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Systematic Review| Volume 37, ISSUE 6, P1811-1819.e1, June 01, 2021

Ligamentum Teres Reconstruction May Lead to Improvement in Outcomes Following a Secondary Hip Arthroscopy for Symptomatic Microinstability: A Systematic Review

Published:January 27, 2021DOI:https://doi.org/10.1016/j.arthro.2021.01.022
Ligamentum Teres Reconstruction May Lead to Improvement in Outcomes Following a Secondary Hip Arthroscopy for Symptomatic Microinstability: A Systematic Review
Previous ArticleEditorial Commentary: The Hook Test Is More Accurate for Detecting Foveal Triangular Fibrocartilage Complex Tears but Not More Important Than the Trampoline Test
Next ArticleEditorial Commentary: Ligamentum Teres Reconstruction May Improve Hip Stability But Has High Revision Rates: Fad or Restoration of Function?

      Purpose

      To present the indications, surgical technique, outcomes, and complications for patients undergoing arthroscopic reconstruction of the ligamentum teres (LT).

      Methods

      Articles were included if they had postoperative patient-reported outcomes (PROs) for arthroscopic LT reconstruction. Studies were analyzed for patient demographics, clinical assessment and indications, radiographic and magnetic resonance imaging data, concomitant procedures performed, PROs, surgical techniques, intra-articular classifications, complications, and need for follow-up surgeries. For PROs, the standard mean difference was calculated. The proportion of patients achieving patient acceptable symptomatic state for postoperative modified Harris Hip Score (≥74) was recorded. The number of patients achieving minimal clinically important difference for modified Harris Hip Score (Δ ≥8) was calculated.

      Results

      The majority of the cases were revision arthroscopies. Of the 3 studies reporting on patients undergoing LT reconstruction due to microinstability, 4, 9, and 11 patients demonstrated a mean improvement of 25.7, 35.2, and 27.7 in modified Harris Hip, respectively. In addition, one of the studies reported a mean improvement of 31.1 and 4.2 in Nonarthritic Hip Score and visual analog scale, respectively. Of the 3 studies, the percentile of patients surpassing minimal clinically important difference and patient acceptable symptomatic state ranged between 50% and 100% and 33.3% and 88.8%, respectively. Overall, 5 patients underwent revision hip arthroscopy due to adhesions, iliopsoas impingement, and persistent microinstability, and 3 patients underwent a secondary hip arthroplasty due to refractory pain and radiographic evidence of hip osteoarthritis.

      Conclusion

      Reconstruction of the LT may be considered in surgical management for patients with symptomatic hip instability due to soft-tissue causes. Current evidence supports for LT reconstruction predominantly for patients experiencing refractory instability following previous hip preservation procedures. Patients’ expectations as well as the relatively high reoperation rate (i.e., 33%) should be discussed before the procedure.

      Level of Evidence

      Level IV, systematic review of Level IV studies.
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      Article Info

      Publication History

      Published online: January 27, 2021
      Accepted: January 4, 2021
      Received: June 15, 2020
      See commentary on page 1820

      Footnotes

      The authors report the following potential conflicts of interest or sources of funding: B.G.D. reports grants and other from American Orthopedic Foundation, during the conduct of the study; personal fees from Adventist Hinsdale Hospital; personal fees and nonfinancial support from Amplitude; grants, personal fees, and nonfinancial support from Arthrex; personal fees and nonfinancial support from DJO Global; grants from Kaufman Foundation; grants, personal fees, and nonfinancial support from Medacta; grants, personal fees, nonfinancial support, and other from Pacira Pharmaceuticals; grants, personal fees, nonfinancial support, and other from Stryker; grants from Breg; personal fees from Orthomerica; grants, personal fees, nonfinancial support, and other from Mako Surgical Corp; grants and nonfinancial support from Medwest Associates; grants from ATI Physical Therapy; grants, personal fees, and nonfinancial support from St. Alexius Medical Center; and grants from Ossur, outside the submitted work; In addition, B.G.D. has a patent 8920497–Method and instrumentation for acetabular labrum reconstruction with royalties paid to Arthrex , a patent 8708941–Adjustable multi-component hip orthosis with royalties paid to Orthomerica and DJO Global, and a patent 9737292–Knotless suture anchors and methods of tissue repair with royalties paid to Arthrex . B.G.D. also is the Medical Director of Hip Preservation at St. Alexius Medical Center, a board member for the American Hip Institute Research Foundation , AANA Learning Center Committee, the Journal of Hip Preservation Surgery, Arthroscopy; and has had ownership interests in the American Hip Institute, Hinsdale Orthopedic Associates, Hinsdale Orthopedic Imaging, SCD#3, North Shore Surgical Suites, and Munster Specialty Surgery Center. D.R.M, reports nonfinancial support from Arthrex , Smith & Nephew, and Ossur, outside the submitted work. He is also an editorial board member of Arthroscopy. J.S. reports nonfinancial support from Arthrex , Smith & Nephew, Stryker , and Ossur, outside the submitted work. M.B.M. reports nonfinancial support from Arthrex , Stryker , and Smith & Nephew, outside the submitted work. A.C.L. reports grants, personal fees, and nonfinancial support from Arthrex; nonfinancial support from Iroko; nonfinancial support from Medwest; nonfinancial support from Smith & Nephew; grants and nonfinancial support from Stryker; nonfinancial support from Vericel; nonfinancial support from Zimmer Biomet; and personal fees from Graymont Medical, outside the submitted work. A.C.L. also is the Medical Director of Hip Preservation at St. Alexius Medical Center. Philip J. Rosinsky reports P.J.R. reports nonfinancial support from Arthrex , Stryker , Smith & Nephew, and Ossur, outside the submitted work. Full ICMJE author disclosure forms are available for this article online, as supplementary material.

      This study was performed at the American Hip Institute Research Foundation, Chicago, Illinois, U.S.A.

      Identification

      DOI: https://doi.org/10.1016/j.arthro.2021.01.022

      Copyright

      © 2021 by the Arthroscopy Association of North America

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