Ligamentum teres maintenance and transfer as a stabilizer in open reduction for pediatric hip dislocation: Surgical technique and early clinical results

Abstract

The ligamentum teres has primarily been considered as an obstruction to reduction in children with developmental dislocation of the hip (DDH). In the early surgical descriptions of both the medial (Ludloff) approach and the anterior (Salter) approach to the hip, it was generally accepted that the ligamentum teres was an obstruction to reduction and was excised (similar to the discarding of menisci for knee surgery in our orthopedic history). Because of the known propensity for early re-dislocation following open reduction, we developed surgical methods for maintaining the ligamentum teres when performing open reduction for hip dislocation in young children. This study presents the surgical methods developed for ligament maintenance and transfer, and analyzes the early clinical and radiographic results in a study group. The techniques for open reduction by both the medial Ludloff approach and the anterior open reduction were developed and refined. Twenty-one children (23 hips) had ligamentum teres shortening and transfer performed as part of either a medial Ludloff or anterior open reduction for hip dislocation. Complete pre-operative and post-operative clinical and radiographic analysis was performed. All patients had stable hips at follow-up. The transferred ligamentum teres appeared to provide additional stability to prevent repeat dislocation. We noted no apparent loss of hip motion or other adverse events. One patient had avascular necrosis (AVN). In this series of 23 hips, in which ligamentum teres transfer/tenodesis was utilized, we found no residual subluxation or dislocation in either the medial Ludloff or the anterior open reduction groups. Based on these early positive results, we recommend the method for children treated with the Ludloff open reduction procedure. Although we have less experience with it, the technique presented for ligamentum maintenance and transfer in anterior open reduction may provide similar added stability. This is an early follow-up study, and long-term follow-up will be required to confirm the ultimate femoral head and acetabular development.