LCF in 2026 (August)
(Quotes from articles and books published in August 2026 mentioning the ligamentum capitis femoris)
Maldonado, D. R., Schab, A. R., & Domb, B. G. (2026). Improvement in Patient‐Reported Outcomes, High Rate of Return to Sport, and Secondary Surgery Rate Ranging From 0% to 9.8% After Hip Arthroscopy in Dancers and Athletes in Flexibility Sports: A Systematic Review. Arthroscopy, Sports Medicine, and Rehabilitation, e70020. [i] arthroscopyjournals.onlinelibrary.wiley.com
Klingele, K., & Strub, D. (2026). Author Response: Considerations and Challenges in Open Reduction With Ligamentum Teres Reconstruction for Pediatric Developmental Dysplasia of the Hip. Journal of Pediatric Orthopaedics. [ii] ovid.com
Quesada‐Jimenez, R., Rana, K., Strok, M. J., Kahana‐Rojkind, A. H., Burt, A. K., Sugarman, E. P., & Domb, B. G. (2026). Dual Labral and Ligamentum Teres Reconstruction Achieves High Functional Outcomes and Arthroplasty‐Free Survivorship at 2 Years. Arthroscopy, Sports Medicine, and Rehabilitation, e70049. [iii] arthroscopyjournals.onlinelibrary.wiley.com
Deverre, A. (2026) Clinical presentation of coxofemoral joint luxation in horses a case series. University of Veterinary Medicine Budapest. Department of Equine Medicine. Thesis. [iv] huveta.hu
Hemeda, Y. H., Al Saied El Mekawy, A. G., & El Gohary, A. E. A. (2026) Magnetic Resonance Imaging Findings in Cases with Lateral Hip Pain. The Egyptian Journal of Hospital Medicine (July 2026), 104, 4167-4179. [v] ejhm.journals.ekb.eg
Baumann, J. R., Rucinski, K., Cook, J. L., Crist, B. D., Crecelius, C. R., & DeFroda, S. F. (2026). Open and Arthroscopic Acetabular Labral Reconstructions Are Associated With Improvements in Hip Patient‐Reported Outcome Measures at 1 Year, but Only an Open Approach Is Associated With Significant Reductions in Pain. Arthroscopy, Sports Medicine, and Rehabilitation, e70003. [vi] pmc.ncbi.nlm.nih.gov
Ribeiro, R. A. B., Fernandes, L. R., de Gois, J. R., & de Oliveira, M. B. (2026). Clinical and radiographic profile of canine hip dysplasia in a mobile veterinary radiology service: A retrospective study in Aracaju, Brazil. Research, Society and Development, 15(7), e8615751450-e8615751450. [vii] rsdjournal.org rsdjournal.org/PDF
Bisen, S., Kapgate, D., & Ghubade, A. (2026). Correlation of Snayu with Modern Ligaments. Journal of Shalya and Shalakya Vigyan, 3(2), 01-13. [viii] shalakyajournal.com
Monge Calleja, A. M., Ribeiro, C., Ramos Gaspar, R., Cristóvão, J., Tente, C., Carvalho, P. C., & Silva, A. M. (2026). Health, trauma, and social care in a medieval rural community: the evidence of remodeled severe bone lesions in the necropolis of Santa Maria (Idanha-a-Velha, Portugal). Journal of Medieval Iberian Studies, 1-33. [ix] tandfonline.com
Breivik, G. A. (2026). A Systematic Review of the Ligamentum Capitis Femoris: Embryology, Anatomy, Potential Function, and Absence. Muscles, Ligaments and Tendons Journal. 16. https://doi.org/10.32098/mltj_2026_6239 [x] ejcrim.com
Tilyakov, A. B. , Mirzaev, A. G. (2026). Reconstructive Surgery for Hip Dislocation in Patients with Cerebral Palsy: A Comparative Analysis With and Without Capsuloplasty. Traumatology and Orthopedics of Russia. https://doi.org/10.17816/2311-290 [in Rus] Тиляков АБ, Мирзаев АГ. (2026) Селективная капсулотомия при реконструкции тазобедренного сустава у детей с церебральным параличом: роль интраосии. перационного флюороскопического теста вправляе-мости. Травматология и ортопедия России [xi] journal.rniito.org
Correa, F. B. P., Savarese, L. G., & Nogueira-Barbosa, M. H. (2026). Association of ligamentum teres thickness on MRI with femoral head extrusion in Legg–Calvé–Perthes disease. Skeletal Radiology, 1-11. [xii] link.springer.com
Kung, J. E., Pumilia, C. A., Harrison, P., Stirling, B., Cunningham, D. J., Murr, K., & Jones, T. M. (2026). Femoroacetabular stabilization using a suspensory fixation device in post-traumatic hip instability after hip fracture–dislocation: technique and report of 6 cases. OTA International, 9(3), e512. [xiii] ovid.com
Saks et al.15 have clearly shown that athletes involved in flexibility sports experience higher rates of femoral head cartilage lesions and more frequent tears of the ligamentum teres when compared with their counterparts in nonflexibility sports.
15 Saks BR, Monahan PF, Maldonado DR, et al. Pathologic findings on hip arthroscopy in high-level athletes competing in flexibility sports. Am J Sports Med. 2022;50:1028-1038.
To the Editor:
We would like to thank you for your response and recent inquiry regarding the publication “Open Reduction with Ligamentum Teres Reconstruction—Preliminary Results of a Novel Technique for the Management of Pediatric Developmental Dysplasia of the Hip.”!
…
Recent studies have described the common and often accepted risk factors and poor patient/family satisfaction related to spica casting. Use of the LTR [Ligamentum Teres Reconstruction], especially in the idiopathic DDH population. has essentially eliminated the need for postoperative pics cast immobilızation. Unless otherwise needed, most nonidiopathic and almost all idiopathic DDH. patients undergoing open reduction with LTR Are immobilized with custom abduction bracing instead of casting. Early accepted compliance and satisfaction feedback has shown no increased risk of recurrent instability and eliminated complications specific to spica casting.
The authors designed this technique to be one of the additions to standard, open reduction techniques, making the independent impact of LTR on outcomes difficult to judge. Previous literature confirms the effect and importance of hip stability on postreduction acetabular remodeling. This relates to the described benefit of ‚open reduction compared with closed reduction on acetabular development and the risk of future surgery for residual dysplasia.
The authors have studied the early effects of this technique on acetabular remodeling and compared them with historical controls of both ‚open and closed reduction cohorts. In he recent study entitled, “Does Hip Stability Influence Rates of Acetabular Remodeling Following Reduction of Idiopathic Developmental Hip Dysplasia? A Comparison of Closed vs Open Reduction with and without Ligamentum Teres Reconstruction,” the addition of LTR significantly improved acetabular re ‚modeling rates to nearly double and triple the amounts seen with open and closed reduction techniques alone. Rates diminished to a degree similar to what was seen in isolated open reduction once the implant was removed, suggesting a benefit of the internal brace on stability and remodeling. The authors acknowledge this technique to be one in addition t0 standard, open reduction techniques, making the independent impact of LTR on remodeling difficult to judge; however, early results suggest a positive influence on acetabular development.
It is believed by the authors that short-term follow-up suggests this technique to be both safe and beneficial in the management of both nonidiopathic and idiopathic DDH. We agree that longer follow-up is needed to evaluate avascular necrosis and the ‚more definitive effect on hip development, as well as functional assessments such as range of motion, gait analysis, and functional scores. We agree that further research is warranted and welcome further investigation and discussion.
Abstract
Purpose: To evaluate the clinical outcomes and survivorship of hip arthroscopy with simultaneous labral and ligamentum teres (LT) reconstruction for the treatment of irreparable labral and LT tears, with a minimum follow-up of 2 years.
Methods: Prospectively collected data were retrospectively reviewed for patients who underwent combined arthroscopic labral and LT reconstruction between 2017 and 2021. Inclusion criteria required completion of preoperative and 2-year postoperative patient reported outcomes, including the modified Harris Hip Score, Non-Arthritic Hip Score, Hip Outcome Score-Sports-Specific Subscale, International Hip Outcome Tool, and visual analog scale. Clinically relevant thresholds—minimal clinically important difference and patient acceptable symptom state—were included in the analysis. Survivorship was defined as the absence of revision surgery or conversion to total hip arthroplasty.
Results: Seven patients underwent hip arthroscopy with concomitant LT and labral reconstruction, all with 2-year follow-up. Six patients (85.7%) underwent the procedure as revision surgery. Statistically significant improvements were observed across all evaluated patient reported outcomes measures, with a mean patient satisfaction score of 7.4. All patients (100%) met the minimal clinically important difference for modified Harris Hip Score, Non-Arthritic Hip Score, and visual analog scale. Additionally, 6 patients (85.7%) achieved minimal clinically important difference for International Hip Outcome Tool and Hip Outcome Score-Sports-Specific Subscale. Five patients (71.4%) answered positively to the patient acceptable symptom state anchor question. A 100% arthroplasty-free survivorship at 2 years was observed; subsequently, at 38 months, 1 patient underwent conversion to total hip arthroplasty.
Conclusions: Hip arthroscopy with simultaneous labral and LT reconstruction for irreparable tears resulted in significant improvements in functional outcomes and high patient satisfaction. A high proportion of patients achieved clinically meaningful thresholds at a minimum 2-year follow-up. Notably, a high arthroplasty-free survivorship rate was observed at short-term follow-up.
Level of Evidence: Level IV, therapeutic retrospective case series.
Arthroscopy, Sports Medicine, and Rehabilitation. 2026;00:e70049
The coxofemoral joint is stabilized by three principal ligaments: the femoral head ligament (also referred to as the round ligament), the transverse acetabular ligament, and the accessory ligament [3]. The femoral head ligament and accessory ligament run through the acetabular notch (incisura acetabuli) [1]. The ligamentum transversum acetabuli runs over this notch, acting as a bridge and supporting the other ligaments [2]. The acetabular notch is found between the craniodorsal and caudodorsal margins of the facies lunata, near the foramen obturatum [2].
1. Budras K-D, Sack WO, Röck S (2012) Anatomy of the Horse: with Aaron Horowitz and Rolf Berg. Schlütersche Verlagsgesellschaft, s.l
2. Constantinescu GM, Habel RE (2012) Illustrated veterinary anatomical nomenclature, 3., rev. ed. Enke, Stuttgart
3. Budras K-D, Sack WO, Röck S (2012) Anatomy of the Horse: with Aaron Horowitz and Rolf Berg. Schlütersche Verlagsgesellschaft, s.l
2.3.3 Round ligament injuries
Rupture of the round ligament (ligamentum capitis ossis femoris) can occur with or without luxation of the coxofemoral joint [7]. Clinical signs can be very similar and it is crucial to establish the presence of concurrent joint subluxation or luxation [7]. Shortening of the limb is often seen in coxofemoral joint luxation but not in horses with round ligament rupture alone [7]. Differentiation can be particularly challenging in cases of chronic coxofemoral luxation, where secondary changes such as muscle atrophy, fibrosis, and modeling appear similar to other hip pathologies [7].
7. Adams OR, Stashak Ted S. (2002) Adams’ Lameness in horses, 5th ed. Williams & Wilkins, Philadelphia
Subluxation of the coxofemoral joint can occur due to trauma causing rupture or injury to the round ligament, but also as a chronic process preceded by an acetabular fracture [10].
10. Brenner S, Whitcomb MB (2009) ULTRASONOGRAPHIC DIAGNOSIS OF COXOFEMORAL SUBLUXATION IN HORSES. Vet Radiol Ultrasound 50:423–428. https://doi.org/10.1111/j.1740-8261.2009.01560.x
Post-mortem examination was performed in 4/7 horses that had been euthanised. In all, the diagnosis of coxofemoral joint luxation was confirmed. For two of them the expected diagnosis seen upon clinical signs were confirmed. Further pathology was diagnosed in two others. In one case, the horse had been lame for approximately four months prior to presentation, consistent with the chronic pathological changes observed post-mortem. Examination revealed severe osteoarthrosis and pseudoarthrosis of the coxofemoral joint, with the femoral head dorsally displaced and encased in proliferative new bone arising from the dorsal acetabular rim. Extensive remodeling of the femoral head and acetabulum, along with thickening of the joint capsule and fibrinous effusion, reflected a long-standing and unstable luxation. The round ligament was thin, elongated, and frayed, suggesting chronic strain rather than acute rupture.
Postmortem examination was performed in four horses. Findings indicated progressive degenerative and adaptive changes that can occur in chronic coxofemoral luxation and highlight the difficulty of achieving an early diagnosis in such cases. In the case with an acute onset, the short duration of the lameness corresponded with the traumatic nature lesions observed post-mortem. Examination revealed complete rupture of the ligamentum capitis femoris, comminution of the acetabulum, and extensive soft tissue trauma findings consistent with a high-impact, acute injury leading to coxofemoral luxation. The extent of structural damage supports the traumatic origin and explains the severity of clinical signs and poor prognosis associated with such cases.
Comparing the two cases, one with a chronic lameness and the other with an acute onset. In the chronic case, post-mortem findings reflected gradual degenerative changes that could have led to coxofemoral luxation, with anatomical adaptations allowing the horse to function for four months before diagnosis and 1.5 years before euthanasia. In contrast, the acute case showed no secondary changes, and rupture of the ligamentum capitis femoris prevented any compensatory adaptation of the anatomy.
Diagnosis was confirmed using ultrasound and/or radiography in all cases. Seven horses were euthanized due to hopeless prognosis, one was retired and four were lost to follow-up. Post-mortem examination was performed in four horses. In addition to coxofemoral joint luxation, in two horses rupture of or damage to the femoral head ligament was observed. In conclusion, common clinical features of coxofemoral joint luxation in horses include outward limb rotation, proximal position of the tuber calcanei, and gluteal, biceps femoris and quadriceps muscle atrophy. The duration of lameness before presentation can vary from hours to months. Although traumatic events may contribute to coxofemoral luxation, routine daily activities can also result in this injury. Our findings can contribute to early recognition and accurate diagnosis of coxofemoral joint luxation.
Figure (1): Bilateral early cam-type femoroacetabular impingement (FAI) with bilateral labral degeneration and bilateral ligamentum teres sprain/tear.
(A) Axial PDFS image: This image is demonstrating bilateral thickening and abnormally increased signal intensity within the ligamentum teres (white arrows), more pronounced on the left, which is highly suggesting a ligamentous tear/sprain.
There are several different autograft or allograft options available for acetabular labral reconstruction. Common autograft options include the ligamentum teres, joint capsule, rectus femoris, fascia lata, iliotibial band, gracilis tendon, and quadriceps tendon.
Pain upon joint manipulation was the most prevalent clinical sign (76.92%), which is consistent with the pathophysiology of canine hip dysplasia . Joint instability leads to repetitive stretching of the joint capsule and the round ligament, structures richly innervated by nociceptive fibers (Fries & Remedios, 1995).
Fries CL, Remedios AM. The pathogenesis and diagnosis of canine hip dysplasia: a review. Can Vet J. 1995 Aug;36(8):494-502. PMID: 7585436; PMCID: PMC1687006.
Abstract
In the domain of Rachana Sharira (Ayurvedic Anatomy), the concept of Snayu constitutes a cornerstone for understanding the structural integrity, stability, and dynamic mobility of the musculoskeletal framework. While historically and broadly translated into English simply as a "ligament," a comprehensive investigation of classical texts demonstrates that Snayu denotes a more extensive, functional grouping of dense regular fibrous connective tissues encompassing modern ligaments, tendons, fascial sheets, aponeuroses, and muscular sphincters.
2. Vritta Snayu (Round or Cord-like Structures) Vritta denotes a circular, cylindrical, or tightly condensed cord-like geometry. These are highly focused, thick bundles designed to transmit massive linear forces across specific joint axes. Classical commentary directly links large Vritta Snayus with Kandara (Singh et al., 2022) [10].
Modern Anatomical Correlation: These align with cord-like ligaments and deep, high-load tendons. Classic examples include the Ligamentum teres of the hip joint, the anterior and posterior cruciate ligaments (ACL/PCL) of the knee, the long head of the biceps tendon, and the Achilles tendon (Gulpha-Kandara) (Woo et al., 2021) [8]. Their circular profile minimizes friction while maximizing directional tensile strength.
The Santa Maria necropolis (Idanha-a-Velha), primarily dated to the twelfth and thirteenth centuries, represents a rare and securely dated medieval skeletal assemblage from the interior of Portugal.
In addition, a highly porous articular surface with near-complete reduction of the fovea capitis, the attachment pit for the femoral head ligament, is observed ( Figure 8 A). No eburnation or fracture lines were observed, although the proximal femur exhibits coxa magna, with mild compression on the femoral neck, …
Abstract
Ligamentum capitis femoris (LCF) is a robust ligament that connects the femoral head to the pelvis, and it derives from the mesenchymal cells. It is composed of dense, regular connective tissue and collagen. The evidence for its involvement in active hip joint motion is limited. The findings suggest that LCF stabilises the hip joint while also playing a role in preventing hypermobility. Its primary role is to prevent excessive motion of the hip joint rather than facilitate movements, as evidence for its involvement in active hip joint motion is limited. Specifically, the LCF restricts hip flexion, extension and lateral rotation, as studies indicate that individuals with an absent or torn LCF exhibit an increased range of motion compared to those with an intact LCF. Although a complete absence of LCF is rare, it is observed frequently in patients with developmental dysplasia of the hip (DDH). A condition characterised by abnormal hip development in children. Absence of LCF may be unilateral or bilateral. In cases of unilateral absence, the limb with the LCF intact was often observed to maintain the normal robust strength despite the developmental abnormalities. Given that DDH affects the mesenchymal cell development, LCF is particularly susceptible to underdevelopment or absence due to its embryological origin. Damage to or absence of LCF may lead to microinstability of the hip joint, whereby the femoral head is not properly aligned within the acetabulum. Over time, persistent microinstability may result in more pronounced hip instability as the cartilage is challenged by the constant friction. This may cause increasing pain to the patient as a microinstability of the hip joint progresses to a more severe and loose state of the joint. Nevertheless, pain related to an LCF tear is particularly prevalent in athletes rather than in other groups. Athletes are at a higher risk of developing hip joint instability faster due to the high frequency of activity and extreme use of the hip joint.
The standard reconstructive treatment for hip dislocation in cerebral palsy includes varicose femoral osteotomy (VDOF), if necessary, combined with various types of pelvic osteotomy [9, 10, 11]. The advisability of arthrotomy followed by intra-articular manipulation remains controversial. Proponents of capsulotomy point to the need to eliminate mechanical obstacles to achieving concentric reduction of the hip head within the acetabulum—hypertrophic ligamentum teres, inverted labrum, and acetabular fat pad.
During subsequent capsulotomy, mechanical obstacles to repositioning were verified intraoperatively: hypertrophic ligamentum teres—in 90% of patients in Group II, hypertrophy of the pulvinar fat pad—in 71%, and inverted labrum—in 55%.
Abstract
Objective
To evaluate the association between ligamentum teres thickness measured on hip MRI and lateral femoral head extrusion in patients with Legg–Calvé–Perthes disease and to assess the intra- and interobserver reproducibility of these measurements.
Materials and methods
This retrospective study included pelvic radiographs and hip MRI examinations of patients with Legg–Calvé–Perthes disease. Femoral head extrusion was assessed on anteroposterior pelvic radiographs using the Reimers migration index, which served as the reference standard. Two musculoskeletal radiologists independently measured ligamentum teres thickness on MRI in the mediolateral and anteroposterior planes and performed qualitative assessment of ligament morphology. Intra- and interobserver agreement was evaluated using intraclass correlation coefficients and kappa statistics.
Results
Sixty-four hips from 58 patients (mean age, 13.4 years) were included; femoral head extrusion was present in 24 hips (37.5%). Mediolateral ligamentum teres thickness showed excellent intraobserver and good interobserver reproducibility and was significantly greater in hips with extrusion than in those without extrusion (mean, 5.03 mm vs 3.80 mm; p = 0.008). Mediolateral thickness correlated positively with the migration index (ρ = 0.30, p = 0.016). Age was not significantly associated with ligamentum teres thickness or migration index values, and the association between mediolateral thickness and extrusion remained significant after adjustment for age (OR = 1.61; 95% CI, 1.14–2.28; p = 0.007). No significant associations were observed for anteroposterior thickness or qualitative ligament morphology.
Conclusion
In Legg–Calvé–Perthes disease, increased mediolateral ligamentum teres thickness on MRI is associated with lateral femoral head extrusion and may represent a reproducible imaging parameter.
Abstract
Residual instability after a complex hip dislocation is rare and difficult to manage. Orthopaedic traumatologists should be aware of adjunctive techniques that provide additional internal constraints and enhance hip joint stability after bony fixation. Ligamentum teres reconstruction has gained attention in the sports medicine and pediatric literature for reconstructing the secondary stabilizer of the hip. In this technique, we describe the use of a femoroacetabular suspension device to address residual instability in 6 patients with complex hip dislocations. In essence, deployment of a suspensory fixation device across the femoroacetabular joint provides an internal stabilization strategy to maintain reduction, serving as a salvage option or as a primary stabilization method in select cases where traditional fixation or soft tissue repair is unlikely to restore stability, and thereby avoiding the need for postreconstruction immobilization or more complex reconstructive procedures.
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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