Ligamentum teres tendinopathy and tears

Kraeutler, Matthew J.; Garabekyan, T.; Pascual-Garrido, C.; Mei-Dan, Omer

doi:10.32098/mltj.03.2016.09

Cited by 13 publications

(10 citation statements)

References 22 publications

(39 reference statements)

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“…The ligamentum teres also seems to play a role as a pain generator and joint lubricator 13,14 . Some studies have highlighted the presence of nociceptive receptors in the ligamentum teres 11 and shown evidence of pain due to damage to it, in some traumatic conditions 15 which may improve with arthroscopic debridement 16 …”

Section: Introductionmentioning

confidence: 99%

Fascia and soft tissues innervation in the human hip and their possible role in post‐surgical pain

Fede

Porzionato

Petrelli

et al. 2020

Journal Orthopaedic Research

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Persistent symptoms, most commonly pain, may remain after otherwise successful hip replacement surgery. Innervation of fascia and soft tissues has become increasingly important in etiopathogenesis of pain, but the relative importance of the various anatomical structures in the hip region is still not known. Innervation of skin, superficial adipose tissue, superficial fascia, deep adipose tissue, deep fascia, muscles, capsule, capsule ligament, ligamentum teres, and tendon in the human hip from 11 patients and 2 cadavers were quantified by staining with anti‐S100 antibody for myelin‐forming Schwann cells, to obtain the percentage of antibody positivity, density and mean diameter of the nerve fibers. The skin was the most highly innervated (0.73% ± 0.37% of positive area in patients; 0.80% ± 0.28% in cadavers); the tendon was the least innervated (0.07% ± 0.01% in patients, 0.07% ± 0.007% in cadavers). The muscles (vasto‐lateral and gluteus medius) were the second most innervated structure according the percentage (0.31% ± 0.13% in living humans, 0.30% ± 0.07% in cadavers), but with only a few nerves, with large diameters (mean diameter 36.4 ± 13.4 µm). Instead, the superficial fasciae showed 0.22% ± 0.06% and 0.26% ± 0.05% of positive areas in living humans and cadavers, respectively. Fasciae were invaded by networks of small nerve fibers, revealing a possible role in pain. The superficial fascia was the second most highly innervated tissue after the skin, with a density of 33.0 ± 2.5/cm2, and a mean nerve sizes of 19.1 ± 7.2 µm. Lastly, the capsule turned out to be poorly innervated (0.09%), showing that its removal does not necessarily lead to painful consequences. Statement of clinical significance: Deeper knowledge about the innervation of the soft tissue in the human hip joint will enhance study and understanding of the best surgical procedures to follow during hip arthroplasty to reduce post‐operative pain.

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Section: Introductionmentioning

confidence: 99%

Fascia and soft tissues innervation in the human hip and their possible role in post‐surgical pain

Fede

Porzionato

Petrelli

et al. 2020

Journal Orthopaedic Research

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“…Early work by Fuss and Bacher 6 could not identify a unique function for the LT. However, recent studies have offered evidence that the LT does have a purpose in restraining hip rotation range of motion 7,8 and used a ball and string model to describe the function of the LT. [9][10][11][12][13] Femoral head rotation that occurs in the transverse and frontal planes was found to cause the LT to tighten and act as a sling as the LT wrapped around the femoral head. 13 Also, as the LT tightened the femoral head was pulled into the acetabulum, presumably to increase stability at the end range of hip motion.…”

Section: Functionmentioning

confidence: 99%

“…Evidence supports older age and acetabular bony deformities, either FAI or dyplasia, as risk factor for generalized LT pathology. 7,34 Domb et al 25 specifically studied the risk factors for LT pathology. They found the relative risk of having LT pathology was 1.51 higher for individuals older than 30 years of age.…”

Section: Risk Factorsmentioning

confidence: 99%

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CLINICAL RELEVANCE of the LIGAMENTUM TERES: A LITERATURE REVIEW

Martin

McDonough

Enseki

et al. 2019

Intl J Sports Phys Ther

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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.

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“…The purpose of this study was to clarify the characteristics of the micro-anatomy of the LT, especially its construction, the arrangement of the collagenous fibers contained within the LT, and the structure of the region where the ligament adheres to the femoral head, by using an optical microscope [light microscope (LM)] and scanning electron microscope (SEM). Though older age and acetabular bony pathomorphology are two of known risk factors for LT tears 6 , we are interested in whether the LT itself has micro-anatomical vulnerable feature.…”

Section: Three-dimensional Architecture Of the Ligamentum Teres In Thmentioning

confidence: 99%

Three-dimensional architecture of the ligamentum teres in the human hip joint

Kaku

Shimada

Tabata

et al. 2019

Muscle Ligaments and Tendons J

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Background:We aimed to investigate the threedimensional structure of the collagenous fibers of the ligamentum teres (LT) of the human hip and clarify the LT micro-anatomy at the attachment of the femoral head. Methods: Femoral heads and LT were collected during hip arthroplasty. Specimens were cut into 5-10-mm squares, prepared, developed, and observed under a light microscope. Next, specimens were prepared and examined under a scanning electron microscope (SEM). Results: Under optical microscope, LT adhered to the artificial cartilage at the attachment of the femoral head. Under SEM, LT comprised parallelly arranged collagenous fibers and the fine collagenous fibrils were twisted. While the central collagenous fibers of the LT at the attachment of the femoral head penetrated the articular cartilage tissue and reached the ring-shaped bone, fibers at the margin traversed and adhered to the cartilage surface. Conclusion: Articular cartilage and subchondral bone are present at the LT attachment to the femoral head. Although collagenous fibers of the LT show parallel arrangement at the main trunk, they are dispersed at the cartilage surface and not all reach the thin subchondral bone of the femoral head. This could possibly weaken ligament strength at the attachment of the femoral head. Level of evidence: IV.

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Ligamentum teres tendinopathy and tears

Cited by 13 publications

References 22 publications

Fascia and soft tissues innervation in the human hip and their possible role in post‐surgical pain

Fascia and soft tissues innervation in the human hip and their possible role in post‐surgical pain

CLINICAL RELEVANCE of the LIGAMENTUM TERES: A LITERATURE REVIEW

Three-dimensional architecture of the ligamentum teres in the human hip joint

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