McMaster University

McMaster University

Ligamentum Teres Injuries of the Hip: A Systematic Review

We are pleased to share with you a recent publication in Arthroscopy. This publication is entitled "Ligamentum Teres Injuries of the Hip: A Systematic Review Examining Surgical Indications, Treatment Options, and Outcomes".

Find the abstract below and here to access the full-version of the article.

de SA D, Phillips M, Philippon MJ, Letkemann S, Simunovic S, Ayeni OR. Ligamentum Teres Injuries of the Hip: A Systematic Review Examining Surgical Indications, Treatment Options, and Outcomes. Arthroscopy: The Journal of Arthroscopic & Related Surgery, Available online 12 August 2014, ISSN 0749-8063

Abstract

Purpose
Hip arthroscopy is becoming a common technique for the diagnosis and treatment of ligamentum teres pathologic conditions. This systematic review aims to determine the indications/contraindications, treatments, and surgical outcomes for management of ligamentum teres injuries.

Methods
We searched EMBASE, MEDLINE, and PubMed databases from 1946 to November 28, 2013 for all relevant English articles pertaining to surgical treatment of the ligamentum teres. A hand search of the reference sections of included articles was performed, and all relevant articles were systematically screened in duplicate, with agreement and descriptive statistics presented.

Results
We identified 1,016 studies, 9 of which (4 case series and 5 case reports) met our eligibility criteria. These studies had a total of 87 patients (89 hips) who had undergone either arthroscopic debridement (81 patients, 83 hips) or reconstruction with autografting, allografting, or synthetic grafting (6 patients) of a torn ligamentum teres. Major qualifications for surgery included persistent hip pain despite conservative treatment and mechanical symptoms or instability symptoms (e.g., clicking or locking). Advanced arthritis (i.e., radiographic joint space < 2 mm) was the only reported contraindication. Patients were followed postoperatively for 1.5 to 60 months and were assessed using subjective methods (i.e., modified Harris Hip Score [mHHS] and Non-Arthritic Hip Score [NAHS]). Overall, both debridement and reconstruction improved the condition of patients, with a 40% increase in reported postoperative functional scores as well as a reported 89% of patients who were able to return to regular activity/sport.

Conclusions
Ligamentum teres debridement is indicated for short-term relief of hip pain caused by partial-thickness tears (type 2) failing conservative management, whereas reconstruction with autografts, allografts, or synthetic grafts may be indicated for type 1 (full-thickness) ligamentum teres tears that are deemed “reparable,” cause instability, have failed previous debridement, or a combination of these conditions.

 

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