Content
Abstract of the article: Sarassa C. et al. Intraosseous
Tunneling and Ligamentum Teres Ligamentodesis “Teretization” to Enhance
Stability in Congenital Hip Dislocation Surgery: Surgical Technique and
Mid-Term Outcomes (2025). The article describes a technique for
fixing the femoral head using the ligamentum capitis femoris (LCF) in
congenital hip dislocation. The text in Russian is available at the following
link: 2025SarassaC_HerreraAM.
Abstract
Background
Developmental dysplasia of the hip (DDH) with
complete dislocation (grade ≥III) in older patients often requires open
reduction. However, achieving long-term stability remains challenging. This
study introduces and evaluates a novel surgical technique, intraosseous
tunneling and ligamentodesis of the ligamentum teres (LT), conceived to enhance
postoperative hip stability while preserving the ligament’s anatomic course.
Methods
Pediatric patients with grade ≥III DDH, as
classified by the International Hip Dysplasia Institute (IHDI), underwent open
reduction using a novel ligamentum teres ligamentodesis technique to enhance
joint stability. The ligament was detached, sutured, and tunneled
intraosseously from the fovea to the greater trochanter, then anchored to the
periosteum. Postoperative evaluation included gait status, pain, hip range of
motion, reluxation, residual dysplasia, avascular necrosis (AVN), physeal bars,
growth arrest, complications, and need for reintervention.
Results
Nineteen hips in 16 patients (14 females, 2
males) with a median age of 24 months underwent LT intraosseous ligamentodesis
combined with femoral and pelvic osteotomies. At a median follow-up of 23
months, all patients were pain-free, had normal gait, and no functional
limitations, except for one case of persistent limping and one hip with mild
limitation of abduction. Radiographically, all hips achieved satisfactory
outcomes with IHDI type I, and severing grades I (80%) and II (20%). No cases
of redislocation, dysplasia, infection, physeal bars, or growth arrest were
observed. Two hips (10.5%) developed asymptomatic AVN.
Conclusions
The ligamentum teres intraosseous
ligamentodesis (“Teretization”) is a safe and technically feasible adjunct to
open reduction in severe DDH, demonstrating favorable mid-term outcomes with no
redislocations and low complication rates. These findings support its potential
role in enhancing hip stability without jeopardizing femoral head physis and
vascularity.
Level of Evidence
Level IV—therapeutic case series. This study
evaluates a novel surgical technique in a series of patients with congenital
hip dislocation without a control group.
Noordin S, Umer M, Hafeez K, et al. Developmental
dysplasia of the hip. Orthop Rev. 2010;2:e19.
Zhou W, Sankar WN, Zhang F, et al. Evolution
of concentricity after closed reduction in developmental dysplasia of the hip. Bone
Joint J. 2020;102-B:618–626.
Castañeda P, Moscona L, Masrouha K.
The effect of femoral shortening in the treatment of developmental dysplasia of
the hip after walking age. J Child Orthop. 2019;13:371–376.
Garcia S, Demetri L, Starcevich A,
et al. Developmental dysplasia of the hip: controversies in management. Curr
Rev Musculoskelet Med. 2022;15:272–282.
Zhang Z, Li H, Li H, et al. Timing
for closed reduction procedure for developmental dysplasia of the hip and its
failure analysis. BMC Musculoskelet Disord. 2020;21:613.
Alexiev V, Georgiev H, Mileva S.
Middle term results of simple open hip reduction of irreducible DDH - what is
the cut-off age to safely perform it with lower complications? Acta Chir
Orthop Traumatol Cech. 2017;84:386–390.
Ergin ON, Demirel M, Meric E, et al.
A comparative study of clinical and radiological outcomes of open reduction using
the anterior and medial approaches for the management of developmental
dysplasia of the hip. Indian J Orthop. 2021;55:130–141.
Antonio Redón Tavera M, Saúl Renán
León Hernández M, Cleva Villanueva López G, et al. Ligamentopexia del ligamento
redondo al acetábulo. Reluxación y necrosis postoperatorias en la cadera
congénita. Rev Mex Ortop Ped. 2012;14:17–25.
Bache CE, Graham HK, Dickens DRV, et
al. Ligamentum teres tenodesis in medial approach open reduction for
developmental dislocation of the hip. J Pediatr Orthop. 2008;28:607–613.
Gardner ROE, Bradley CS, Sharma OP,
et al. Long-term outcome following medial open reduction in developmental
dysplasia of the hip: a retrospective cohort study. J Child Orthop.
2016;10:179–184.
Li T, Zhang M, Wang H, et al. Absence
of ligamentum teres in developmental dysplasia of the hip. J Pediatr
Orthop. 2015;35:708–711.
Martin RL, Palmer I, Martin HD. Ligamentum
teres: a functional description and potential clinical relevance. Knee
Surg Sports Traumatol Arthrosc. 2012;20:1209–1214.
Paez C, Badrinath R, Holt J, et al. Ligamentum
teres transfer during medial open reduction in patients with developmental
dysplasia of the hip. Iowa Orthop J. 2021;41:47–53.
Kivlan BR, Richard Clemente F,
Martin RL, et al. Function of the ligamentum teres during multi-planar movement
of the hip joint. Knee Surg Sports Traumatol Arthrosc.
2013;21:1664–1668.
Dehao BW, Bing TK, Young JLS. Understanding
the ligamentum teres of the hip: a histological study. Acta Ortop Bras.
2015;23:29–33.
Wenger D, Firoz Miyanji Þ, Mahar A,
et al. The mechanical properties of the ligamentum teres: a pilot study to
assess its potential for improving stability in children’s hip surgery. J
Pediatr Orthop. 2007;27:408–410.
Hosalkar HS, Varley ES, Glaser D, et
al. Isocentric reattachment of ligamentum teres. J Pediatr Orthop.
2011;31:847–852.
Abibe RB, Rahal SC, Reis Mesquita
LD, et al. Ligamentum teres reconstruction using autogenous semitendinosus tendon
with toggle technique in rabbits. PeerJ. 2023;11:e14777.
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.
Youssef AO. Medial approach open
reduction with ligamentum teres partial excision and plication for the
management of congenital hip dislocation. J Pediatr Orthop B.
2018;27:244–249.
Dodds MK, Lee J, McCormack D.
Transarticular stabilization of the immature femoral head. J Pediatr
Orthop. 2008;28:36–42.
Narayanan U, Mulpuri K, Sankar WN,
et al. Reliability of a new radiographic classification for developmental
dysplasia of the hip. J Pediatr Orthop. 2015;35:478–484.
Mckay DW. A comparison of the
innominate and the pericapsular osteotomy in the treatment of congenital
dislocation of the hip. Clin Orthop Relat Res. 1974;98:124–132.
Baghdadi S, Sankar WN. Residual
acetabular dysplasia in the reduced hip. Indian J Orthop. Springer;
2020;55:1480–1489.
SEVERIN E. Congenital dislocation of
the hip; development of the joint after closed reduction. J Bone Joint
Surg Am. 1950;32-A:507–518.
Kalamchi A, MacEwen GD. Avascular
necrosis following treatment of congenital dislocation of the hip. J
Bone Joint Surg Am. 1980;62:876–888.
Watson-Jones R. Fractures of the
neck of the femur. J Br Surg. 1936;23:787–808.
O’Donnell JM, Pritchard M, Salas AP,
et al. The ligamentum teres–its increasing importance. J Hip Preserv
Surg. 2014;1:3–11.
Vitale MG, Skaggs DL. Developmental
dysplasia of the hip from six months to four years of age. J Am Acad
Orthop Surg. 2001;9:401–411.
Sankar WN, Young CR, Lin AG, et al. Risk
factors for failure after open reduction for DDH. J Pediatr Orthop.
2011;31:232–239.
Thomas SR, Wedge JH, Salter RB. Outcome
at forty-five years after open reduction and innominate osteotomy for
late-presenting developmental dislocation of the hip. J Bone Joint Surg.
2007;89:2341–2350.
Umer M, Nawaz H, Kasi PM, et al. Outcome
of triple procedure in older children with developmental dysplasia of hip
(DDH). J Pak Med Assoc. 2007;57:591–595.
Galpin RD, Roach JW, Wenger DR, et
al. One-stage treatment of congenital dislocation of the hip in older children,
including femoral shortening. J Bone Joint Surg Am. 1989;71:734–741.
Makela E, Vainionpaa S, Vihtonen K,
et al. The effect of trauma to the lower femoral epiphyseal plate. An
experimental study in rabbits. J Bone Joint Surg Br. 1988;70-B:187–191.
Seil R, Pape D, Kohn D. The risk of
growth changes during transphyseal drilling in sheep with open physes. Arthroscopy.
2008;24:824–833.
Knapik DM, Zirkle LG, Liu RW. Consequences
following distal femoral growth plate violation in an ovine model with an
intramedullary implant: a pilot study. J Pediatr Orthop.
2018;38:e640–e645.
Darwich A, Geiselhardt C, Bdeir M,
et al. Anthropometry of the proximal femur and femoral head in
children/adolescents using three-dimensional computed tomography-based
measurements. Surg Radiol Anat. 2021;43:2009–2023.
Bertocci G, Brown NP, Thompson A, et
al. Femur morphology in healthy infants and young children. Clin Anat.
2022;35:305–315.
Elzohairy MM, Elhefnawy MM, Khairy
HM. Revision of failed open reduction of developmental dysplasia of the hip. Clin
Orthop Surg. 2020;12:542.
Alassaf N. Predictors of femoral
shortening for pediatric developmental hip dysplasia surgery: an observational
study in 435 patients. Patient Saf Surg. 2018;12:29.
Türközü T. One-stage combined
surgical treatment of developmental dysplasia of the hip in the children aged
over 18 months. Cyprus J Med Sci. 2023;8:328–333.
Willis MC. Medical Terminology: The
Language of Health Care. Goucher J. 1st ed. Baltimore: Lippincott Williams
& Wilkins; 1996:1–631.
Oxford Latin Dictionary : OXFORD
UNIVERSITY PRESS : Free Download, Borrow, and Streaming : Internet Archive.
Accessed July 22,2025. archive.org
Online Etymology Dictionary.
Accessed July 22,2025. etymonline.com
A Dictionary Of Linguistics And Phonetics : Free Download, Borrow, and Streaming : Internet Archive. Accessed July 22,2025. archive.org
Sarassa C, Aristizabal S, Mejía R,
García JJ, Quintero D, Herrera AM. Intraosseous Tunneling and Ligamentum Teres
Ligamentodesis “Teretization” to Enhance Stability in Congenital Hip
Dislocation Surgery: Surgical Technique and Mid-Term Outcomes. Journal of
Pediatric Orthopaedics. 2025 Dec 4. doi: 10.1097/BPO.0000000000003189 journals.lww.com
Carlos
Sarassa – Department
of Pediatric Orthopaedics and Traumatology, Clínica del Campestre. Department
of Children's Orthopaedics, Fundación Clínica Noel, Medellín.
Simon
Aristizabal – Department of Pediatric Orthopaedics and Traumatology, Clínica del
Campestre. Department of Children's Orthopaedics, Fundación Clínica Noel,
Medellín.
Roiman Mejía – Department of
Orthopaedics and Traumatology, Fundación Valle del Lili, Cali, Colombia.
Juan J García – Department of
Children's Orthopaedics, Fundación Clínica Noel, Medellín.
Daniel
Quintero – Department
of Pediatric Orthopaedics and Traumatology, Clínica del Campestre. Department
of Children's Orthopaedics, Fundación Clínica Noel, Medellín.
Ana M
Herrera – Department
of Epidemiology and Clinical Research, Clínica del Campestre.
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
Comments
Post a Comment