Contribution of the Pubofemoral Ligament to Hip Stability: A Biomechanical Study

Martin, Hal David; Khoury, Anthony; Schröder, R; Johnson, Eric; Gómez-Hoyos, Juan; Campos, S M; Palmer, Ian J.

doi:10.1016/j.arthro.2016.07.025

Cited by 17 publications

(14 citation statements)

References 16 publications

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“…The piriformis originates from the anterior surface of the second to fourth sacral vertebrae and inserts on the crest of the great trochanter. The conjoint tendon connects with the joint capsule medially, connects with the posterior margin of the gluteus medius laterally, and connects with the tendon of the obturator externus inferiorly [ 6 ]. The obturator externus, passing like a sling, originates from the external bony margin of the obturator foramen and inserts into the piriformis fossa [ 6 ].…”

Section: Introductionmentioning

confidence: 99%

“…The conjoint tendon connects with the joint capsule medially, connects with the posterior margin of the gluteus medius laterally, and connects with the tendon of the obturator externus inferiorly [ 6 ]. The obturator externus, passing like a sling, originates from the external bony margin of the obturator foramen and inserts into the piriformis fossa [ 6 ]. As capsular contributions, the conjoint and obturator externus tendons course along the posterior aspect of the hip capsule [ 7 ].…”

Section: Introductionmentioning

confidence: 99%

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Soft tissue restrictors of femoral elevation in direct anterior approach—an anatomic study

Zhao¹,

Zhu²,

Jiang³

et al. 2018

J Orthop Surg Res

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BackgroundWith the patient in a constant supine position, elevation of the femur in THA (DAA) provides a more intuitive and conducive location of the acetabulum for the correct placement of the acetabular prosthesis, but elevation of the femur for broaching becomes more challenging. The purpose of this study is to analyze the restriction of the ischiofemoral ligament and short external rotation muscles, and its effect on the elevation of the proximal femur in the DAA.MethodsThe study subjects comprised 5 freshly frozen cadavers with 10 normal hips. All of the anatomic dissections of all of the hips were performed through the DAA. The ischiofemoral ligament, piriformis, conjoint tendon, and external obturator were successively resected. All of the proximal femurs of the specimens were levered by a point tip curved retractor that was connected with a dynamometer. Through preliminary measurements, an applied force of 80 N was adopted and maintained on the curved retractor. The experiment was repeated to measure the displacement of the proximal femur being raised after the posterior structures of the hip joint had been resected in a stepwise fashion. The displacement of the retractor was recorded, and the data were then analyzed.ResultsThe distance significantly increased after the ischiofemoral ligament was severed (P < 0.001). A prominent increase was demonstrated after the conjoint tendons were severed (P < 0.001). The distance insignificantly increased after the piriformis was severed (P > 0.05). After the obturator externus was cut off, the distance increased by an insignificant amount (P > 0.05).ConclusionIn DAA, the ischiofemoral ligament contributed stability when the femur was being raised. The main contribution of restriction was provided by the conjoint tendon. The tendons of the obturator externus muscle and piriformis muscle did not provide any significant restriction when the femur was being raised.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Soft tissue restrictors of femoral elevation in direct anterior approach—an anatomic study

Zhao¹,

Zhu²,

Jiang³

et al. 2018

J Orthop Surg Res

View full text Add to dashboard Cite

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“…Moreover, a previous study proposed the use of the stepwise approach for soft-tissue releases [4]. The capsular ligament can help achieve hip joint stability during dynamic and static motions [6]. Biomechanical cadaveric studies of the capsular ligament have shown that ILFL can facilitate primary restraint while in extension and external rotation [9,22].…”

Section: Discussionmentioning

confidence: 99%

“…Recent anatomical studies have reported that the capsular ligament plays a repressive role in external and internal rotation [6,7] and traction force [8] of the hip joint. The capsular ligament comprises three primary fibrous ligaments: iliofemoral, ischiofemoral, and pubofemoral.…”

Section: Introductionmentioning

confidence: 99%

An Anatomic Study of the Relationship Between the Iliocapsularis Muscle and Iliofemoral Ligament in Total Hip Arthroplasty

et al. 2021

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“…Earlier studies explored the biomechanical contributions of local hip anatomy to stability, 4,5 and this evolved into a greater understanding of how the capsule itself taken together with pericapsular structures contributes to hip stability. 3,[6][7][8] More recently, the debate over the importance of capsular repair 9,10 and various repair strategies [11][12][13] has culminated with several outcome studies that leave no question as to the evidence in support of superior surgical outcomes with capsular repair. 14,15 Yes, folks, it is quite clear that the capsule must be addressed during routine arthroscopy.…”

Section: See Related Article On Page 116mentioning

confidence: 99%

Editorial Commentary: #Capsule-ophilesRejoice! The Evidence in Support of Diligent Capsular Management During Hip Arthroscopy Can No Longer Be Ignored

Walters

2020

Arthroscopy: The Journal of Arthroscopic & Related Surgery

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From its infancy until now, the enthusiasm and growth of the field of hip arthroscopy have been exciting to watch. Perhaps, it could be argued that there has not been a more hotly debated topic in recent years than what to do with the hip capsule. Once merely an afterthought in the context of hip arthroscopy, the oft overlooked and underappreciated intricacies of hip capsular anatomy and its role in hip stability have now taken center stage. As surgical indications continue to expand, our surgical techniques have rapidly evolved. Despite the rapid growth and advent of industry, the leaders in this field have remained steadfast in their relentless quest to improve their scientific knowledge and understanding of the native hip joint. If we have learned nothing else from watching the capsular debate evolve, it is that without an advanced understanding of the critical and complex marriage of anatomy and function that exists in a healthy hip joint, we cannot begin to master the surgical treatment of its pathologic states.

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Contribution of the Pubofemoral Ligament to Hip Stability: A Biomechanical Study

Cited by 17 publications

References 16 publications

Soft tissue restrictors of femoral elevation in direct anterior approach—an anatomic study

Soft tissue restrictors of femoral elevation in direct anterior approach—an anatomic study

An Anatomic Study of the Relationship Between the Iliocapsularis Muscle and Iliofemoral Ligament in Total Hip Arthroplasty

Editorial Commentary: #Capsule-ophilesRejoice! The Evidence in Support of Diligent Capsular Management During Hip Arthroscopy Can No Longer Be Ignored

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