Indications and Outcomes After Ligamentum Teres Reconstruction: A Systematic Review

Abstract

Purpose: To systematically review the literature to better understand the current indications for ligamentum teres reconstruction (LTR), current graft and acetabular fixation options used, patient-reported outcomes after LTR, and incidence of complications and reoperations after LTR. Methods: A systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) statement. All literature related to LTR published prior to July 2020 was identified. The inclusion criteria consisted of investigations reporting on human patients with pathology of the ligamentum teres who underwent LTR, including mentions of the indications, graft type, acetabular fixation method, postoperative patient-reported outcome scores, and incidence of complications and reoperations. Results: Seven studies comprising 26 patients (28 hips) were included. The most commonly reported indication for LTR was persistent pain and instability after failed prior hip arthroscopy (68%, 19 of 28 hips). The mean postoperative modified Harris Hip Score, Non-arthritic Hip Score, and visual analog scale score all showed improvement when compared with preoperative values. A total of 2 complications occurred. Complication rates ranged from 0% to 100% in included case reports and 0% to 11% in included case series. A total of 9 reoperations were performed. Reoperation rates ranged from 0% to 100% for case reports and 18% to 100% for case series. Reoperation rates ranged from 33% to 100% in studies with patients receiving acetabular fixation using anchors versus 0% to 22% in studies performing LTR with buttons. Reoperation rates in athletic patients and patients with Ehlers-Danlos syndrome ranged from 0% to 100% and 0% to 50%, respectively. Conclusions: The main indication for LTR was persistent hip or groin pain and instability after a prior hip arthroscopy. The short-term postoperative modified Harris Hip Score, Non-arthritic Hip Score, and visual analog scale score after LTR showed favorable outcomes. However, reoperations after LTR were not uncommon. Level of Evidence: Level V, systematic review of Level IV and V studies.

What the papers say

“…The authors from the United States [ 3 ] systematically reviewed the literature to better understand the current indications for ligamentum teres reconstruction (LTR), current graft and acetabular fixation options used, patient-reported outcomes after LTR and incidence of complications and reoperations after LTR.…”

A guide to facilitate the creation of a femoral tunnel for arthroscopic ligamentum teres reconstruction: a three-dimensional computed tomography study

“…Therefore, studies recommend the LT reconstruction surgery in such cases [ 10–13 ]. Since patient-reported early outcomes are favourable [ 14 , 15 ] and numerous studies have already described the detailed surgical technique of the LT reconstruction [ 11 , 16–18 ], it is reasonable to expect the LT reconstruction surgery may become more frequent procedure than before.…”

Quantitative cotyloid fossa thickness and proximity to obturator neurovascular bundle: implications for arthroscopic ligamentum teres reconstruction

“…The LTR was first described by Simpson et al . [ 9 ] in 2011 as graft implantation that spans between the femoral head and cotyloid fossa through two tunnels, thereby restoring the function of the native LT. As an increasing body of evidence reports favorable outcomes following LTR [ 10 ], its indication has been expanded not only to patients with failed hip arthroscopy but also to patients with hip pain and instability (Beighton score >4 points) in the presence of LT tear >50% and normal acetabular coverage [ 11 ].…”