Content
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.
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 the hip (CDH) should be diagnosed in the first 24 hours in the newborn, and some form of abduction treatment instituted without primary dysplasia.? The purpose of the authors in presenting this paper is to explain the helpful contributions of the ligamentum teres in the early stages of CDH.
EMBRYOLOGY
Description of the development of the hip joint has differed markediy
over the years. At one time, a germinal defect was implicated, but the most
careful studies (by Strayer in 1943, Gardner and Gray in 1950), have
demonstrated that all the elements of the hip joint differentiate in situ from
one mass of blastema.
A definite interzone between the future skeletal masses is first noted
in the 17 mm specimen which represents a fertilization age of 6 1/2 weeks. The
cells lack any specific Orientation at this stage, but by 20 mm, or 7 weeks,
the middle portion of this interzone is lighter. This middle zone is directly ‚continuous
with the mesenchymal tissue surrounding the potential joint. The outer layers
of this interzone are continuous with the perichondrium of the adjacent
cartlages. The inner layers are the first indication of synovial mesenchyme.
Capsular condensation is fairly well advanced in 25 mm specimens at 8 weeks,
but a deficiency still exists in the region destined to be the acetabular notch.
The first hint of a joint space as such is seen in the 30 mm specimens, where small coaleseing spaces are evident and blood vessels are entering the acetabular fossa. By 37 mm, which represents a fertilization age of 8-9 weeks, synovial tissue can be defined at the reflection of the capsule of the now completed joint space. The synovial tissue is clearly defined in the 60 mm (10% week old) specimen.
Michaels and Matles also studied the ligamentum teres in DDH, and also
noted that it is generally hypertrophied and elongated. However, they stated
that the ligamentum teres exerts “ball and chain control” on the femoral head,
which may spontaneously reduce a congenitally dislocated hip (2008WengerDR_MiyanjiF).
Michaels G, Matles AL. The role of the ligamentum teres in congenital dislocation of the hip. Clin Orthop Relat Res. 1970;71:199–201. journals.lww.com
Wenger DR, Mubarak
SJ, Henderson PC, Miyanji F. Ligamentum teres maintenance and transfer as a
stabilizer in open reduction for pediatric hip dislocation: surgical technique
and early clinical results. Journal of children's orthopaedics.
2008;2(3)177-85. Doi: 10.1007/s11832-008-0103-3 pmc.ncbi.nlm.nih.gov , journals.sagepub.com
Michaels G, MD
Matles AL, MD
From the Hospital for Joint Discases
and Medical Center, New York, N. Y.
ligamentum capitis femoris, ligamentum teres, ligament of head of femur, pathology, role, dysplasia, congenital dislocation, embryology, development
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