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Labral Reconstruction Using the Ligamentum Teres Capitis: Report of a New Technique

  • Symposium: Femoroacetabular Impingement: Current Status of Diagnosis and Treatment
  • Published:
Clinical Orthopaedics and Related Research

Abstract

We have used the ligamentum teres capitis to reconstruct the deficient or absent labrum in five patients with femoroacetabular impingement at the time of surgical hip dislocation. Two had a deficient labrum overlying a sectorial retroverted acetabulum causing pincer-type impingement. Three patients had the labrum previously resected arthroscopically. The minimum followup from surgery was 5 months (average, 10 months; range, 5–20 months). There were no intraoperative or postoperative complications related to the reconstruction. All patients had improvement in their clinical function and one patient underwent total hip arthroplasty at last followup for unresolved pain without radiographic progression of arthritis. Reconstruction of the labrum in patients with deficient or resected labrums at the time of surgical hip dislocation provides the theoretical advantage of sealing and stabilizing the hip joint, restoring the fluid layer which could potentially prevent continued cartilage degeneration.

Level of Evidence: Level II, prognostic study. See the Guidelines for Authors for a complete description of levels of evidence.

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References

  1. Amstutz HC. Treatment of primary osteoarthritis of the hip: A comparison of total joint surface replacement arthroplasty. J Bone Joint Surg Am. 1984;66:228–241.

    PubMed  CAS  Google Scholar 

  2. Beck M, Kalhor M, Leunig M, Ganz R. Hip morphology influences the pattern of damage to the acetabular cartilage: femoroacetabular impingement as a cause of early osteoarthritis of the hip. J Bone Joint Surg Br. 2005;87:1012–1018.

    Article  PubMed  CAS  Google Scholar 

  3. Chandler SB, Kreuscher PH. A study of the blood supply of the ligamentum teres and its relation to the circulation of the head of the femur. J Bone Joint Surg Am. 1932;14:834–846.

    Google Scholar 

  4. Crawford MJ, Dy CJ, Alexander JW, Thompson M, Schroder SJ, Vega CE, Patel RV, Miller AR, McCarthy JC, Lowe WR, Noble PC. The 2007 Frank Stinchfield Award. The biomechanics of the hip labrum and the stability of the hip. Clin Orthop Relat Res. 2007;465:16–22.

    PubMed  Google Scholar 

  5. Espinosa N, Rothefluh DA, Beck M, Ganz R, Leunig M. Treatment of femoroacetabular impingement: preliminary results of labral refixation. J Bone Joint Surg Am. 2006;88:925–935.

    Article  PubMed  Google Scholar 

  6. Ezoe M, Naito M, Inoue T. The prevalence of acetabular retroversion among various disorders of the hip. J Bone Joint Surg Am. 2006;88:372–379.

    Article  PubMed  Google Scholar 

  7. Ferguson SJ, Bryant JT, Ganz R, Ito K. The acetabular labrum seal: a poroelastic finite element model. Clin Biomech (Bristol, Avon). 2000;15:463–468.

    Google Scholar 

  8. Ferguson SJ, Bryant JT, Ganz R, Ito K. The influence of the acetabular labrum on hip joint cartilage consolidation: a poroelastic finite element model. J Biomech. 2000;33:953–960.

    Article  PubMed  CAS  Google Scholar 

  9. Ferguson SJ, Bryant JT, Ganz R, Ito K. An in vitro investigation of the acetabular labral seal in hip joint mechanics. J Biomech. 2003;36:171–178.

    Article  PubMed  CAS  Google Scholar 

  10. Ferguson SJ, Bryant JT, Ito K. The material properties of the bovine acetabular labrum. J Orthop Res. 2001;19:887–896.

    Article  PubMed  CAS  Google Scholar 

  11. Ganz R, Gill TJ, Gautier E, Ganz K, Krugel N, Berlemann U. Surgical dislocation of the adult hip: a technique with full access to femoral head and acetabulum without the risk of avascular necrosis J Bone Joint Surg Br. 2001;83:1119–1124.

    Article  PubMed  CAS  Google Scholar 

  12. Ganz R, Leunig M, Leunig-Ganz K, Harris WH. The etiology of osteoarthritis of the hip: an integrated mechanical concept. Clin Orthop Relat Res. 2008;466:264–272.

    Article  PubMed  Google Scholar 

  13. Ganz R, Parvizi J, Beck M, Leunig M, Notzli H, Siebenrock KA. Femoroacetabular impingement: a cause for osteoarthritis of the hip. Clin Orthop Relat Res. 2003;417:112–120.

    PubMed  Google Scholar 

  14. Ito K, Leunig M, Ganz R. Histopathologic features of the acetabular labrum in femoroacetabular impingement. Clin Orthop Relat Res. 2004;429:262–271.

    Article  PubMed  Google Scholar 

  15. Ito K, Minka II MA, Leunig M, Werlen S, Ganz R. Femoroacetabular impingement and the cam-effect: a MRI-based, quantitative anatomical study of the femoral head-neck offset. J Bone Joint Surg Br. 2001;83:171–176.

    Article  PubMed  CAS  Google Scholar 

  16. Kelly BT, Shapiro GS, Digiovanni CW, Buly RL, Potter HG, Hannafin JA. Vascularity of the hip labrum: a cadaveric investigation. Arthroscopy. 2005;21:3–11.

    Article  PubMed  Google Scholar 

  17. Lavigne M, Parvizi J, Beck M, Siebenrock KA, Ganz R, Leunig M. Anterior femoroacetabular impingement: Part I: techniques of joint preserving surgery. Clin Orthop Relat Res. 2004;418:61–66.

    Article  PubMed  Google Scholar 

  18. Li PL, Ganz R. Morphologic features of congenital acetabular dysplasia: one in six is retroverted. Clin Orthop Relat Res. 2003;416:245–253.

    Article  PubMed  Google Scholar 

  19. Petersen W, Petersen F, Tillmann B. Structure and vascularization of the acetabular labrum with regard to the pathogenesis and healing of labral lesions. Arch Orthop Trauma Surg. 2003;123:283–288.

    Article  PubMed  Google Scholar 

  20. Rao J, Zhou YX, Villar RN. Injury to the ligamentum teres: mechanism, findings, and results of treatment. Clin Sports Med. 2001;20:791–799.

    Article  PubMed  CAS  Google Scholar 

  21. Reynolds D, Lucas J, Klaue K. Retroversion of the acetabulum: a cause of hip pain. J Bone Joint Surg Br. 1999;81:281–288.

    Article  PubMed  CAS  Google Scholar 

  22. Seldes RM, Tan V, Hunt J, Katz M, Winiarsky R, Fitzgerald Jr RH. Anatomy, histologic features, and vascularity of the adult acetabular labrum. Clin Orthop Relat Res. 2001;382:232–240.

    Article  PubMed  Google Scholar 

  23. Takechi H, Nagashima H, Ito S. Intra-articular pressure of the hip joint outside and inside the limbus. J Japan Orthop Assoc. 1982;56:529–536.

    CAS  Google Scholar 

  24. Weber W, Weber E. Ueber die mechanik der menschlichten gehwerkzeuge nebst der beschreibung eines versuches ueber das herausfallen des schenkelkopfes aus der pfanne im luftverduennten raum. Annals Physics Chem. 1837;40:1–13.

    Article  Google Scholar 

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Acknowledgments

We thank Professor Reinhold Ganz for contribution to the knowledge and care of patients with FAI and Karen Fasbender for her help with manuscript preparation.

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Authors and Affiliations

  1. Department of Orthopedic Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA

    Rafael J. Sierra MD & Robert T. Trousdale MD

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  1. Rafael J. Sierra MD
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  2. Robert T. Trousdale MD
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Correspondence to Rafael J. Sierra MD.

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Each author certifies that he has no commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc.) that might pose a conflict of interest in connection with the submitted article.

Each author certifies that his or her institution has approved the reporting of these cases, that all investigations were conducted in conformity with ethical principles of research, and that informed consent for participation in the study was obtained.

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Sierra, R.J., Trousdale, R.T. Labral Reconstruction Using the Ligamentum Teres Capitis: Report of a New Technique. Clin Orthop Relat Res 467, 753–759 (2009). https://doi.org/10.1007/s11999-008-0633-5

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  • DOI: https://doi.org/10.1007/s11999-008-0633-5

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