Purpose
To compare the patient-reported outcomes scores (PROs) of patients with femoroacetabular
impingement (FAI), labral tears, and complete ligamentum teres (LT) tears to a matched-pair
control group with intact LTs, as well as to report the relative risk of total hip
arthroplasty (THA) conversion.
Methods
Data between February 2008 and April 2015 were retrospectively reviewed. Patients
undergoing hip arthroscopy included those who had complete LT tear, labral tears,
FAI, and minimum 2-year follow-up with modified Harris Hip Score (mHHS), Non-arthritic
Hip Score (NAHS), Hip Outcome Score–Sports Specific Subscale (HOS-SSS), International
Hip Outcome Tool–12 (iHOT-12), and visual analog scale (VAS). Patients were excluded
for Tönnis osteoarthritis grade >1, previous hip conditions or surgeries, and Worker's
Compensation claims. Patients with full LT tears were matched in a 1:3 ratio with
patients without LT tears based on age at surgery ± 5 years, sex, body mass index
± 5, capsular treatment, and acetabular Outerbridge grade. Revision surgeries and
conversions to THA were documented. Relative risk for conversion to THA was determined
(P = .05).
Results
Eighteen patients (18 hips) had minimum 2-year follow-up and were eligible for matching;
as described, each study group patient was matched to 3 control patients, resulting
in a size of 18 to 54 patients. PROs showed significant improvement in the complete
LT tear group with the exception of the HOS-SSS measure. In the intact LT control
group, all PROs significantly improved, with no exception. Based on relative risk,
patients with complete LT tears were 3 times more likely to require THA than a matched
control group.
Conclusions
After hip arthroscopy, patients with FAI and complete LT tears reported significant
improvement in PROs. Among hips that did not require THA, functional scores were comparable
to a matched control group. However, patients with complete LT tears were 3 times
more likely to require an eventual THA than the matched control group. We conclude
that patients with complete LT tears should be considered an at-risk population, and
that indications and treatment may be refined to incorporate the clinical significance
of complete LT tears.
Level of Evidence
Level III, comparative trial, case-control.
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Article info
Publication history
Accepted:
July 30,
2018
Received:
January 29,
2018
Footnotes
See commentary on page 89
The authors report the following potential conflicts of interest or sources of funding: B.G.D. reports consulting fees from Adventist Hinsdale Hospital, Amplitude, Arthrex, Medacta, and Stryker; research support to the American Hip Institute from Arthrex, Medacta, and Stryker; research support to the American Hip Institute from Arthrex, Medacta, and Stryker; royalties from Arthrex, DJO Global, and Orthomerica; ownership interest in Hinsdale orthopedic Associates, Hinsdale Orthopedic Imaging, American Hip Institute, SCD#3, North Shore Surgical Suites, and Munster Specialty Surgery Center; is a board member for the American Hip Institute, which funds research and is the institute where our studies are performed; and is also a board member at American Orthopedic Foundation, American Hip Foundation, AANA Learning Center Committee, Hinsdale Hospital Foundation, and Arthroscopy Journal. Full ICMJE author disclosure forms are available for this article online, as supplementary material.
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© 2018 by the Arthroscopy Association of North America
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Access this article on ScienceDirectLinked Article
- Editorial Commentary: Chicken or the Egg? The Ligamentum Teres and Degenerative Hip DiseaseArthroscopyVol. 35Issue 1
- PreviewThe ligamentum teres has traditionally been described as a vestigial remnant or redundant structure with little contribution to hip biomechanics or function. However, interest in the ligamentum teres has been renewed as evidence has emerged that it not only plays a role as a pain generator in the hip but also acts as a secondary stabilizer to supplement the work of the capsular ligaments. Furthermore, an association has been proposed between tearing of the ligamentum teres and the development of degenerative hip disease.
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