Ligamentum Teres Tears and Femoroacetabular Impingement: Prevalence and Preoperative Findings

Chahla, Jorge; Soares, Eduardo; Devitt, Brian M.; Peixoto, Lourenço P.; Goljan, Peter; Philippon, Marc J.

doi:10.1016/j.arthro.2016.01.045

Cited by 40 publications

(59 citation statements)

References 18 publications

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“…34,35 It is also interesting to note that there was a significantly higher prevalence of LT pathology in patients with a BTS ≥4, which correlates with a thinner capsule. This would concur with the findings of Chahla et al, 10 who reported that joint hypermobility is a risk factor for LT pathology.…”

Section: Discussionsupporting

confidence: 93%

Generalized Joint Hypermobility Is Predictive of Hip Capsular Thickness

Devitt

Smith

Stapf

et al. 2017

Orthopaedic Journal of Sports Medicine

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Background:The pathomechanics of hip microinstability are not clearly defined but are thought to involve anatomical abnormalities, repetitive forces across the hip, and ligamentous laxity.Purpose/Hypothesis:The purpose of this study was to explore the relationship between generalized joint hypermobility (GJH) and hip capsular thickness. The hypothesis was that GJH would be predictive of a thin hip capsule.Study Design:Cross-sectional study; Level of evidence, 3.Methods:A prospective study was performed on 100 consecutive patients undergoing primary hip arthroscopy for the treatment of hip pain. A Beighton test score (BTS) was obtained prior to each procedure. The maximum score was 9, and a score of ≥4 was defined as hypermobile. Capsular thickness at the level of the anterior portal, corresponding to the location of the iliofemoral ligament, was measured arthroscopically using a calibrated probe. The presence of ligamentum teres (LT) pathology was also recorded.Results:Fifty-five women and 45 men were included in the study. The mean age was 32 years (range, 18-45 years). The median hip capsule thickness was statistically greater in men than women (12.5 and 7.5 mm, respectively). The median BTS for men was 1 compared with 4 for women (P < .001). A statistically significant association was found between BTS and capsular thickness; a BTS of <4 is strongly predictive of having a capsular thickness of ≥10 mm, while a BTS ≥4 correlates with a capsular thickness of <10 mm. There was a statistically greater incidence of LT tears in patients with a capsular thickness of ≤7.5 mm and a BTS of ≥4 (P < .001).Conclusion:Measurement of the GJH is highly predictive of hip capsular thickness. A BTS of <4 correlates significantly with a capsular thickness of ≥10 mm, while a BTS ≥4 correlates significantly with a thickness of <10 mm.

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Section: Discussionsupporting

confidence: 93%

Generalized Joint Hypermobility Is Predictive of Hip Capsular Thickness

Devitt

Smith

Stapf

et al. 2017

Orthopaedic Journal of Sports Medicine

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“…A more recent study by Chahla et al . (21), reporting on a cohort of 2213 patients undergoing hip arthroscopy for FAI, revealed a prevalence rate of LT pathology of 89.5%. These figures are similar to this study of 40 consecutive patients, in which the prevalence of LT tears was on average 90% (range 85–95%).…”

Section: Discussionmentioning

confidence: 99%

“…It is interesting to note that in the study by Chahla et al . (21), a similarly detailed assessment of the LT was made, which is likely to increase the rate of detection of pathology. This level of assessment is probably not always performed routinely.…”

Section: Discussionmentioning

confidence: 99%

The reliability of commonly used arthroscopic classifications of ligamentum teres pathology

Devitt

Smith

Stapf

et al. 2017

Journal of Hip Preservation Surgery

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The importance of the ligamentum teres (LT) in the hip is increasingly being recognized. However, the incidence of LT tears in the literature is extremely variable. Although classification systems exist their reliability in classifying LT pathology arthroscopically has not been well defined. To determine the inter- and intra-observer reliability of two existing classifications systems for the diagnosis of LT pathology at hip arthroscopy. Second, to identify key pathological findings currently not included. Four experienced hip-arthroscopists reviewed 40 standardized arthroscopic videos. Arthroscopic findings of the LT were classified using the Gray and Villar (G&V) and descriptive classification (DC). Reviewers were asked to record other relevant pathology encountered. Inter- and intra-observer reliability was defined using Fleiss-Kappa and Cohen-Kappa statistics. Both classifications demonstrated fair inter-observer reliability. The intra-observer reliability for G&V was moderate-to-substantial and for DC was slight-to-moderate. An absolute agreement rate of 10% (G&V) and 37.5% (DC) was found. Differentiation between normal, and partial or low-grade tears was a common source of disagreement. The prevalence of LT pathology was 90%. Synovitis was the most common diagnostic finding that was not included in either classification system used in this study. Arthroscopic classification of LT pathology using the G&V and the DC demonstrated only fair inter-observer reliability. The major discrepancy in interpretation was between normal, and partial or low-grade tears. The presence of synovitis was not in either classification but was considered an important arthroscopic finding. Thorough arthroscopic scrutiny reveals the prevalence of LT pathology is higher than previously reported.

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Section: Discussionmentioning

confidence: 99%

“…4 Ligamentum teres tears were associated with increased hip laxity and chondral defects of the femoral head. 4 The role of the ligamentum teres may be especially important in patients with dysplasia of the hip or joint hypermobility because deficiency of the normal bony architecture and/or soft tissue restraints about the hip can lead to increased reliance on the ligamentum teres as a secondary stabilizer. 10 Therefore, these abnormalities in a patient with a ligamentum teres tear more commonly were indicative of a need for a ligamentum teres reconstruction in addition to treatment of the underlying pathology.…”

Section: Discussionmentioning

confidence: 99%

Quantitative Anatomic Analysis of the Native Ligamentum Teres

Mikula

Slette

Chahla

et al. 2017

Orthopaedic Journal of Sports Medicine

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Background:While recent studies have addressed the biomechanical function of the ligamentum teres and provided descriptions of ligamentum teres reconstruction techniques, its detailed quantitative anatomy remains relatively undocumented. Moreover, there is a lack of consensus in the literature regarding the number and morphology of the acetabular attachments of the ligamentum teres.Purpose:To provide a clinically relevant quantitative anatomic description of the native human ligamentum teres.Study Design:Descriptive laboratory study.Methods:Ten human cadaveric hemipelvises, complete with femurs (mean age, 59.6 years; range, 47-65 years), were dissected free of all extra-articular soft tissues to isolate the ligamentum teres and its attachments. A coordinate measuring device was used to quantify the attachment areas and their relationships to pertinent open and arthroscopic landmarks on both the acetabulum and the femur. The clock face reference system was utilized to describe acetabular anatomy, and all anatomic relationships were described using the mean and 95% confidence intervals.Results:There were 6 distinct attachments to the acetabulum and 1 to the femur. The areas of the acetabular and femoral attachment footprints of the ligamentum teres were 434 mm2 (95% CI, 320-549 mm2) and 84 mm2 (95% CI, 65-104 mm2), respectively. The 6 acetabular clock face locations were as follows: anterior attachment, 4:53 o’clock (95% CI, 4:45-5:02); posterior attachment, 6:33 o’clock (95% CI, 6:23-6:43); ischial attachment, 8:07 o’clock (95% CI, 7:47-8:26); iliac attachment, 1:49 o’clock (95% CI, 1:04-2:34); and a smaller pubic attachment that was located at 3:50 o’clock (95% CI, 3:41-4:00). The ischial attachment possessed the largest cross-sectional attachment area (127.3 mm2; 95% CI, 103.0-151.7 mm2) of all the acetabular attachments of the ligamentum teres.Conclusion:The most important finding of this study was that the human ligamentum teres had 6 distinct points of attachment on the acetabulum (transverse, anterior, and posterior margins of the acetabular notch and cotyloid fossa attachments: ilium, ischium, and pubis) and 1 on the femur. On the acetabulum, the anterior attachment was substantially larger than the posterior attachment and was located at a mean clock face position of 4:53 o’clock.Clinical Relevance:These quantitative descriptions of the ligamentum teres can be used by clinicians to arthroscopically identify the attachments of the ligamentum teres, guiding arthroscopic surgical interventions designed to address ligamentum teres pathology.

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Ligamentum Teres Tears and Femoroacetabular Impingement: Prevalence and Preoperative Findings

Cited by 40 publications

References 18 publications

Generalized Joint Hypermobility Is Predictive of Hip Capsular Thickness

Generalized Joint Hypermobility Is Predictive of Hip Capsular Thickness

The reliability of commonly used arthroscopic classifications of ligamentum teres pathology

Quantitative Anatomic Analysis of the Native Ligamentum Teres

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