturbance in developmental dysplasia of the hip:
what do we know?. J Child Orthop.
2018;12:331–341.
Englert G, Mansour A, Strub D, Badowski E, Tulchin-Francis K, Kadado A, Smith
C, Klingele K. Open Reduction With Ligamentum Teres Reconstruction—Preliminary
Results of a Novel Technique for the Management of Pediatric Developmental
Dysplasia of Hip. Journal of Pediatric Orthopaedics. 2025;45(10)e889-97. pubmed.ncbi.nlm.nih.gov , journals.lww.com
Graham Englert – Department of
Orthopedic Surgery, Center for Hip Preservation, Nationwide Children's Hospital
Adam Mansour – Department of
Orthopedic Surgery, Center for Hip Preservation, Nationwide Children's Hospital
Daryn Strub – Department of
Orthopedic Surgery, Center for Hip Preservation, Nationwide Children's Hospital
Elizabeth Badowski – Department of
Orthopedic Surgery, Center for Hip Preservation, Nationwide Children's Hospital
Kirsten Tulchin-Francis – Department of Orthopedic Surgery, Center for Hip
Preservation, Nationwide Children's Hospital. Department of Orthopedic Surgery,
Center for Orthopedic Innovation, Nationwide Children's Hospital, Columbus, OH.
Allen Kadado – Department of Orthopedic Surgery, Center for Hip
Preservation, Nationwide Children's Hospital. Department of Orthopedic Surgery,
Center for Orthopedic Innovation, Nationwide Children's Hospital, Columbus, OH.
Craig Smith – Department of Orthopedic Surgery, Center for Hip
Preservation, Nationwide Children's Hospital. Department of Orthopedic Surgery,
Center for Orthopedic Innovation, Nationwide Children's Hospital, Columbus, OH.
Kevin Klingele –Department of Orthopedic Surgery, Center for Hip
Preservation, Nationwide Children's Hospital. Department of Orthopedic Surgery,
Center for Orthopedic Innovation, Nationwide Children's Hospital, Columbus, OH.
ligamentum capitis femoris, ligamentum teres, ligament of head of femur, pathology, congenital dislocation, dislocation, plastic surgery, reconstruction, open plastic surgery
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
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