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Function of the Ligamentum Teres in Limiting Hip Rotation: A Cadaveric Study

      Purpose

      The purpose of this cadaveric study was to evaluate the function of the ligamentum teres (LT) in limiting hip rotation in 18 distinct hip positions while preserving the capsular ligaments.

      Methods

      Twelve hips in 6 fresh-frozen pelvis-to-toes cadaveric specimens were skeletonized from the lumbar spine to the distal femur, preserving only the hip ligaments. Hip joints were arthroscopically accessed through a portal located between the pubofemoral and iliofemoral ligaments to confirm the integrity of the LT. Three independent measurements of hip internal and external rotation range of motion (ROM) were performed in 18 defined hip positions of combined extension-flexion and abduction-adduction. The LT was then arthroscopically sectioned and rotation ROM reassessed in the same positions. A paired sample t test was used to compare the average internal and external hip rotation ROM values in the intact LT versus resected conditions in each of the 18 positions. P < .0014 was considered significant.

      Results

      A statistically significant influence of the LT on internal or external rotation was found in 8 of the 18 hip positions tested (P < .0014). The major increases in internal and external rotation ROM occurred when the hip was in 90° or 120° of flexion.

      Conclusions

      The major function of the LT is controlling hip rotation. The LT functions as an end-range stabilizer to hip rotation dominantly at 90° or greater of hip flexion, confirming its contribution to hip stability.

      Clinical Relevance

      Ruptures of the LT contribute to hip instability dominantly in flexed hip positions.
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      References

        • Savory W.
        The use of the ligamentum teres of the hip-joint.
        J Anat Physiol. 1874; 8: 291-296
        • Sutton J.B.
        The ligamentum teres.
        J Anat Physiol. 1883; 17: 190-193
        • Fuss F.K.
        • Bacher A.
        New aspects of the morphology and function of the human hip joint ligaments.
        Am J Anat. 1991; 192: 1-13
        • Maeyama A.
        • Naito M.
        • Moriyama S.
        • Yoshimura I.
        Evaluation of dynamic instability of the dysplastic hip with use of triaxial accelerometry.
        J Bone Joint Surg Am. 2008; 90: 85-92
        • Fischer J.W.
        • Todd B.
        • Sanville P.
        • Webb M.
        • Mirza A.H.
        Bilateral recurrent atraumatic dislocation of the hip joints—a case report.
        Acta Orthop Scand. 2003; 74: 104-106
        • Boykin R.E.
        • Anz A.W.
        • Bushnell B.D.
        • Kocher M.S.
        • Stubbs A.J.
        • Philippon M.J.
        Hip instability.
        J Am Acad Orthop Surg. 2011; 19: 340-349
        • Philippon M.J.
        • Zehms C.T.
        • Briggs K.K.
        • Manchester D.J.
        • Kuppersmith D.A.
        Hip instability in the athlete.
        Oper Tech Sport Med. 2007; 15: 189-194
        • Martin R.L.
        • Palmer I.
        • Martin H.D.
        Ligamentum teres: A functional description and potential clinical relevance.
        Knee Surg Sport Traumatol Arthrosc. 2012; 20: 1209-1214
        • Kivlan B.R.
        • Richard Clemente F.
        • Martin R.L.
        • Martin H.D.
        Function of the ligamentum teres during multi-planar movement of the hip joint.
        Knee Surg Sport Traumatol Arthrosc. 2012; 21: 1664-1668
        • Martin R.L.
        • Kivlan B.R.
        • Clemente F.R.
        A cadaveric model for ligamentum teres function: a pilot study.
        Knee Surg Sport Traumatol Arthrosc. 2013; 21: 1689-1693
        • Martin H.D.
        • Savage A.
        • Braly B.A.
        • Palmer I.J.
        • Beall D.P.
        • Kelly B.
        The function of the hip capsular ligaments: a quantitative report.
        Arthroscopy. 2008; 24: 188-195
        • Myers C.A.
        • Register B.C.
        • Lertwanich P.
        • et al.
        Role of the acetabular labrum and the iliofemoral ligament in hip stability: An in vitro biplane fluoroscopy study.
        Am J Sport Med. 2011; 39: 85S-91S
        • Demange M.K.
        • Kakuda C.M.S.
        • Pereira C.A.M.
        • Sakaki M.H.
        • Albuquerque R.F.M.
        Influence of the femoral head ligament on hip.
        Acta Ortop Bras. 2007; 15: 187-190
        • Byrd J.W.T.
        • Jones K.S.
        Traumatic rupture of the ligamentum teres as a source of hip pain.
        Arthroscopy. 2004; 20: 385-391
        • Philippon M.
        • Schenker M.
        • Briggs K.
        • Kuppersmith D.
        Femoroacetabular impingement in 45 professional athletes: Associated pathologies and return to sport following arthroscopic decompression.
        Knee Surg Sport Traumatol Arthrosc. 2007; 15: 908-914
        • Dy C.J.
        • Thompson M.T.
        • Crawford M.J.
        • Alexander J.W.
        • McCarthy J.C.
        • Noble P.C.
        Tensile strain in the anterior part of the acetabular labrum during provocative maneuvering of the normal hip.
        J Bone Joint Surg Am. 2008; 90: 1464-1472
        • Domb B.G.
        • Martin D.E.
        • Botser I.B.
        Risk factors for ligamentum teres tears.
        Arthroscopy. 2013; 29: 64-73
        • McKibbin B.
        Anatomical factors in the stability of the hip joint in the newborn.
        J Bone Joint Surg Br. 1970; 52-B: 148-159
        • Norkin C.
        • White D.
        Measurement of joint motion: A guide to goniometry.
        3rd ed. F.A. Davis, Philadelphia2003
        • Stratford P.W.
        • Binkley J.
        • Solomon P.
        • Finch E.
        • Gill C.
        • Moreland J.
        Defining the minimum level of detectable change for the Roland-Morris questionnaire.
        Phys Ther. 1996; 76 (discussion 366-368): 359-365
        • Shrout P.E.
        • Fleiss J.L.
        Intraclass correlations: Uses in assessing rater reliability.
        Psychol Bull. 1979; 86: 420-428
        • Akiyama K.
        • Sakai T.
        • Koyanagi J.
        • Yoshikawa H.
        • Sugamoto K.
        Evaluation of translation in the normal and dysplastic hip using three-dimensional magnetic resonance imaging and voxel-based registration.
        Osteoarthritis Cartilage. 2011; 19: 700-710
        • Tibor L.M.
        • Leunig M.
        The pathoanatomy and arthroscopic management of femoroacetabular impingement.
        Bone Joint Res. 2012; 1: 245-257
        • Safran M.R.
        • Giordano G.
        • Lindsey D.P.
        • et al.
        Strains across the acetabular labrum during hip motion: A cadaveric model.
        Am J Sport Med. 2011; 39: 92S-102S
        • Leunig M.
        • Beck M.
        • Stauffer E.
        • Hertel R.
        • Ganz R.
        Free nerve endings in the ligamentum capitis femoris.
        Acta Orthop Scand. 2000; 71: 452-454
        • Sarban S.
        • Baba F.
        • Kocabey Y.
        • Cengiz M.
        • Isikan U.E.
        Free nerve endings and morphological features of the ligamentum capitis femoris in developmental dysplasia of the hip.
        J Pediatr Orthop B. 2007; 16: 351-356
        • Wenger D.
        • Miyanji F.
        • Mahar A.
        • Oka R.
        The mechanical properties of the ligamentum teres: A pilot study to assess its potential for improving stability in children’s hip surgery.
        J Pediatr Orthop. 2007; 27: 408-410
        • Wenger D.R.
        • Mubarak S.J.
        • Henderson P.C.
        • Miyanji F.
        Ligamentum teres maintenance and transfer as a stabilizer in open reduction for pediatric hip dislocation: Surgical technique and early clinical results.
        J Pediatr Orthop. 2008; 2: 177-185
        • Ganz R.
        • Gill T.J.
        • 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.
        J Bone Joint Surg Br. 2001; 83: 1119-1124
        • Salter R.B.
        Innominate osteotomy in the treatment of congenital dislocation and subluxation of the hip.
        J Bone Joint Surg Br. 1961; 43-B: 518-539
        • Weinstein S.L.
        • Ponseti I.V.
        Congenital dislocation of the hip.
        J Bone Joint Surg Am. 1979; 61: 119-124