CLINICAL RELEVANCE of the LIGAMENTUM TERES: A LITERATURE REVIEW

Abstract

Background: The ligamentum teres (LT) continues to be a structure of debate and interest. Previously thought of as a vestigial structure, an awareness of LT pathology and its potential importance has increased with the expansion of hip arthroscopy. Purpose: To provide a comprehensive literature synthesis on the LT and provide clinicians with the most current research regarding the LT and its anatomical features, functional relevance, prevalence of injury, risk factors for injury, clinical presentation, and treatment for pathology. Methods: A systematic literature search was conducted using Medline/PubMed, CINAHL/EBSCO, and Cochrane/ Wiley databases/platforms using the following search terms: ligament, ligament teres, hip, femur, femoral head, round ligament. Results: This search yielded 1284 articles of which 44 met the inclusion/exclusion criteria and contributed to this manuscript. Information on the LT was summarized into the following areas: anatomy, function, injury prevalence, risk factors, mechanism of injury, duration of symptoms, clinical presentation (symptoms, range of motion, functional limitations, special testing), imaging, and treatment. Conclusions: The results of this review supported the following: 1) the LT has a function in restraining hip rotation range of motion; 2) the prevalence of LT pathology in any given population may be largely dependent on the severity of bony deformity (either femoroacetabular impingement(FAI) or dyplasia) and activity level; 3) older age and acetabular bony deformity (either FAI or dyplasia) are risk factors for generalized LT pathology; 4) unique signs and symptoms are difficult to identify because LT pathology rarely occurs in isolation and is likely the end-stage consequence of other hip pathology; 5) the presence of LT pathology may negatively affect an individual's ability to function; and 6) surgical debridement is recommend for pain relief of partial LT tears with reconstruction possible for complete LT tears when complaints of instability are noted.

The role and clinical relevance of the ligamentum teres: long-term outcomes after hip arthroscopic surgery of cam-type femoroacetabular impingement

“…The reported prevalence of LT pathology (including synovitis, partial and complete tears) found during HA surgery varies from 4% to 93% [ 3 , 19 ]. According to Haviv and O’Donnell, an LT tear is observed in 9% of the patients who undergo HA [ 9 ].…”

“…Studies on the function of the ligamentum teres (LT) were first published in the 19th century [ 1 ]. With the development of hip arthroscopy (HA) in recent decades, interest in and the importance of the function and role of the LT has been gradually emphasized [ 2 , 3 ]. Leunig et al .…”

Intra- and Periarticular Ganglia (Synovial Cysts) of the Hip with Compression of the Obturator Nerve, Concomitant with Lesions of the Ligamentum Teres—A Report of 3 Cases

“…The function of the Ligamentum teres (LT) has not been fully clarified to date. According to recent studies, it restricts external rotation and flexion in the hip joint, where it acts as a final stabilizer [8] [9] [10]. Additionally, the LT seems to have mechanoreceptors which help to counter micro instability by activating muscular stabilizers of the hip joint [11].…”

“…Consequently, chronic instability, such as dysplasia or femoroacetabular impingement (FAI) with hypomochlion effect, can lead to recurrent overstretching of the LT and concomitant lesions [12]. This can also be caused by certain sports where a large range of motion is required [10].…”

Indications and Outcomes After Ligamentum Teres Reconstruction: A Systematic Review

“… 6 , 18 , 19 , 20 , 21 Moreover, the prevalence of complete LT tears has been reported to range from 1% to 26%, 1 , 7 , 13 , 14 , 15 , 19 , 22 with complete tears being more common in patients with greater severity of bony deformity. 17 , 23 Studies to date have rarely found LT tears to occur in isolation and have instead suggested LT tears to represent an end-stage consequence of pathomechanical changes occurring within the hip due to concurrent bony and soft-tissue pathology. 6 , 7 , 17 , 24 …”