A Novel Technique for Proximal Fixation

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

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THE GIFTS OF THE MAGI FOR ORTHOPEDIC SURGEONS

Translation of the article: Архипов СВ. Новая техника проксимального крепления при реконструкции ligamentum capitis femoris: Дары волхвов ортопедическим хирургам. The text in Russian is available at the following link: 2026АрхиповСВ . A Novel Technique for Proximal Fixation of Ligamentum Capitis Femoris Reconstruction: The Gifts of the Magi for Orthopedic Surgeons S.V. Arkhipov, Independent Researcher, Joensuu, Finland CONTENT [i] Abstract [ii] Introduction [iii] Materials and Methods [iv] Technique [v] Discussion [vi] Conclusion [vii] Appendix [viii] References [ix] Structured Abstract [x] Additional material [i] Abstract An experimental technique for reconstruction of the ligamentum capitis femoris (ligamentum teres femoris) is described. The proposed method involves creating two portions of the ligament analog: a pubic portion and an ischial portion. Fixation of thes...

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NEWS 2026

New publications of our resource in 2026 The initial phase of collecting data on LCF, accumulated prior to the 20th century, is largely complete. Next, we plan to analyze and synthesize thematic information, adding data from the 20th and 21st centuries. The work will focus primarily on: prevention, diagnosis, arthroscopy, plastic surgery, and endoprosthetics. January 15, 2026 Tweet of January 15, 2026 A Novel Technique for Proximal Fixation (facebook) January 14, 2026 2026 ArkhipovSV. THE GIFTS OF THE MAGI FOR ORTHOPEDIC SURGEONS ( A Novel Technique for Proximal Fixation of Ligamentum Capitis Femoris Reconstruction ). January 05, 2026 2018YoussefAO The article describes a me thod for transposition of the proximal attachment of the LCF in congenital hip dislocation. 2007WengerD_OkaetR The authors demonstrated in the experiment that the strength of the LCF is sufficient to ensure early stability during hip joint reconstruction i...

1970MichaelsG_MatlesAL

Content [i] Annotation [ii] Original text [iii] References [iv] Source & links [v] Notes [vi] Authors & Affiliations [vii] Keywords [i] Annotation Abstract of the article: Michaels G, Matles AL. The role of the ligamentum teres in congenital dislocation of the hip (1970). The authors proposed an analogy for the role of the ligamentum capitis femoris (LCF) as a “ball and chain control” and noted that it can spontaneously reduce congenital hip dislocation. The text in Russian is available at the following link: 1970MichaelsG_MatlesAL . [ii] Original text Quote p. 199 Many papers in the literature have implicated the ligamentum teres as a hindrance to the late open reduction of a congenitally dislocated hip. Occasionally the ligamentum teres has been reported to be absent. However, in most cases it is hypertrophied and elongated. Our present knowledge confirms the fact that congenital dislocation of t...

11th-15th Century

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1834MitchellE_KnoxR

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2008WengerDR_MiyanjiF

Article: Wenger DR et al. Ligamentum teres maintenance and transfer as a stabilizer in open reduction for pediatric hip dislocation: surgical technique and early clinical results (2008). The article describes a method of open reconstruction of the ligamentum capitis femoris (LCF) for hip dysplasia. The text in Russian is available at the following link: 2008WengerDR_MiyanjiF . Ligamentum teres maintenance and transfer as a stabilizer in open reduction for pediatric hip dislocation: surgical technique and early clinical results Wenger DR, Mubarak SJ, Henderson PC, Miyanji F CONTENT [i] Abstract [ii] Introduction [iii] Materials and Methods [iv] Surgical technique & Results [v] Discussion & Conclusion [vi] References [vii] Application [i] Abstract Purpose The ligamentum teres has primarily been considered as an obstruction to reduction in children with developmental dislocation of the hip (DDH). In the ea...

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The classifications are intended to systematize of ligamentum capitis femoris pathology and assist in the development of general approaches to its description, registration, analysis and treatment. Keywords ligamentum capitis femoris, ligamentum teres, ligament of head of femur, hip joint, histology, pathological anatomy, pathology, trauma INTRODUCTION In Russia, the initial attempts to classify pathology of the ligamentum capitis femoris (LCF) were made by morphologists. The development of arthroscopic surgery has made it possible to identify various, previously undescribed types of LCF pathology, which prompted the development of various modern classifications based on intraoperative observations. Analysis of literature data and our own morphological observations allowed us to propose a General Classification of the Ligamentum Teres Pathology, which has the form of a collection of classifiers, as well as a Classification of Functions of the Ligamentum Teres. The ...

2018YoussefAO

Content [i] Annotation [ii] Original text [iii] References [iv] Source & links [v] Notes [vi] Authors & Affiliations [vii] Keywords [i] Annotation Abstract of the article: Youssef AO. Medial approach open reduction with ligamentum teres partial excision and plication for the management of congenital hip dislocation (2018). The article describes a method for transposition of the proximal attachment of the ligamentum capitis femoris (LCF) in congenital hip dislocation. The text in Russian is available at the following link: 2018YoussefAO . [ii] Original text Abstract Because of the known tendency for early redislocation following open reduction, we developed surgical methods for shortening the ligamentum teres to improve immediate postoperative stability when performing medial approach open reduction (MAOR) for the management of developmental dysplasia of the hip. Between 2004 and 2014, 32 patients w...

LCF in 2025 (June)

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 Microins...

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