Arthroscopic Reconstruction of the Ligamentum Teres: A Guide to Safe Tunnel Placement

Brady, Alex W.; Chahla, Jorge; Locks, Renato; Mikula, Jacob D.; Slette, Erik; LaPrade, Robert F.; Philippon, Marc J.

doi:10.1016/j.arthro.2017.08.308

Cited by 15 publications

(24 citation statements)

References 19 publications

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“…The present study found favorable outcomes in patients with borderline dysplasia and LT tears using LT debridement only; however, LT reconstruction can be a valid option in select patients. 6,10…”

Section: Discussionmentioning

confidence: 99%

An Intact Ligamentum Teres Predicts a Superior Prognosis in Patients With Borderline Dysplasia: A Matched-Pair Controlled Study With Minimum 5-Year Outcomes After Hip Arthroscopic Surgery

et al. 2020

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Background: Hip arthroscopic surgery in patients with borderline dysplasia continues to be controversial. In addition, it has been suggested that ligamentum teres (LT) tears may lead to inferior short-term patient-reported outcomes (PROs) when compared with a match-controlled group. Purposes: (1) To report minimum 5-year PROs in patients with borderline dysplasia and LT tears who underwent hip arthroscopic surgery and (2) to compare these PROs to those of a matched-pair control group of patients with borderline dysplastic hips without LT tears. Study Design: Cohort study; Level of evidence, 3. Methods: Data were prospectively collected for patients who underwent hip arthroscopic surgery between September 2008 and August 2013. Patients were included if they had a preoperative diagnosis of borderline dysplasia (lateral center-edge angle [LCEA], 18°-25°) and had preoperative and minimum 5-year postoperative modified Harris Hip Score (mHHS), Nonarthritic Hip Score (NAHS), and visual analog scale (VAS) for pain scores. Exclusion criteria were osteoarthritis of Tönnis grade >1, previous hip conditions, any previous ipsilateral hip surgery, or workers’ compensation status. There were 2 borderline dysplastic groups created. An LT tear group was matched 1:1 to a control group (no LT tear) with similar age, sex, body mass index (BMI), and laterality via propensity score matching. Significance was set at P < .05. Results: A total of 24 patients with an LT tear (24 hips) were matched to 24 patients without an LT tear (24 hips). There was no significant difference in age, sex, BMI, or laterality between groups. The mean age was 36.2 ± 17.2 and 34.9 ± 15.9 years for the control and LT tear groups, respectively ( P = .783). There were 17 (70.8%) and 16 (66.7%) female patients in the control and LT tear groups, respectively, and the mean preoperative LCEA was 23.3° and 22.2° in the control and LT tear groups, respectively. No differences were observed between groups in baseline PROs, intraoperative findings, or surgical procedures. LT debridement was performed in 17 (70.8%) patients in the LT tear group compared with 0 (0.0%) in the control group. Also, 5-year postoperative PROs were comparable in both groups, with the control group exhibiting superior Veterans RAND 12-Item Health Survey (VR-12) mental ( P = .041) and Short Form–12 (SF-12) mental ( P = .042) scores. Finally, hips with an intact LT were significantly more likely ( P = .022) to achieve the patient acceptable symptomatic state (PASS) for the mHHS (100.0% and 75.0%, respectively). No significant differences were present between the groups for the minimal clinically important difference (MCID) of the mHHS ( P = .140), MCID of the Hip Outcome Score–Sport-Specific Subscale (HOS-SSS) ( P = .550), or PASS of the HOS-SSS ( P = .390). Conclusion: After hip arthroscopic surgery, patients with borderline dysplasia and LT tears demonstrated favorable PROs at a minimum 5-year follow-up. Outcomes were similar to a matched-pair control group without LT tears, with the group with intact LTs showing higher VR-12 mental and SF-12 mental scores. Furthermore, patients with borderline dysplasia and intact LTs were significantly more likely to achieve the PASS for the mHHS.

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Section: Discussionmentioning

confidence: 99%

An Intact Ligamentum Teres Predicts a Superior Prognosis in Patients With Borderline Dysplasia: A Matched-Pair Controlled Study With Minimum 5-Year Outcomes After Hip Arthroscopic Surgery

et al. 2020

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“…The 2 main safe zones identified by Brady et al 4 are in abduction with internal rotation and in adduction with internal rotation. The latter is difficult to reproduce in the intraoperative setting because the legs positioned in a hip distractor are separated with a bulky well-padded post, which makes adduction rather challenging especially in patients with larger thighs.…”

Section: See Related Article On Page 144mentioning

confidence: 95%

“…Hence, the optimization of the acetabular tunnel position through a femoral tunnel by altering the femoral head position is an attractive proposition. We must encourage other authors submitting their scientific work to follow the example in this article by Brady et al 4 and note the relative shortcomings and limitations of the study. It not only highlights the authors' insight into the subject but also helps the reader to think broadly about the subject area.…”

Section: See Related Article On Page 144mentioning

confidence: 98%

“…10,14 These studies have highlighted the careful placement of the tunnels especially on the acetabular side. This is where the data from the cadaveric digitization study by Brady et al 4 are extremely helpful for clinical use in LT reconstruction with respect to the obturator neurovascular bundle.…”

Section: See Related Article On Page 144mentioning

confidence: 99%

“…1 The hip joint perhaps has lagged behind in the application of the instability concept, especially in the context of major ligament damage, as compared with other joints. In this issue of Arthroscopy, the article titled "Arthroscopic Reconstruction of Ligamentum Teres: A Guide to Safe Tunnel Placement" by Brady, Chahla, Locks, Mikula, Slette, LaPrade, and Philippon 4 is a major paradigm shift because we are debating the technical considerations in performing LT reconstruction rather than the question of whether we should be doing it at all. The authors' approach, in our opinion, is exceptional, combining common sense with available technology.…”

Section: See Related Article On Page 144mentioning

confidence: 99%

See 2 more Smart Citations

Editorial Commentary: Arthroscopic Hip Ligamentum Teres Reconstruction—Reality or Mythology?

Bajwa¹,

Villar²

2018

Arthroscopy: The Journal of Arthroscopic & Related Surgery

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The ligamentum teres (LT) is perceived to contribute to hip stability and proprioception. LT incompetence can lead to pain and instability, which may play a role in chondral damage. Hip arthroscopy plays a role in diagnosing and treating LT tears. Reconstruction of the LT is feasible, but careful attention needs to be paid to tunnel positioning, graft material, graft length, and fixation methods. An anatomic femoral tunnel should exit at the fovea capitis on the femoral side, whereas the location for safe placement of the acetabular attachment is thought to be in the posteroinferior part of the cotyloid fossa. On the basis of a recent study, optimization of the acetabular tunnel can potentially be achieved by drilling from the femoral tunnel aided by 15° of abduction and 15° of internal rotation. The femoral neck-shaft angle and femoral anteversion must be factored in while planning the entry point of the femoral tunnel, and this may vary based on the amount of femoral head distraction during hip arthroscopy.

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Ligamentum Teres Injuries and Treatment

Lindner

Gilat

Domb

2020

Hip Preservation Surgery

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Arthroscopic Reconstruction of the Ligamentum Teres: A Guide to Safe Tunnel Placement

Cited by 15 publications

References 19 publications

An Intact Ligamentum Teres Predicts a Superior Prognosis in Patients With Borderline Dysplasia: A Matched-Pair Controlled Study With Minimum 5-Year Outcomes After Hip Arthroscopic Surgery

An Intact Ligamentum Teres Predicts a Superior Prognosis in Patients With Borderline Dysplasia: A Matched-Pair Controlled Study With Minimum 5-Year Outcomes After Hip Arthroscopic Surgery

Editorial Commentary: Arthroscopic Hip Ligamentum Teres Reconstruction—Reality or Mythology?

Ligamentum Teres Injuries and Treatment

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