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

Abstract

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.

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

“…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…”

“…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 There is a growing body of literature showing that LT reconstruction can successfully address LT dysfunction, particularly in patients with hip instability and generalized ligamentous laxity. To date, most of the available literature on LT reconstruction consists of technical articles, cadaveric or biomechanical studies, and small case series with short-term follow-up.…”