LCF in 2026 (September)
(Quotes from articles and books published in September 2026 mentioning the ligamentum capitis femoris)
Goetz, J. E., Hockman, J., & Willey, M. C. (2026). Rabbit models of hip dysplasia: a narrative review. Laboratory animal research, 42(1), 32. [i] link.springer.com
Kahana-Rojkind, A. H., Strok, M. J.,
Walsh, E. G., Quesada-Jimenez, R., Kuhns, B. D., & Domb, B. G. (2026).
Factors Associated With Return to Sport at Minimum 10-Year Follow-up in
Athletes With Borderline Hip Dysplasia Undergoing Hip Arthroscopy With Capsular
Plication. Orthopaedic Journal of Sports Medicine, 14(9),
23259671261451218. [ii] journals.sagepub.com
Stanard, I., Almhanna, H.,
Al-Mahmodi, A. M. M., Kilroy, D., & Kumar, A. H. (2026). Comparative
Analysis of Vascular Density in the Femoral Head Ligament of the Dog, Sheep,
and Goat. [iii] oajr.org , researchgate.net
Hirt, J., Roshardt, J., Schwab, J.
M., Steppacher, S. D., & Tannast, M. (2026). Gluteus Minimus Indentation Is
Associated With Acetabular Undercoverage and Increased Femoral Torsion in
Patients With Nontraumatic Hip Pain. Clinical Orthopaedics & Related
Research. September 8, 2026. | DOI: 10.1097/CORR.0000000000004124 [iv] ovid.com
Hip Dysplasia in Dogs (2026) Movement Referrals: Independent
Veterinary Specialists [v] movementvets.co.uk
Ade-Conde, M., Skaik, K., Duru, D.
O., Vivekanantha, P., Bouchard, M. D., & Ayeni, O. R. (2026). Mid-to
long-term survivorship and patient-reported outcomes following hip arthroscopy
in paediatric and adolescent patients: a systematic review. Journal of Hip
Preservation Surgery, hnag041. [vi] academic.oup.com
Akdogan, A. I., Tokgöz, N., &
Tosun, O. (2026, September). Overuse Injuries of the Hip and Pelvis:
Apophysitis, Stress Fractures, and Tendinopathies. Seminars in
Musculoskeletal Radiology. Thieme Medical Publishers, Inc. 09 September 2026. DOI: 10.1055/a-2932-1299 [vii] thieme-connect.com
Bal, Z., Tanabe, Y., Rahmawati, F.
N., Wang, M., Sitompul, F. N., Su, R., & Takakura, N. (2026). A novel mouse
trauma model for osteonecrosis of the femoral head. JBMR Plus,
ziag135. [viii] scholar.google.com
Henry, L., Funk, K., Yen, Y. M.,
& Abzug, J. (2026). The Unique Features of Pediatric Sports Injuries: The
Hip. Children, 13(9), 1229.
[ix] mdpi.com
Yetter, T. R., Mendoza, Z. D.,
Miller, R. R., Trachtenberg, B. H., Liberman, S. R., Mendoza, Z., ... &
Liberman, S. (2026). False-Negative Ligamentum Teres Tendon Sampling for the
Detection of Systemic Amyloidosis. Cureus, 18(9):e116430. doi:10.7759/cureus.116430. [x] cureus.com
Dopke, K.,
Campbell, R., Talathi, N., Bomar, J. D., Elias, A., & Thompson, R. M.
(2026). Concomitant Open Reduction Does Not Improve Outcomes in Patients
Undergoing Osseous Reconstruction for Severe Hip Dysplasia Secondary to
Cerebral Palsy: A Radiographic and Clinical Comparative Analysis. Journal of
Pediatric Orthopaedics. September 16, 2026. DOI:
10.1097/BPO.0000000000003478 [xi] ovid.com
Verma, A., & Shalini, C. (2026).
Complementary application of Yoga Prana Vidya (YPV) healing in postoperative
recovery following surgical management of recurrent hip dislocation in a
Labrador retriever: A case report. 2026;SP-11(8):284-288. [xii] yogapranavidya.com
Afzaltoosi, A., Rasi, A. M.,
Baroutkoub, M., Zarei, R., Mirkheshti, A., Shakeri, A., & Nesaei, F.
Pericapsular Nerve Group Block Versus Peri-Hip Ropivacaine Infiltration for
Analgesia After Total Hip Arthroplasty: A Comparative Clinical Study. SMMR Journal (2026)
12; 02: 01-10 doi.org/10.66224/smmr.202602.12.01 [xiii] simmr.info
Barry, C., Simpson, E., &
Gibbins, I. (2026). Human Musculoskeletal Anatomy: Developing applied knowledge
for effective clinical reasoning. Flinders University. [xiv] oer.flinders.edu.au scholar.google.com
Shah, A., Pandey, N., & Shrestha,
S. (2026). Morphometric study of dry proximal femur of the Nepalese population:
Implications for arthroplasty. Journal of Universal College of Medical
Sciences, 14(02), 37. [xv] researchgate.net
Tran P. Ligamentum teres tear and what it means for your hip. Professor
Phong Tran. Last reviewed 22 September 2026.
[xvi] phongtran.com.au
Pullen, W. M., Pierre, K. J.,
Simunovic, N., Pham, N. S., Aoki, S., Ayeni, O. R., ... & Safran, M. R.
(2026). Interobserver Reliabilities of 2 Classifications for Arthroscopic
Classification of the Pulvinar Tissue. Orthopaedic Journal of Sports
Medicine, 14(9), 23259671261444305.
[xvii] journals.sagepub.com
Multiple papers describe traumatic or excisional methods to create dysplastic deformities in the rabbit hip (Table 1) [18,19,20,21,22,23,24]. ... Other studies describe directly removing portions of the rim [19, 20, 22], ablating the growth plate [21], or transecting the ligamentum capitis femoris [23, 24]. These techniques result in acetabular deficiencies, joint subluxations, and femoral abnormalities which do occur in mechanically unstable dysplastic hips.
23 Tomé I, Costa L, Alves-Pimenta S, Sargo R, Pereira J, Colaço B, et
al. Morphometric assessment of the hip joint in a functional dysplastic rabbit
model. Vet Sci. 2024;11(8). https://doi.org/10.3390/vetsci11080387.
24 Costa L, Tomé I, Colaço B, Alves-Pimenta S, Sargo R, Pereira J, et
al. Hip dysplasia induction: Establishment of a new surgical model in rabbits.
Vet J. 2025;310:106308. https://doi.org/10.1016/j.tvjl.2025.106308.
Hip dysplasia causes pathologic joint mechanics that directly lead to soft tissue injuries and intra-articular degeneration. Labral tears, articular chondral injury, and partial-thickness ligamentum teres tears are typically seen as a result of hip dysplasia [43,44,45], and these pathologies are often treated arthroscopically at the time of PAO.
43 Domb BG, Lareau JM, Baydoun H, Botser I, Millis MB, Yen YM. Is
intraarticular pathology common in patients with hip dysplasia undergoing
periacetabular osteotomy? Clin Orthop Relat Res. 2014;472(2):674–80.
https://doi.org/10.1007/s11999-013-3140-2.
44 Fujii M, Nakashima Y, Jingushi S, Yamamoto T, Noguchi Y, Suenaga E,
et al. Intraarticular findings in symptomatic developmental dysplasia of the
hip. J Pediatr Orthop. 2009;29(1):9–13.
https://doi.org/10.1097/BPO.0b013e318190a0be.
45 Noguchi Y, Miura H, Takasugi S, Iwamoto Y. Cartilage and labrum
degeneration in the dysplastic hip generally originates in the anterosuperior
weight-bearing area: an arthroscopic observation. Arthroscopy.
1999;15(5):496–506. https://doi.org/10.1053/ar.1999.v15.015049.
The rabbit hip dysplasia model also develops macroscopic intra-articular pathology, providing a vehicle for investigators to critically assess the impact of surgically correcting these human-like intra-articular changes. Hypertrophy, lengthening, and tearing of the ligamentum teres is reported in the rabbit model in accordance with magnitude of subluxation/dislocation [25, 31, 34, 38]. Capsular thickening or thinning, dependent on the time immobilized and amount of subluxation, are both reported [34]. Grossly, the acetabular articular cartilage can appear dull, yellow, or abraded [34], and the acetabular rim cartilage also often everts, driving remodeling of the acetabular rim and promoting tearing of the acetabular labrum. Other studies have reported evidence of a neolimbus or formation of a false acetabulum in dislocated hips [31].
25 Wilkinson JA. Prime factors in the etiology of congenital dislocation
of the hip. J Bone Joint Surg Br. 1963;45–B(2):268–83.
https://doi.org/10.1302/0301-620x.45b2.268.
31 Moraleda L, Albinana J, Forriol F. Selective epiphysiodesis of the
triradiate cartilage for treatment of residual experimental acetabular
dysplasia. J Pediatr Orthop. 2013;33(8):821–8.
https://doi.org/10.1097/BPO.0b013e31829b2f3f.
34 Wei YS, Li DH, Liu WL, Jiang DM. Altered chondrocyte apoptosis status
in developmental hip dysplasia in rabbits. Balkan Med J. 2016;33(6):639–44.
https://doi.org/10.5152/balkanmedj.2016.150557.
38 Zuccon A, Pereira HDR, Santos S, Felisbino SL, Junior LAJ, Cataneo
DC. The round liagment in develomental hip dysplasia: Are it mechanical and
histological properties preserved? Acta Ortop
Bras. 2022;30(1):e235808. https://doi.org/10.1590/1413-785220223001e235808.
A diagnostic arthroscopy to evaluate the labrum, intra-articular cartilage, and ligamentum teres (LT) was performed after the anterolateral and midanterior portals were created. Labral damage was graded according to the Seldes system.42 Chondral pathologies were measured according to the acetabular labrum articular disruption (ALAD) and Outerbridge classification systems.33,38 The Domb and Villar classifications were used to grade LT tears.5,37
5 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.
37 O’Donnell JM, Arora M. A novel and simple classification for
ligamentum teres pathology based on joint hypermobility. J Hip Preserv Surg.
2018;5(2):113-118.
Tears of the LT were debrided, and patients with recurrent painful
internal snapping refractory to conservative treatment received an iliopsoas
fractional lengthening.
Intraoperative Findings and Surgical Procedures
The BHD and control groups demonstrated similar intraoperative findings
for Seldes labral tear classification, ALAD, acetabular Outerbridge, femoral
Outerbridge, and LT tears in the Villar classification system (Table 3). The
BHD group demonstrated high type 2 LT tears in the Domb classification system,
26.4% compared with 7.5% (P = .02).
The BHD and control groups demonstrated similar rates of labral
treatment, femoroplasty, LT debridement, capsular repair, iliopsoas fractional
lengthening, loose body removal, microfracture, and notchplasty (Table 4). The
control cohort had higher rates of acetabuloplasty (73.6%) compared with the
BHD group (45.3%) (P \.01).
Background
The ligament of the head of the femur (ligamentum teres) is an
intra-articular structure 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.
*This is an open access article
distributed under the Creative
Commons Attribution License 4.0 (CCBY)
Earlier thinking suggested that the indentation [Gluteus Minimus Indentation] resulted from a thickened ligamentum teres, a taut acetabular capsule, or the pars reflecta of the rectus femoris muscle [22, 27].
22.Renshaw TS, Green NE,
Griffin PP, Root L. Cerebral palsy: orthopaedic management. Instr Course Lect.
1996;45:475-4
27.Samilson RL, Tsou P, Aamoth G,
Green WM. Dislocation and subluxation of the hip in cerebral palsy.
Pathogenesis, natural history and management. J Bone Joint Surg Am.
1972;54:863-873.
*This is an open access article
distributed under the Creative
Commons Attribution License 4.0 (CCBY)
The hip is a ball-and-socket joint,
formed by the femoral head (ball) and the acetabulum (socket). Normal stability
depends on the close fit between these structures, together with support from
the joint capsule, surrounding muscles and the ligament of the femoral head.
Capsular management, including repair, closure, or plication, was
reported in four studies [12, 23, 24, 26] Less commonly performed procedures
included iliopsoas lengthening [12, 24], ligamentum teres debridement [12], and
osteochondroplasty for slipped capital femoral epiphysis (SCFE) [25].
Intraoperative findings were characterized by a high prevalence of labral pathology and CAM-pincer morphology (Table 1). Advanced chondral damage [14], ligamentum teres tears [12, 14], and capsular laxity [14] were reported in a minority of hips.
12. Domb BG, Prabhavalkar ON, Maldonado DR et al. Long-term outcomes of
arthroscopic labral treatment of Femoroacetabular impingement in adolescents. J
Bone Joint Surg (United States) 2024;106:1062–8. 2032895773.
10.2106/JBJS.23.00648
14. Menge TJ, Briggs KK, Rahl
MD et al. Hip arthroscopy for Femoroacetabular impingement in adolescents:
10-year patient-reported outcomes. Am J Sports Med (United States) 2021;49:76–81. 10.1177/0363546520973977
Intra-articular snapping hip:
intra-articular snapping hip arises from mechanical abnormalities within the
joint, including acetabular labral tears, loose bodies, cartilage flaps, or
ligamentum teres pathology.
To establish a reproducible
trauma-induced ONFH model, the blood supply to the femoral head was surgically
disrupted by transecting the retinacular vessels and ligamentum teres.
A small incision was made parallel to the third trochanter, followed by
careful dissection until the third trochanter was reached. From the superior
aspect of the third trochanter, the femoral capsule was accessed and incised.
The femoral head was then dislocated from the acetabulum. A circumferential
incision was made around the femoral neck to disrupt the retinacular vessels.
The remnants of the ligamentum teres were transected, and the femoral head was
kept dislocated for at least 30 seconds to 1 minute, before being repositioned
into the acetabulum, to prevent any potential for revascularization. The incision was then closed.
The hip joint relies on static stability from the labrum, capsule,
capsular ligaments, and ligamentum teres, as well as dynamic stability from hip
musculature [19]. The joint capsule consists of longitudinal fibers that form
capsular ligaments—the iliofemoral, pubofemoral, and ischiofemoral ligaments—as
well as circular fibers that form the zona orbicularis that encircle the
femoral neck [19,20]. The ligamentum teres houses the foveal artery, which
provides femoral head perfusion during infancy and early childhood. In addition
to its vascular function, the ligamentum teres acts as a secondary constraint
during high flexion, adduction, and external rotation of the hip [21,22].
The arterial supply of the hip develops in accordance with further musculoskeletal growth [21]. The pediatric femoral head is predisposed to avascular necrosis when physes are open, as this creates a functional barrier between the epiphyseal and metaphyseal circulation. While the physis remains open, the femoral head is supplied largely by the lateral epiphyseal vasculature [23]. At age 3 months and below, the femoral head is supplied by the ligamentum teres and lateral epiphyseal arteries. By 18 months, the lateral epiphyseal arteries, which are branches of the medial femoral circumflex artery, become the dominant source of arterial supply [23]. By adolescence, there are metaphyseal and epiphyseal circulations that supply the femur. The medial femoral circumflex artery becomes the dominant supply to the femoral head in adulthood [24].
21 Seeley, M.A.; Georgiadis, A.G.; Sankar, W.N. Hip Vascularity: A
Review of the Anatomy and Clinical Implications. J. Am. Acad. Orthop. Surg.
2016, 24, 515–526.
22 van Arkel, R.J.; Amis, A.A.; Cobb, J.P.; Jeffers, J.R.T. The capsular
ligaments provide more hip rotational restraint than the acetabular labrum and
the ligamentum teres: An experimental study. Bone Jt. J. 2015, 97, 484–491.
23 Chung, S.M. The arterial supply of the developing proximal end of the
human femur. J. Bone Jt. Surg. Am. 1976, 58,
961–970.
Abstract
This case
report involves a 60-year-old man with bilateral carpal tunnel syndrome, hip
osteoarthritis, and lumbar spinal stenosis who underwent biopsies of the
ligamentum teres, ligamentum flavum, and carpal flexor tenosynovium. Amyloid
deposits were identified in the ligamentum flavum and flexor tenosynovium, but
not the ligamentum teres. Amyloid was typed by mass spectrometry, cardiac
scintigraphy was negative, and genetic testing remains pending. This supports
that ligamentum flavum and carpal flexor tenosynovium biopsies may have better
diagnostic value for the early diagnosis of amyloidosis, while the ligamentum
teres is an unpredictable location of biopsy for early diagnosis.
Given the growing evidence of musculoskeletal manifestations as early
indicators of wtATTR, intraoperative biopsies during routine orthopedic
procedures are becoming common practice for many surgeons. To our knowledge,
there is no published literature regarding the efficacy of ligamentum teres
biopsy during total hip arthroplasty for the early detection of amyloidosis.
This case report aims to further explore this landscape by presenting a patient
with bilateral CTS, LSS, and hip osteoarthritis, whose diagnostic workup
included discordant amyloid detection among three musculoskeletal biopsy sites
of the carpal flexor tenosynovium, ligamentum flavum, and ligamentum teres. The
ligamentum teres is routinely removed during total hip arthroplasty and is an
easily accessible tissue that could potentially aid in the early diagnosis of
amyloidosis.
Secondary to his age and multiple musculoskeletal complaints, there was
a high index of suspicion for amyloidosis. Thus, biopsies of the ligamentum
teres, ligamentum flavum, and carpal flexor tenosynovium were taken at the time
of the respective surgeries. Amyloid deposition on Congo red stain was
identified within the ligamentum flavum and carpal flexor tenosynovium, but not
the ligamentum teres.
However, the utility of ligamentum teres biopsy in the setting of total
hip arthroplasty is not well described in the literature, and to our knowledge,
there are no published studies evaluating this. The biopsy of the ligamentum
teres in this patient was negative for amyloidosis less than two months prior
to his carpal tunnel and lumbar stenosis surgeries. This would suggest that the
ligamentum teres may be an unreliable site for biopsy for the early detection
of amyloidosis.
However, definitive claims cannot be made regarding this case report as
the findings in a single patient can have many causations of sampling error.
Inadequate quality or quantity of tissue samples, nonstandardized tissue
volumes, absence of diagnostic-accuracy estimates, incomplete genetic
evaluation, and limited follow-up are all possible confounding factors that
would impact the results in this single patient. Additional investigation via
studies with larger sample sizes is necessary to fully understand the efficacy
of ligamentum teres biopsy for the detection of amyloidosis.
Conclusions
We discussed a 60-year-old patient with chronic bilateral hip
osteoarthritis, bilateral CTS and cubital tunnel syndrome, and LSS with
biopsy-proven amyloidosis. This case supports that ligamentum flavum and carpal
flexor tenosynovium biopsies aid in the early detection of amyloidosis.
However, it questions the utility of ligamentum teres biopsies for the early
detection of amyloidosis. There is limited literature evaluating the efficacy
of ligamentum teres biopsies for amyloidosis, and this is an area for future
investigation.
One patient in the
open reduction group underwent a Salter osteotomy combined with a ligamentum
teres transfer based on the surgeon's clinical decision-making.
Hip luxation (Coxofemoral luxation) is the most frequently encountered
joint luxation in dogs, accounting for approximately 50–90% of all joint dislocations
reported in veterinary practice [1, 2]. The hip joint is a highly stable
ball-and-socket articulation formed by the femoral head and the acetabulum of
the pelvis. Joint stability is maintained through the joint capsule, the
ligament of the femoral head (round ligament), surrounding musculature, and
negative intra-articular pressure.
Hip luxation occurs when the femoral head is displaced completely from
the acetabulum, resulting in rupture of the joint capsule and tearing of the
round ligament. This condition is considered one of the most painful orthopedic
emergencies in dogs and is characterized by acute lameness, inability to bear
weight, severe pain, and abnormal limb positioning. The most common causes
include road traffic accidents, falls from height, traumatic twisting injuries,
and collisions during vigorous activity. Pre-existing joint instability,
including canine hip dysplasia (CHD) [3], may predispose affected animals to
luxation. In most cases, the luxation is craniodorsal, primarily due to the
direction of traumatic forces and the influence of the gluteal musculature
[4].
The pericapsular nerve group (PENG) block and peri-hip local anesthetic
infiltration are both used for postoperative pain management, but their
relative analgesic effectiveness remains uncertain.
Peri-Hip Ropivacaine Infiltration Group
Patients allocated to the surgical infiltration group received 20 mL of
0.25% ropivacaine through peri-hip infiltration performed by the surgeon at
predefined stages of the procedure. Before stem insertion, 5 mL was infiltrated
into the region of the ligamentum teres. Following stem insertion, an
additional 5 mL was administered into the labral region. After capsular repair,
the remaining 10 mL was distributed between the repaired capsule (5 mL) and
adjacent muscle tissue (5 mL). The total dose and concentration of ropivacaine
were identical in the two intervention groups, thereby allowing comparison of
the analgesic techniques while minimizing potential confounding attributable to
differences in local anesthetic exposure.
The
ligament of the head of femur (ligamentum teres) is a small intra-articular
ligament passing from the transverse acetabular ligament and specific margins
of the acetabulum to the fovea of the head of femur. In infants, it transmits
an artery to the femoral epiphysis and traditionally was considered a remnant
structure in adults. However, it may contribute to stability and have other
roles, including proprioception, nociception and distribution of synovial
fluid.
The depth of foveal capitis in the present study was 2.17±0.89 mm, which was lower than that reported in the studies of Yarar B et al.8 [2020, 146 dry femurs, Turkey, 2.67±1.13], Roy T et al.19 [2024, India, 297 dry femurs, 30.41.41 mm] and Golpinar Murat20 [2022, Turkey, 57 dry femurs, 2.71±1.09 mm]. Foveal capitis allows attachment to the ligamentum teres femoris and allows passage to blood vessels to supply the head. The depth of the fovea may vary because different vascular foramina are present at the attachment site of the ligamentum teres femoris. Foveal capitis and its morphometry also help in the positioning of the hip joint, with surgical and clinical implications.19
8 Yarar B, Malas MA, Çizmeci G. The morphometry, localization, and shape
types of the fovea capitis femoris, and their relationship with the femoral head
parameters. Surg Radiol Anat. 2020 Oct;42(10):1243–54.
19 Roy T, Basu R, Das B, Mandal I, Langstastang A. Morphological and
Morphometric Variations of Fovea Capitis Femoris: A Cross-sectional Study from
Kolkata, West Bengal, India. Int J Anat Radiol Surg. 2024;13(5):AO14–8.
20 Gölpinar M. Morphometric and Morphological Evaluation of the Fovea
Capitis Femoris. Med Rec. 2022 Sep
22;4(3):400–4.
The ligamentum teres is a short, strong band deep inside the hip joint. It runs from a notch at the bottom of the hip socket to a small dip on the ball at the top of the thigh bone.
For many years doctors thought this band did almost nothing in adults. That view has changed. It is now thought to help steady the hip when the leg is moved to its limit. It also carries nerve endings, so it may add to pain and help the body sense where the leg is.
Tears of this band are found more often than they once were. The main reason is hip arthroscopy surgery, which lets a surgeon look right inside the joint with a small camera.
Plenty is still unclear. How often these tears cause trouble on their
own is not settled. Nor is how well scans pick them up, or how much treatment
helps. This article sets out what is known and what is not.
What a ligamentum teres tear feels like?
Deep pain in the groin that is hard to point to
Clicking, catching, or a feeling that the hip locks
A feeling that the hip is not steady, or might give way, with nothing
clearly blocking it
Pain at the very end of a movement rather than in the middle
Worse with twisting, deep squats, wide leg positions, or getting out of
a car
The unsteady feeling is the most telling sign. Even so, none of these
signs points only to a ligamentum teres injury, as many problems of the hip
joint have the same symptoms.
Does the ligamentum teres do anything in adults?
Current thinking is that it helps steady the hip at the limits of movement. It also carries nerve endings, which may add to pain and to the sense of where the leg is. Its exact role is still being studied.
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Disruption of the tissue of the acetabular fossa, including the pulvinar
tissue and the ligamentum teres, has been implicated as a source of pain, a
contributor to hip microinstability, and a precursor for arthritic
change.3,5,11,13,15 These factors led Byrd2 to liken the pulvinar tissue within
the acetabular fossa to a “canary in a coal mine,” emphasizing its role as an
early indicator of hip pathology.
The ideal classification system would be both reliable and reproducible
as well as help inform prognosis and/or treatment algorithms.10 Several
classifications of the acetabular fossa exist but demonstrate low inter- and
intraobserver reliabilities, focus primarily on the ligamentum teres, or are
based on open visualization of the lesion.9,13,16
These findings likely highlight the variety and complexity of the tissue
of the acetabular fossa.
Several studies have commented on classification systems of the
acetabular fossa, with most focusing on the appearance of the ligamentum teres.
Devitt et al4 investigated the reliability of the commonly used Gray and
Villar6 and the descriptive Botser et al1 classification systems for the
ligamentum teres. They found fair interobserver reliability (0.39 [0.150-0.598]
and 0.384 [0.213-0.569], respectively), noting that synovitis is not accounted
for in either classification but was considered important for the treatment
algorithm. Subsequently, O’Donnell and Arora9 identified the challenges with
these classification systems and proposed an alternative to define normal,
include synovitis, and account for joint hypermobility. Although their system
is more comprehensive, the interobserver reliability is unknown.16
These studies and classification systems primarily focus on the ligamentum teres, with the pulvinar tissue receiving little direct attention. To account for the complexity of the tissue within the cotyloid fossa, Stetzelberger et al16 proposed a novel grading system for the ligamentous-fossa-foveal complex during open hip preservation surgery. They found excellent interobserver reliabilities for ligament, perifoveolar, and acetabular fossa lesions, although acetabular fossa lesions had the lowest reliability at 0.79 (0.67-0.89). They highlight the challenges with the fossa and pulvinar tissue, attributing lower scores to misinterpretation of the nature of the fossa.16 While this system is superior to others presented within the literature, as well as ours within this study, it is based on open surgery, and its translation to arthroscopic surgery has not been demonstrated.
1. 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(suppl):117S-125S.
4. Devitt BM, Smith B, Stapf R, Jo S, O’Donnell JM. The reliability of
commonly used arthroscopic classifications of ligamentum teres pathology. J Hip
Preserv Surg. 2017;4(2):187-193.
6. Gray AJ, Villar RN. The ligamentum teres of the hip: an arthroscopic
classification of its pathology. Arthroscopy. 1997;13(5):575-578.
9. O’Donnell JM, Arora M. A novel and simple classification for
ligamentum teres pathology based on joint hypermobility. J Hip Preserv Surg. 2018;5(2):113-118.
16. Stetzelberger VM, Zurmuhle CA, Hanauer M, et al. Reliability and
reproducibility of a novel grading system for lesions of the
ligamentous-fossafoveolar complex in young patients undergoing open hip
preservation surgery. Orthop J Sports Med. 2022;10(6):23259671221098750.
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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