Ligamentum Teres: Difference between revisions

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== Description ==
== Description ==
The Ligamentum Teres, also known as ligamentum femoris capitis, is an intra-articular extrasynovial ligament that has acetabular and femoral attachments.<ref>Rosinsky PJ, Shapira J, Lall AC, Domb BG. All about the ligamentum teres: from biomechanical role to surgical reconstruction. JAAOS-Journal of the American Academy of Orthopaedic Surgeons. 2020 Apr 15;28(8):e328-39.</ref>  
The Ligamentum Teres, also known as ligamentum femoris capitis, is an intra-articular extrasynovial ligament of the hip that has acetabular and femoral attachments.<ref>Rosinsky PJ, Shapira J, Lall AC, Domb BG. All about the ligamentum teres: from biomechanical role to surgical reconstruction. JAAOS-Journal of the American Academy of Orthopaedic Surgeons. 2020 Apr 15;28(8):e328-39.</ref> Earlier research described it as a vestigial structure due to its slack state during distraction and surgeons have promoted its excision during procedures such as reduction of dislocations in developmental dysplasia of the hip and surgical hip dislocations<ref>Ganz R, Gill TJ, Gautier E, Ganz K, Krügel N, Berlemann U. Surgical dislocation of the adult hip: a technique with full access to the femoral head and acetabulum without the risk of avascular necrosis. The Journal of Bone & Joint Surgery British Volume. 2001 Nov 1;83(8):1119-24.</ref><ref>Gray AJ, Villar RN. The ligamentum teres of the hip: an arthroscopic classification of its pathology. Arthroscopy: The Journal of Arthroscopic & Related Surgery. 1997 Oct 1;13(5):575-8.</ref>. On the contrary, more recent studies have suggested the ligamentum teres to have an important function in proprioception, nociception, and as a secondary stabilizer of the hip joint. <ref>Mikula JD, Slette EL, Chahla J, Brady AW, Locks R, Trindade CA, Rasmussen MT, LaPrade RF, Philippon MJ. [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5347434/ Quantitative anatomic analysis of the native ligamentum teres.] Orthopaedic Journal of Sports Medicine. 2017 Feb 24;5(2):2325967117691480.</ref><ref>Van Arkel RJ, Amis AA, Cobb JP, Jeffers JR. The capsular ligaments provide more hip rotational restraint than the acetabular labrum and the ligamentum teres: an experimental study. The bone & joint journal. 2015 Apr 1;97(4):484-91.</ref><ref>Martin HD, Hatem MA, Kivlan BR, Martin RL. Function of the ligamentum teres in limiting hip rotation: a cadaveric study. Arthroscopy: The Journal of Arthroscopic & Related Surgery. 2014 Sep 1;30(9):1085-91.</ref>


Earlier research have described it as a vestigial structure due to its slack state during distraction and surgeons have promoted its excision during procedures such as reduction of dislocations in developmental dysplasia of the hip and surgical hip dislocations.<ref>Ganz R, Gill TJ, Gautier E, Ganz K, Krügel N, Berlemann U. Surgical dislocation of the adult hip: a technique with full access to the femoral head and acetabulum without the risk of avascular necrosis. The Journal of Bone & Joint Surgery British Volume. 2001 Nov 1;83(8):1119-24.</ref><ref>Gray AJ, Villar RN. The ligamentum teres of the hip: an arthroscopic classification of its pathology. Arthroscopy: The Journal of Arthroscopic & Related Surgery. 1997 Oct 1;13(5):575-8.</ref>
It is composed of a single layer of investing synovium, with an underlying framework of connective tissue. Within the connective tissue are:<ref>Dehao BW, Bing TK, Young JL. [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4544517/ Understanding the ligamentum teres of the hip: a histological study.] Acta Ortopédica Brasileira. 2015 Jan;23:29-33.</ref>


On the other hand, more recent studies have suggested the ligamentum teres to have an important function in proprioception, nociception, and as a secondary stabilizer of the hip joint. <ref>Mikula JD, Slette EL, Chahla J, Brady AW, Locks R, Trindade CA, Rasmussen MT, LaPrade RF, Philippon MJ. [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5347434/ Quantitative anatomic analysis of the native ligamentum teres.] Orthopaedic Journal of Sports Medicine. 2017 Feb 24;5(2):2325967117691480.</ref><ref>Van Arkel RJ, Amis AA, Cobb JP, Jeffers JR. The capsular ligaments provide more hip rotational restraint than the acetabular labrum and the ligamentum teres: an experimental study. The bone & joint journal. 2015 Apr 1;97(4):484-91.</ref><ref>Martin HD, Hatem MA, Kivlan BR, Martin RL. Function of the ligamentum teres in limiting hip rotation: a cadaveric study. Arthroscopy: The Journal of Arthroscopic & Related Surgery. 2014 Sep 1;30(9):1085-91.</ref>
* blood vessels
* adipose tissue
* collagen fibers
* fibrous tissue
* nerve bundles


=== Attachments  ===
=== Attachments  ===
'''Origin: acetabular fossa and transverse acetabular ligament'''
'''Origin: acetabular fossa and transverse acetabular ligament'''
[[File:Ligamentum teres attachment.jpg|center|thumb|600x600px|(A) Photograph and (B) illustration of the ligamentum teres (LT) attachment locations on the acetabulum. 1 = transverse attachment (to the transverse acetabular ligament, on the reverse side of the ligamentum teres from what is shown); 2 = posterior attachment; 3 = anterior attachment; 4 = ischial attachment; 5 = iliac attachment; 6 = pubic attachment.]]  
[[File:Ligamentum teres attachment.jpg|center|thumb|700x700px|(A) Photograph and (B) illustration of the ligamentum teres (LT) attachment locations on the acetabulum. 1 = transverse attachment (to the transverse acetabular ligament, on the reverse side of the ligamentum teres from what is shown); 2 = posterior attachment; 3 = anterior attachment; 4 = ischial attachment; 5 = iliac attachment; 6 = pubic attachment.]]  




'''Insertion: fovea capitis of the posteroinferior aspect of the femoral head'''
'''Insertion: fovea capitis of the posteroinferior aspect of the femoral head'''
[[File:Ligamentum teres anatomy.jpg|center|thumb|600x600px|(A) Photograph and (B) illustration of the attachment location of the ligamentum teres (LT) on the femur. FC, fovea capitis; FN, femoral neck.]]
[[File:Ligamentum teres anatomy.jpg|center|thumb|700x700px|(A) Photograph and (B) illustration of the attachment location of the ligamentum teres (LT) on the femur. FC, fovea capitis; FN, femoral neck.]]


== Function  ==
== Function  ==

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Description[edit | edit source]

The Ligamentum Teres, also known as ligamentum femoris capitis, is an intra-articular extrasynovial ligament of the hip that has acetabular and femoral attachments.[1] Earlier research described it as a vestigial structure due to its slack state during distraction and surgeons have promoted its excision during procedures such as reduction of dislocations in developmental dysplasia of the hip and surgical hip dislocations[2][3]. On the contrary, more recent studies have suggested the ligamentum teres to have an important function in proprioception, nociception, and as a secondary stabilizer of the hip joint. [4][5][6]

It is composed of a single layer of investing synovium, with an underlying framework of connective tissue. Within the connective tissue are:[7]

  • blood vessels
  • adipose tissue
  • collagen fibers
  • fibrous tissue
  • nerve bundles

Attachments[edit | edit source]

Origin: acetabular fossa and transverse acetabular ligament

(A) Photograph and (B) illustration of the ligamentum teres (LT) attachment locations on the acetabulum. 1 = transverse attachment (to the transverse acetabular ligament, on the reverse side of the ligamentum teres from what is shown); 2 = posterior attachment; 3 = anterior attachment; 4 = ischial attachment; 5 = iliac attachment; 6 = pubic attachment.


Insertion: fovea capitis of the posteroinferior aspect of the femoral head

(A) Photograph and (B) illustration of the attachment location of the ligamentum teres (LT) on the femur. FC, fovea capitis; FN, femoral neck.

Function[edit | edit source]

Clinical Relevance[edit | edit source]

Assessment[edit | edit source]

Treatment[edit | edit source]

Resources[edit | edit source]

References[edit | edit source]

  1. ↑ Rosinsky PJ, Shapira J, Lall AC, Domb BG. All about the ligamentum teres: from biomechanical role to surgical reconstruction. JAAOS-Journal of the American Academy of Orthopaedic Surgeons. 2020 Apr 15;28(8):e328-39.
  2. ↑ Ganz R, Gill TJ, Gautier E, Ganz K, Krügel N, Berlemann U. Surgical dislocation of the adult hip: a technique with full access to the femoral head and acetabulum without the risk of avascular necrosis. The Journal of Bone & Joint Surgery British Volume. 2001 Nov 1;83(8):1119-24.
  3. ↑ Gray AJ, Villar RN. The ligamentum teres of the hip: an arthroscopic classification of its pathology. Arthroscopy: The Journal of Arthroscopic & Related Surgery. 1997 Oct 1;13(5):575-8.
  4. ↑ Mikula JD, Slette EL, Chahla J, Brady AW, Locks R, Trindade CA, Rasmussen MT, LaPrade RF, Philippon MJ. Quantitative anatomic analysis of the native ligamentum teres. Orthopaedic Journal of Sports Medicine. 2017 Feb 24;5(2):2325967117691480.
  5. ↑ Van Arkel RJ, Amis AA, Cobb JP, Jeffers JR. The capsular ligaments provide more hip rotational restraint than the acetabular labrum and the ligamentum teres: an experimental study. The bone & joint journal. 2015 Apr 1;97(4):484-91.
  6. ↑ Martin HD, Hatem MA, Kivlan BR, Martin RL. Function of the ligamentum teres in limiting hip rotation: a cadaveric study. Arthroscopy: The Journal of Arthroscopic & Related Surgery. 2014 Sep 1;30(9):1085-91.
  7. ↑ Dehao BW, Bing TK, Young JL. Understanding the ligamentum teres of the hip: a histological study. Acta Ortopédica Brasileira. 2015 Jan;23:29-33.
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