LCF in 2026 (July)
(Quotes from articles and books published in July 2026 mentioning the ligamentum capitis femoris)
Çetik, R. M., Bakırcıoğlu, S., Büyükdoğan, K., Çağlar, Ö., Atay, Ö. A., & Atilla, B. (2026). Cam-type femoro-acetabular impingement: Mid-term functional results and joint awareness of arthroscopic, mini-open and surgical dislocation techniques. Acta Medica, 57(2), 123-131. [i] actamedica.org
Khan, M. Y., Khan, R., Shaikh, H.,
Persaud, N. A., Rama, S., & Khan, Y. (2026). Evolution of Hip Arthroscopy
in Modern Orthopedic Practice. Cureus, 18(6). [ii] cureus.com
Sanders, W. J., Ji, X. P., &
Jablonski, N. G. (2026). New remains of Stegodon zhaotongensis (Proboscidea,
Stegodontidae) from the Late Miocene site of Shuitangba, Yunnan Province,
China. Journal of Mammalian Evolution, 33(3), 33. [iii]
link.springer.com
Randelli, F. (2026). Hip arthroscopy-separating the evidence from the hype and why we need it. Mentors in Orthopedics, 8(041). [iv] mentors-in-orthopedics.com
Yershov, D. V., Korolkov, O. I., Klymovytskyi, F. V., Chornenkyi, A. V., & Rakhman, P. M. (2026). Surgical management of hip dislocation in children with cerebral palsy: a multicenter retrospective series analysis of 171 patients (part 1). TRAUMA, 27(3), 268-273. [v] trauma-journal.com
Quesada-Jimenez, R., Patel, D. H., Kahana-Rojkind, A. H., Cohen, M. F., Kuhns, B. D., & Domb, B. G. (2026). Effect of Preoperative Opioid Consumption on Outcomes After Hip Arthroscopy for Femoroacetabular Impingement and Labral Tears: A Minimum 2-Year Follow-up Study. Orthopaedic Journal of Sports Medicine, 14(7), 23259671261431838. [vi] journals.sagepub.com
Johansson, M. (2026). Prediction of Subject-specific Hip Cartilage Stresses Using Combined Musculoskeletal and Finite Element Modelling. Master’s Thesis in Biomedical Engineering. Lund: Lund University. [vii] lup.lub.lu.se
Lu, Y., Cabarcas, B., Ahmad, R. A., Kelly, J. J., Lachman, N., Nho, S., ... & Hevesi, M. (2026). Capsular Contributions to Hip Joint Stability: Clinical Anatomy and Implications for Surgical Management. Clinical Anatomy. [viii] onlinelibrary.wiley.com
Greenhalgh, M. S., & Shah, N. (2026). Management of Hip Dysplasia in Adults: A Review and the Wrightington Philosophy. Journal of Clinical Orthopaedics & Trauma. [ix] sciencedirect.com
Jokubynas, V. V. (2026). The hip odyssey: exploring anterior, posterior and lateral approaches in hip replacement surgery (Doctoral dissertation, Vilniaus universitetas.). [x] scholar.google.com
Sarassa, C., Aristizábal, S., García, J. J., Quintero, D., Mejía, R., & Herrera Torres, A. M. (2026). Intraosseous ‘Synthetic Teretization’ in the absence of ligamentum teres: surgical technique and early results. Journal of Pediatric Orthopaedics B. July 13, 2026. [xi] ovid.com
Miyama, K., Kitamura, K., Fujii, M., Motomura, G., Hamai, S., Kawahara, S., ... & Nakashima, Y. (2026). Artificial Intelligence‐Based Automatic Screening System for Hip Dysplasia. Journal of Orthopaedic Research, 44(7), e70251. [xii] pmc.ncbi.nlm.nih.gov
Dvorská, D. (2026). Kompenzační cvičení při funkčních poruchách kyčelního kloubu u sportovních gymnastek (Bachelor's thesis, Univerzita Palackého v Olomouci, Fakulta tělesné kultury). [xiii] theses.cz
Markes, A. R., & Vyas, D. (2026). Hip Microinstability: A Comprehensive Review of Diagnosis and Management. Operative Techniques in Orthopaedics, 101228. [xiv] sciencedirect.com
Henry, L., Funk, K., & Meredith, S. J. (2026). Traumatic Native Hip Dislocation in the Skeletally Mature Patient. Operative Techniques in Orthopaedics, 101229. [xv] sciencedirect.com
Qu, R., Liu, T., Wang, W., Li, Z., & Gao, F. (2026). An MRI-Based classification of osteonecrosis of the femoral head based on the spatial relationship between the epiphyseal line and osteonecrotic boundary. European Journal of Radiology, 113086. [xvi] sciencedirect.com
Stanard I, Almhanna H, Al-Mahmodi AMM, Kilroy D, Kumar AHS. (2026). Comparative Analysis of Vascular Density in the Femoral Head Ligament of the Dog, Sheep, and Goat. BEMS Reports. 12(2):58-64. [xvii] bemsreports.org
Announcement
Full access to our monographs covering various aspects of the history and pathology of LCF is now available:
Архипов С.В. Связка головки бедренной кости. Функция и роль в патогенезе коксартроза. Йоэнсуу: Издание Автора, 2023. [Arkhipov SV. The ligament of the head of femur. Function and role in the pathogenesis of coxarthrosis. Joensuu: Author's Edition, 2023. (In Russian)] GooglePlay
Архипов С.В. Девятый месяц, одиннадцатый день: Рассуждение о XXXII главе книги Бытие. Йоэнсуу: Издание Автора, 2024. [Arkhipov S.V. The Ninth Month, Eleventh Day: A Reflection on Chapter XXXII of the Book of Genesis. Joensuu: Author’s Edition, 2024. (In Russian)] GooglePlay
Архипов С.В. Дети человеческие: истоки библейских преданий в обозрении врача. Эссе, снабженное ссылками на интерактивный материал. Йоэнсуу: Издание Автора, 2025. [Arkhipov S.V. Human Children: The Origins of Biblical Legends from a Physician's Perspective. An essay with references to interactive materials. Joensuu: Author's Edition, 2025. (In Russian)]. GooglePlay
Arkhipov S.V. 50 Tables of Evidence for the Composition of Genesis in Late Second Intermediate Period Egypt: The Protograph Before the Oral Tradition. Joensuu: Author's Edition, 2026. [Архипов С.В. 50 таблиц, подтверждающих составление книги Бытия в конце Второго промежуточного периода в Египте: Протограф до устной традиции. Йоэнсуу: Издание Автора, 2026. (на англ.)] GooglePlay
[Ru] Дайджест публикаций о ligamentum capitis femoris:
https://kruglayasvyazka.blogspot.com/2026/07/lcf-2026_0597183046.html
[i] The safe surgical dislocation defined by
Ganz et al.[4] in 2001 was previously described as the gold standard, and the
short- to mid-term results for this procedure are also favourable for many
authors. However, Hip arthroscopy (HA) and anterolateral mini open (AMO)
techniques are more
preferred today because surgical
hip dislocation (SHD) is a technically challenging procedure which requires
ligamentum teres detachment, trochanteric osteotomy and refixation, and is more
prone to intraarticular adhesions.
HA [hip arthroscopy] and AMO [anterolateral
mini open techniques] can be applied
without the need of
trochanteric osteotomy and
sacrificing of the ligamentum teres,
compared to surgical
dislocation, also provide faster
rehabilitation and recovery[5,6].
Capsulotomy, trochanteric osteotomy,
existence of hardware, muscle damage
and sacrificing the ligamentum teres
all may contribute to a micro-instability and eventually increased joint
awareness in the SHD [ surgical hip dislocation] group may be the cause of
difference between groups.
[ii] Hip joint
stability is determined not only by osseous anatomy but also by key soft-tissue
structures, including the acetabular labrum, joint capsule, ligamentum teres,
and surrounding musculature such as the iliopsoas. These structures function
synergistically to maintain the labral suction seal, restrict excessive motion,
and provide both static and dynamic stabilization of the hip [32].
32 Ayeni
OR, Alradwan H, de Sa D, Philippon MJ: The hip labrum reconstruction:
indications and outcomes - a systematic review. Knee Surg Sports Traumatol
Arthrosc. 2014, 22:737-43. 10.1007/s00167-013-2804-5
[iii] Stegodon
zhaotongensis
The head is large, spherical, and
oriented proximomedially, set on a very short neck. There is no fovea capitis
femoris on the femoral head. Each femur has a robust, extensive, and low
greater trochanter, associated with muscles responsible for deep lateral
rotation of the hip, and a narrow, deep intertrochanteric fossa, which also
accommodates lateral rotators of the hip.
[iv] The current
state of the art is then reviewed, emphasising the broad therapeutic
armamentarium now available through the arthroscope: postless hip distraction,
femoral and acetabular osteoplasty (including correction of coxa profunda),
labral and capsular repair or reconstruction, removal of loose bodies and
benign bone tumours, management of aggressive synovitis of the acetabular
fossa, gluteal tendon repair, psoas tenotomy, and ligamentum teres
reconstruction.
[v] Hip
reconstruction in children with cerebral palsy and femoral head dislocation was
performed according to a standard technique [28] and included adductor
tenotomy, arthrotomy, open reduction (OR) with removal of fibrotic tissue, the
ligamentum teres, and intra-articular fatty tissue, varus derotation osteotomy
(VDRO) with femoral shor-tening of 1–3 cm and fixation using a locking
compression plate, as well as capsuloplasty.
[vi] Surgical Interventions
Interportal capsulotomy was performed to access the joint. Diagnostic
arthroscopy was conducted to initially assess the labrum, intra-articular
cartilage, and ligamentum teres. Labral tears were categorized using the Seldes
classification system.24 Femoral head chondral injuries were noted using the
ALAD (acetabular labrum articular disruption) and Outerbridge classification
systems. Tears of the ligamentum teres were defined using the Domb and Villar
classification systems.1,3
1. Bardakos NV, Villar RN.
The ligamentum teres of the adult hip. J
Bone Joint Surg Br. 2009;91-B(1):8-15.
3. Botser IB, Martin DE, Stout CE, Domb BG. Tears
of the ligamentum teres: prevalence in hip arthroscopy using 2 classification
systems. Am J Sports Med. 2011;39(1
Suppl):117-125.
Ligamentum teres tears were treated with debridement if necessary.5
5. Chandrasekaran S,
Martin TJ, Close MR, Suarez-Ahedo C, Lodhia P, Domb BG. Arthroscopic
reconstruction of the ligamentum teres: a case series in four patients with
connective tissue disorders and generalized ligamentous laxity. J Hip
Preserv Surg. 2016;3(4):358-367.
Table 2 Intraoperative
Findingsa
|
|
PO (n = 236) |
Control (n = 236) |
P Value |
|
Domb
classification (ligamentum teres tear) |
|
|
.41 |
|
Grade 0 |
117 (49.6) |
130 (55.1) |
|
|
Grade 1 |
63 (26.8) |
53 (22.6) |
|
|
Grade 2 |
49 (20.9) |
42 (17.9) |
|
|
Grade 3 |
7 (3.0) |
11 (4.7) |
|
Table 3 Intraoperative
Procedures
|
|
PO (n = 236) |
Control (n = 236) |
P Value |
|
Ligamentum teres treatment |
|
|
.21 |
|
Debridement |
48 (20.3) |
58 (24.6) |
|
|
None |
188 (79.7) |
178 (75.4) |
|
[vii] The hip
capsule is primarily composed of the iliofemoral, ischiofemoral, pubofemoral
and the teres ligament, see Figure 2.2.
The teres ligament couples the peripheral inferior acetabular notch to
the fovea of the femoral head, providing structural stability [33], [34] .
3.2.4 Ligaments
Ligaments were used in the FE model to provide stabilization and
maintain structural integrity of the parts included in the hip joint model.
Four ligaments were implemented to mimic the hip joint capsule: the ichiofemoral,
iliofemoral, pubofemoral and the teres ligament. The iliofemoral ligament was
further divided into a superior and an
inferior branch. The ligaments were represented by spring
elements in the model. For the teres ligament, the location of the springs was selected to reproduce the characteristic star-shaped attachment points inside the acetabulum. Similarly, attachment points of the remaining springs in the model were chosen to replicate the anatomical locations of the respective ligament in the hip joint capsule. The number of spring elements and the corresponding spring stiffness were selected according to Zou et al., which could be seen in Table 3.2 [22].
[viii] Secondarily,
other pericapsular soft tissue restraints that contribute to hip stability
include the ligamentum teres (Jo et al. 2018), the iliocapsularis muscle (Babst
et al. 2011), the iliopsoas muscle, the gluteus minimus and medius
muscles, …
Babst, D., S.
D. Steppacher, R. Ganz, K. A. Siebenrock, and M. Tannast. 2011. “The
Iliocapsularis Muscle: An Important Stabilizer in the Dysplastic Hip.” Clinical
Orthopaedics and Related Research 469, no.6:1728–1734.
Jo, S., A.
W. Hooke, K. N. An, R. T. Trousdale, and R. J. Sierra. 2018. “Contribution of
the Ligamentum Teres to Hip Stability in the Presence of an Intact Capsule: A
Cadaveric Study.” Arthroscopy 34, no. 5: 1480–1487.
[ix] In severe
subluxation or complete dislocation, the true acetabulum becomes functionally
abandoned and fills with reactive fibrofatty tissue (the pulvinar), an inverted
and hypertrophic labrum, and an abnormally thickened ligamentum teres.
[x] The
ligamentum teres is a ligament attaching the acetabular notch to the fovea of the
femoral head (18,19). Its role in the adult hip is relatively small, but it
contains the foetal foveal artery, which supplies the developing head of the
femur in foetal life (20,21).
[xi] Abstract
Achieving stable, concentric reduction in high-grade developmental
dysplasia of the hip (DDH) remains challenging, particularly in older children
or when the ligamentum teres is absent. Our previously described teretization
technique enhances stability through intraosseous ligamentum teres
ligamentodesis, but cannot be applied directly in such cases. We describe a
synthetic variation using a button-suture-button construct to replicate
ligamentum teres function and report early outcomes. We conducted a prospective
case series of pediatric patients with International Hip Dysplasia Institute
classification (IHDI) grade III–IV DDH and intraoperatively confirmed absence
of the ligamentum teres. Open reduction with intraosseous femoral tunneling and
synthetic teretization was performed, combined with femoral and pelvic
osteotomies. The construct was tensioned to maintain concentric reduction
without overconstraint. Clinical outcomes included hip stability, range of
motion, McKay score, pain, and complications. Radiographic assessment included
IHDI and Severin classification, acetabular index, and avascular necrosis. Nine
hips in eight female patients, with a median age of 24 months, underwent
synthetic teretization. At a median 23-month follow-up, all hips remained stable,
painless, and without functional limitation. Eight hips achieved postoperative
IHDI type I and one type II. Among patients aged 4 years or older at final
follow-up, all hips were Severin grade I. No redislocation, infection, growth
arrest, avascular necrosis, or hardware-related complications occurred. McKay
scores were excellent in seven hips and good in two. Two hips in one patient
developed acetabular graft resorption after Dega osteotomy and were
successfully revised. Synthetic teretization is a feasible stabilizing option
for DDH when the native ligamentum teres is absent.
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.
[xii] In some hips with markedly deficient
anterior coverage, accurate segmentation was challenging owing to a blurred
outline of the anterior acetabular wall caused by overlap with the ligamentum
teres of the femoral head. Segmentation performance for the anterior wall may
be improved by incorporating more training data from multiple centers,
particularly from cases with deficient anterior coverage.
[xiii] 3.2.5 Ligamentum capitis femoris
Ligamentum capitis femoris (vaz hlavice stehenní kosti) je vaz
nacházející se uvnitř kyčelního kloubu. Vaz trojúhelníkovitého tvaru začíná v
zářezu acetabula, poté prochází středem kloubní jamky a spojuje ji s hlavicí
stehenní kosti. Na rozdíl od silných vnějších
vazů stabilizující kloub mechanicky, má tento vaz specifickou roli v oblasti
výživy a propriorecepce. Jeho mechanická pevnost je poměrně malá, přesto má
význam zejména během vývoje. Uvnitř vazu probíhají cévy, které přivádějí krev k
hlavici stehenní kosti a podílejí se na jejím zásobení.
V hloubce kloubu se nachází ještě zona orbicularis, vazivový prstenec obepínající krček kosti stehenní, který funguje jako mechanická pojistka. Přímo uvnitř kloubu pak najdeme ligamentum capitis femoris, který sice nemá velkou mechanickou sílu, ale vede důležité cévy pro výživu hlavice a informuje mozek o aktuální poloze kloubu (Ross & Pawlina, 2018).
3.2.5 Ligamentum capitis femoris
The ligamentum capitis femoris (ligament of the femoral head) is a ligament located inside the hip joint. The triangular-shaped ligament begins in the acetabulum notch, then passes through the center of the joint socket and connects it to the femoral head. Unlike the strong external ligaments that stabilize the joint mechanically, this ligament has a specific role in the area of nutrition and proprioception. Its mechanical strength is relatively low, yet it is important especially during development. Inside the ligament run blood vessels that bring blood to the femoral head and participate in its supply.
Deep within the joint is the zona orbicularis, a fibrous ring
surrounding the femoral neck that acts as a mechanical lock. Directly inside
the joint is the ligamentum capitis femoris, which, although it does not have
great mechanical strength, carries important blood vessels for the head and
informs the brain about the current position of the joint (Ross & Pawlina,
2018).
Ross, M. H., & Pawlina, W. (2018). Histology: A text and atlas: With
correlated cell and molecular biology (8. vyd.). Wolters Kluwer.
[xiv] The hip joint relies on both static stabilizers (labrum,
capsule, ligamentum teres) and dynamic stabilizers (periarticular musculature)
to maintain stability, with greater reliance on soft tissue structures for
anterior stability due to asymmetric bony coverage. Hip microinstability is a
multifactorial phenomenon that can be broadly categorized into six etiologies:
bony abnormalities/dysplasia, connective tissue disorders, post-traumatic,
microtraumatic, iatrogenic, and idiopathic.
The static structures include the labrum, the
ligamentum teres and the 4 capsulolabral ligamentous structures - iliofemoral
ligament, pubofemoral ligament, ischiofemoral ligament, and zona orbicularis.
Operative Management: Ligamentum Teres Reconstruction
Ligamentum teres reconstruction is indicated for patients with pain and
multidirectional instability associated with complete or nearly complete
ligamentum teres tears in those who remain symptomatic after previous hip
arthroscopy with stabilizing procedure and extensive rehabilitation31. Rosinsky
et al. described a technique using tibialis anterior or semitendinosis
autograft (7 mm diameter). The graft is prepped on the back table with three to
four Krackow stitches placed on both ends of the graft using #2 non-absorbable
suture (FiberTape, Arthrex, Naples, FL). The graft is then doubled over, and
the looped end is attached to either aa BicepsButton (Arthrex) or RetroButton
(Arthrex).31 After addressing all relevant concomitant pathology in the central
and peripheral compartments using standard anterolateral and mid-anterior
portals, the ligamentum teres stump is cleared using radiofrequency ablation.
Under dual fluoroscopic guidance and arthroscopic visualization, a 2.3mm
guidewire is inserted from just proximal to the vastus ridge to the fovea. The
femoral tunnel is then reamed to size based on the size of the prepared graft.
The acetabular fossa is then prepped through either the predrilled
tunnel or a separate established portal. With the leg in 15° of abduction and
15° of internal rotation the guidewire is pass through the femoral tunnel into
the posterior footprint of the ligamentum teres at the posteroinferior part of
the cotyloid fossa, directly above the transverse acetabular ligament. A 3.2mm
drill is then used to perforate the inner table. The graft is inserted through
the modified anterior portal and button inserted in the acetabular tunnel and
flipped via aid of an instrument in the femoral tunnel. The femoral end of the
grade is then passed anterograde through the femoral tunnel and fixed with a
Polyether-Ether-Ketone (PEEK) interference anchor with the limb in partial traction
placed in 60° to 90° of external rotation.31 Capsular plication with 3 or more
stitches is then performed to create an inferior shift and imbrication31.
Rosinsky et al. published outcomes from 9 patients (11 hips) at mean
44-month follow-up and found significant improvements were in mHHS (from 44.1
to 71.8), Non-Arthritic Hip Score (from 47.5 to 78.6), and visual analog scale
score (from 7.8 to 3.6). Two patients underwent conversion to total hip
arthroplasty at a mean 21 months.31 O'Donnell et al. also evaluated 9 patients
who underwent ligamentum teres reconstruction and the mHHS improved from 51.15
to 86.9 with all patients expressing satisfaction with the procedure at minimum
12-month follow-up.32 Further research is needed to develop this technique and
confirm the results.
Arthroscopic capsular plication remains the most
performed procedure while capsular reconstruction and ligamentum teres
reconstruction serve as more rare options for more complex cases involving
unrepairable capsular defects or complete ligamentum teres tears in revision
cases.
[xv] The ligamentum teres is an intra-articular,
extra-synovial ligament that extends from the acetabular fossa to the fovea
capitis on the femoral head. It is composed of two bands that originate from
the transverse acetabular ligament and from the pubic bone…
Similarly, disruption of static stabilizers such as
the labrum, capsule, and ligamentum teres, as well as dynamic muscular
stabilizers, plays a critical role in both hip stability immediately
post-injury and with long-term recovery.14, 15, 16, 17
[xvi] Throughout the skeletal developmental stages, the blood supply
of the proximal femur undergoes dynamic and stage-specific changes. During the
first three months of life, the ligamentum teres, together with the lateral
epiphyseal arteries, constitutes the principal vascular supply to the
developing femoral head. By approximately 18 months of age, this supply
progressively shifts to a predominant dependence on the lateral epiphyseal
vessels. In adulthood, eventually, the vascular architecture of the proximal
femur becomes further differentiated into distinct metaphyseal and epiphyseal
circulatory systems. Notably, the metaphyseal circulation is particularly
robust, providing essential perfusion to the subphyseal area while terminating
at the growth plate [2].
[xvii] Abstract
Background: The ligament of the head of the femur (ligamentum teres) is
an intra-articularstructure that contributes to hip joint stability and serves
as a potential conduit for vascular supply to the femoral head. Despite its
recognised anatomical presence across mammalian species, its vascular capacity
and functional significance remain incompletely understood. This study aimed to
comparatively evaluate vascular density within the ligament of the femoral head
in adult dog, sheep, and goat, and to determine whether a relationship exists
between ligament length and vascular characteristics. Materials and Methods:
Nine cadavers (three specimens each of adult dog, sheep, and goat) were
examined. Ligament length was measured macroscopically,and selected samples
were processed for histological analysis using haematoxylin and eosin staining.
High-resolution images were analysed using ImageJ software to quantify blood
vessel area and vascular density. Statistical analysis was performed using
one-way ANOVA followed by Bonferroni post hoc testing, with significance set at
p<0.05. Results: Ligament length ranged from 13-22 mm in dogs and 20-22 mm in
both sheep and goats. No correlation was identified between ligament length and
blood vessel area. However, significant interspecies differences in vascularity
were observed. Goats exhibited a significantly greater mean blood vessel
area(47,025.58 μm²) and higher vascular
density compared to both dogs (10,289.43 μm²) and
sheep(5,806.94 μm²) (p<0.05), while no
significant difference was found between dogs and sheep.The ratio of vessel
area to density was not significantly different among species. Conclusion:These
findings demonstrate that vascular characteristics of the ligament of the
femoral head vary between species and are not dependent on ligament length. The
increased vascular density observed in goats suggests a potentially greater
contribution to femoral head perfusion. This study highlights the importance of
vascular density as a relevant parameter in understanding ligament function and
may have implications for the pathophysiology and treatment of conditions
associated with compromised femoral head blood supply.
Author:
Arkhipov S.V. – candidate of medical sciences, surgeon, traumatologist-orthopedist.
Keywords
ligamentum capitis femoris, ligamentum teres, ligament of head of femur, history .
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