Arkhipov SV. A Novel Technique for Proximal Fixation of Ligamentum Capitis Femoris Reconstruction: The Gifts of the Magi for Orthopedic Surgeons. About Round Ligament of Femur. January 14, 2026. DOI: 10.13140/RG.2.2.25269.33763
https://roundligament.blogspot.com/2026/01/the-gifts-of-magi-for-orthopedic.html
Abstract
Purpose: To describe an experimental technique for
proximal fixation in ligamentum capitis femoris (ligamentum teres femoris; LCF)
reconstruction using pubic and ischial portions anchored in corresponding
pelvic bone tunnels, tested on synthetic hip joint models, and to propose it’s
for arthroscopic application with visualization via an inferior portal and
femoral tunnel.
Methods: Synthetic polyurethane bone analogs (Synbone)
of the pelvis and proximal femur were used to fabricate hip joint models.
Acetabular cartilage analogs were created from self-curing plastic compound.
Femoral tunnels were drilled along the neck axis from the subtrochanteric
region below the tuberculum innominatum to the femoral head fovea. Novel pubic
and ischial tunnels were created from the pubic tubercle and superior to the
ischial tuberosity, respectively, directed toward the bases of the anterior and
posterior horns of the lunate surface, exiting at the acetabular notch. Braided
nylon cords served as LCF analogs. Fixation and tensioning were demonstrated,
with potential arthroscopic control through the acetabular notch via an
inferior portal and femoral tunnel, avoiding distraction where possible.
Mechanical stability was assessed qualitatively on models.
Results: The proposed dual-bundle (pubic and ischial)
proximal fixation replicated natural LCF anatomy and provided satisfactory
limitation of adduction and rotational motions in the model. Femoral tunnel
placement preserved vascular anatomy. Pelvic tunnels avoided intrapelvic
neurovascular structures and organs. Visualization and instrumentation via the
inferior portal, femoral and pelvic tunnels allow for joint inspection,
debridement and graft insertion without distraction. Tensioning of LCF analog was
adjustable in adduction, extension, and external rotation. Integration with implants
for osteosynthesis or future endoprostheses was conceptually demonstrated.
Conclusions:
This
experimental technique offers a novel, potentially more reliable proximal
fixation for LCF reconstruction by distributing load across pubic and ischial
tunnels, addressing limitations of traditional acetabular fossa fixation (thin
bone, neurovascular risk). Arthroscopic feasibility relies on the inferior
portal and femoral tunnel for visualization and manipulation. While promising
for stability and reduced complications in models, clinical validation is
required. The method may represent an advancement in managing LCF pathology,
particularly in instability.
Level of
Evidence: Level V,
technique description, model study.
Keywords: hip joint, reconstruction, ligamentum capitis femoris,
ligamentum teres, fixation, arthroscopy, technique, experiment
Publication in the facebook group 15/01/2026.
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