Ligamentum Teres Tears Research Articles

Tears of the Ligamentum Teres

Background The ligamentum teres (LT) anatomy has been known for many years. While its functionality remains debatable, it is well recognized that the LT can be a source of pain in the hip joint. In 1997, a landmark publication by Gray and Villar established a classification for LT tears and increased the awareness of LT disorders. However, the incidence of LT tears and the various tear types is unknown. Purpose The authors report the prevalence of LT tears in a population of patients who underwent hip arthroscopy, using both the Gray and Villar classification and a new descriptive classification. Study Design Case series; Level of evidence, 4. Methods Between February 2008 and January 2011, 616 hip arthroscopies were performed by the senior author. After excluding revision surgeries, a total of 558 surgeries (502 patients) were included in the study. Data were collected regarding patients’ demographics, mechanism of injury, range of motion, magnetic resonance results, and intraoperative findings. Preoperative hip-specific questionnaire scores and pain level were recorded as well. Ligamentum teres tears were classified according to Gray and Villar's classification, and were also categorized using a descriptive grading system as follows: 0, no tear; 1, <50% tear; 2, >50% tear; or 3, 100% tear. Results A total of 284 (51%) of the 558 surgeries in this cohort revealed LT tears. According to the descriptive grading system, 22% were grade 1, 24% were grade 2, and 5% were grade 3. According to the Gray and Villar classification 3.7% had full rupture, 43% had a partial tear, and 4.5% had a degenerative tear. Patients with LT tears were significantly older and had worse preoperative functional scores; they did, however, have a greater range of motion. Intraoperatively, an association with larger labral tear size and acetabular chondral damage was found. Magnetic resonance arthrography was found to have low accuracy and sensitivity in detection of LT tears. No correlation to the pain level was found. Conclusion Ligamentum teres tears had a higher prevalence in this study than was published in the past, most probably attributable to a lower threshold used in defining a tear. The incidence is defined both using the Gray and Villar classification, as well as a new descriptive classification system that categorizes the LT according to amount of tearing.

Hip Arthroscopy Assessment Tools and Outcomes

The traditional focus on hip pathology has been the older, less-active patient with hip osteoarthritis. Subsequently, hip outcome tools focused on assessing the pain and function of these patients before and after total hip arthroplasty. Magnetic resonance arthrography, hip arthroscopy offering less-morbid surgical options, and a focus on the younger, more athletic patient with nonarthritic hip pain have generated a need for patient-reported hip outcome tools that assess even the highest-level competitive athlete. So far, the modified Harris Hip Score (MMHS), the Hip Outcome Score (HOS), the Nonarthritic Hip Score (NHS), and, most recently, the MAHORN (Multicenter Arthroscopy of the Hip Outcomes Research Network) Hip Outcomes Tool (MAHORN Hip Outcomes Tool [MHOT]) were developed to fill this void. Hip arthroscopy outcomes research is also limited by the lack of an accurate, universally used terminology to describe the characteristics and location of intra-articular lesions. Hip arthroscopy is considered a safe and effective treatment for several indications, including loose bodies, labral tears, femoroacetabular impingement, ligamentum teres tears, and hip instability. Concomitant articular cartilage damage is a negative prognostic indicator for all hip arthroscopy indications. Arthroscopy for radiographically evident degenerative hip disease has almost uniformly poor results. For the most part, only short and midterm follow-up studies are available.

Arthroscopic debridement of the isolated Ligamentum Teres rupture

Most tears of the Ligamentum Teres (LT) are diagnosed when treating other hip pathologies. The purpose of this study was to evaluate the outcome of arthroscopic surgery for a unique group of patients with symptomatic isolated Ligamentum Teres rupture of the hip. The study included 29 patients who suffered from an isolated Ligamentum Teres rupture of the hip and were treated with an arthroscopic debridement from 2003 to 2008. Patients with femoroacetabular impingement or other hip pathologies except Ligamentum Teres tear were excluded. Clinical results were measured preoperatively and postoperatively with the modified Harris Hip Score (MHHS) and Non-Arthritic Hip Score (NAHS). The mean age was 25years (SD±11) with a mean follow-up time of 2.5years (SD±1.5). At the last follow-up, the mean MHHS improved from 70 to 86 [mean difference=16 (95% CI 4-27)] and the mean NAHS improved from 64 to 86 [mean difference=22 (95% CI 10-33)]. Five patients have had a second arthroscopic debridement due to symptomatic recurrent tears. Arthroscopic debridement alone of the isolated Ligamentum Teres rupture has a short-term beneficial result in more than 80% of cases.