Tears of the Ligamentum Teres

Botser, Itamar B.; Martin, Dorea E.; Stout, Chris E.; Domb, Benjamin G.

doi:10.1177/0363546511413865

Cited by 184 publications

(49 citation statements)

References 24 publications

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“…The prevalence of LT tears in hip arthroscopy was reported to be 5% to 17.5% in patients undergoing hip arthroscopy; in contrast, a recent article by Botser et al 4 documented LT tears in 51% of patients undergoing hip arthroscopy. However, this difference in prevalence may be attributed to an increased awareness and inclusion of low-grade partial tears in the study.…”

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confidence: 91%

Arthroscopic Ligamentum Teres Reconstruction

Lindner

Sharp

Trenga

et al. 2013

Arthroscopy Techniques

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The ligamentum teres (LT) has been studied since the 19th century, and its anatomy and biomechanical function have been well described. Recent advancements in hip arthroscopy have caused increased awareness of LT pathology. Previous reports have estimated the incidence of LT tears during hip arthroscopy to be 4% to 51%, and LT tears have been estimated to be the third most common reason for hip pain in athletes. Biomechanical studies have shown the LT's role in stability of the hip. Despite the growing body of literature on LT anatomy and function, its role as a causative factor in hip pain and hip instability has yet to be clearly defined, and the treatment of LT tears remains controversial. However, in certain cases where hip subluxation and overt instability are related to a traumatic full-thickness tear of the LT, reconstruction of the ligamentum has been suggested. We describe a technique for arthroscopic LT reconstruction using either a semitendinosus autograft or allograft in the supine position.

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confidence: 91%

Arthroscopic Ligamentum Teres Reconstruction

Lindner

Sharp

Trenga

et al. 2013

Arthroscopy Techniques

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“…LT tears are infrequently reported or described on MRI. The incidence of reported LT tears confirmed with arthroscopy varies in the literature from 4 to 65% [14, 18–21]. The higher prevalence observed in this study may be due to the fact that only subjects with a normal MRI were included.…”

Section: Discussionmentioning

confidence: 80%

Arthroscopic findings of a diagnostic dilemma- hip pathology with normal imaging

Buikstra

Fary

Tran

2017

BMC Musculoskelet Disord

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BackgroundPatients with groin, hip and pelvic pain but normal findings on MRI and minimal changes on x-ray can be a diagnostic problem. This paper looks at the arthroscopic findings of patients who have had hip pain and a positive response to an intra-articular anaesthetic but have non-contributory imaging. We hypothesized that standard MRI’s were missing significant pathology and if there was a response to intra-articular local anaesthesia, pathology found during arthroscopy was likely.MethodsA retrospective review of all hip arthroscopies performed from March 2011 to January 2015 by two orthopaedic surgeons specializing in hip arthroscopy was conducted to identify patients with clinically suspected intra-articular hip pathology despite a normal MRI report and X-ray. Clinical suspicion of intra-articular hip pathology was confirmed with a positive response to a fluoroscopically guided intra-articular injection of local anaesthetic and corticosteroid. Pathologic findings were collated from the standardised operative notes.ResultsFifty-three hip arthroscopies performed in 51 patients met the inclusion criteria from a total of 1348 hip arthroscopies performed over a 46-month period. All but one of the 53 (98%) hips had arthroscopically confirmed pathology. Mean patient age was 32.5 years [15 to 67 years] with 40 (78%) females and 11 (22%) males. 92.5% of the hips (49/53) were FADIR (flexion, adduction and internal rotation) positive on clinical examination, giving this test a positive predictive value of 98% (95% CI: 89.31 to 99.67%) for intra-articular pathology.ConclusionsIn patients with a normal MRI without contrast and a positive response (relief of pain) to an intra-articular injection that failed conservative management, there is a 98% chance of intra-articular hip pathology being discovered on hip arthroscopy.Electronic supplementary materialThe online version of this article (doi:10.1186/s12891-017-1485-5) contains supplementary material, which is available to authorized users.

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“…These results were consistent with the prior studies. In a recent study [18] LT tears were suspected in 51% of patients who underwent hip arthroscopy indicating a high percentage of LT involvement in symptomatic hips. Gray and Villar classified the ruptures of LT into three types: Type 1 tears are complete, Type 2 tears are partial, and Type 3 tears are degenerative.…”

Section: Discussionmentioning

confidence: 96%

The Effect of Ligamentum Teres Integrity on Hip Scores

Desteli¹

2016

Ann Clin Anal Med

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ÖzetAmaç: Displazik kalçalarda Ligamentum Teres'in (LT) hiperlaksite ve stabiliteye etkisi daha önceki çalışmalarda vurgulanmıştır. LT kesilmiş hastalarda instabilite ve rahatsızlık gözlenmektedir. Duyusal sinir sonlanmalarının varlı-ğı LT'nin eklem propriyosepsiyonu ve nosisepsiyonunda işlevi olduğuna işa-ret etmektedir. Çalışmamızda kalça eklemindeki LT bütünlüğünün klinik işlev-lere etkisinin kıyaslanması amaçlandı. Gereç ve Yöntem: Evre 2-3 koksartrozu olan ardışık 92 hastaya LT testi uygulandı. İç veya dış rotasyonda ağrı LT testinin pozitif olduğunu gösterdi. LT testini takiben hastaların, Kalça Kısıtlılık ve Osteoartrit Sonuç Skoru (HOOS) ve Harris Kalça Skoru (HHS) kaydedildi. Her hastanın etkilenen kalçasından Manyetik Rezonans Görüntüleme (MRG) elde edildi. Bulgular: MR bulguları ile LT testi etkililiği değerlendirildiğinde, sensitivite % 87.37, spesifite ise % 73.47 iken, pozitif ve negatif prediktif değerler sırasıyla % 74.5 ve 80.4 olarak not edildi. MR bulguları ve LT testine göre bağı intakt olan 36 kalça (grup 1) ile bağı yırtık 38 kalça (grup 2) HOOS ve HHS skorları ile karşılaştırıldı. Her iki skorlama da Grup 1'de Grup 2'ye göre önemli ölçüde daha yüksekti (p<0.001). Tartışma: Bilindiği kadarıyla, yırtık ve intakt LT karşılaştırmasıyla bağ bütünlüğünün kalça fonksiyonel skorlarına etkisi literatürde ilk kez çalışmamızda ele alınmaktadır. Ligamentum teres bütünlü-ğünün bozulması, kalça fonksiyonel skorlarını düşürmektedir. Anahtar KelimelerLigamentum Teres; Koksartroz; Kalça; Kalça Skoru Abstract We aimed to compare the clinical functioning of the hips with an intact Ligamentum Teres (LT) to ruptured LT. Patients with resected LT have feelings of instability and discomfort. The effect of LT on hip stability in dysplastic hips and hyperlaxity has been emphasized before. Existence of sensory nerve endings demonstrates that LT has a function in joint proprioception and nociception. LT test was conducted to 92 consecutive patients with Grade 2-3 coxarthrosis. Pain on either internal or external rotation is consistent with a positive LT test result. Following LT test, Hip disability and osteoarthritis outcome score (HOOS) and Harris Hip Score (HHS) were conducted to all of the patients. Each patient underwent MRI Scanning of the involved hip. The efficacy of LT test was evaluated in comparison to MRI findings, sensitivity of the test was 87.37 % and spesificity was 73.47 positive and negative predictive values were found to be 74.51 % nd 80.43 % respectively. 36 hips which had intact LT according to MRI and LT test (Group 1) was compared to the 38 hips with ruptured LT in both LT test and MRI (Group 2) regarding HOOS and Harris Hip Scores. HOOS and Harris Hip Scores of Group 1 were found to be significantly higher than Group 2. As far as we know from the literature this is the first clinical study to investigate the effect of LT integrity on hip scores by comparing hips with ruptured LT to hips with intact LT.

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Tears of the Ligamentum Teres

Cited by 184 publications

References 24 publications

Arthroscopic Ligamentum Teres Reconstruction

Arthroscopic Ligamentum Teres Reconstruction

Arthroscopic findings of a diagnostic dilemma- hip pathology with normal imaging

The Effect of Ligamentum Teres Integrity on Hip Scores

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