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

Published:January 27, 2021DOI:


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


      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.


      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.


      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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        • Kraeutler M.J.
        • Garabekyan T.
        • Pascual-Garrido C.
        • Mei-Dan O.
        Hip instability: A review of hip dysplasia and other contributing factors.
        Muscles Ligaments Tendons J. 2016; 6: 343-353
        • Homma Y.
        • Baba T.
        • Kobayashi H.
        • Murphy C.G.
        • Kaneko K.
        The importance of the soft tissue stabilizers of the hip: Three cases of rapid onset osteoarthritis following hip arthroscopy.
        J Orthop Sci. 2017; 22: 795-801
        • Cerezal L.
        • Kassarjian A.
        • Canga A.
        • et al.
        Anatomy, biomechanics, imaging, and management of ligamentum teres injuries.
        Radiographics. 2010; 30: 1637-1651
        • O’Donnell J.M.
        • Devitt B.M.
        • Arora M.
        The role of the ligamentum teres in the adult hip: Redundant or relevant? A review.
        J Hip Preserv Surg. 2018; 5: 15-22
        • Safran M.R.
        Microinstability of the hip—Gaining acceptance.
        J Am Acad Orthop Surg. 2019; 27: 12-22
        • Rosinsky P.J.
        • Shapira J.
        • Lall A.C.
        • Domb B.G.
        All about the ligamentum teres: From biomechanical role to surgical reconstruction.
        J Am Acad Orthop Surg. 2020; 28: e328-e339
        • O’Donnell J.
        • Economopoulos K.
        • Singh P.
        • Bates D.
        • Pritchard M.
        The ligamentum teres test: A novel and effective test in diagnosing tears of the ligamentum teres.
        Am J Sports Med. 2014; 42: 138-143
        • Shakoor D.
        • Farahani S.J.
        • Hafezi-Nejad N.
        • et al.
        Lesions of ligamentum teres: Diagnostic performance of MRI and MR arthrography—a systematic review and meta-analysis.
        AJR Am J Roentgenol. 2018; 211: W52-W63
        • Rosinsky P.J.
        • Annin S.
        • Maldonado D.R.
        • et al.
        Arthroscopic ligamentum teres reconstruction: Minimum 2-year patient reported outcomes with sub-analysis of patients with Ehlers–Danlos syndrome.
        Arthroscopy. 2020; 36: 2170-2182
        • Simpson J.M.
        • Field R.E.
        • Villar R.N.
        Arthroscopic reconstruction of the ligamentum teres.
        Arthroscopy. 2011; 27: 436-441
        • O’Donnell J.
        • Klaber I.
        • Takla A.
        Ligamentum teres reconstruction: Indications, technique and minimum 1-year results in nine patients.
        J Hip Preserv Surg. 2020; 7: 140-146
        • Moher D.
        • Liberati A.
        • Tetzlaff J.
        • Altman D.G.
        • Group T.P.
        Preferred Reporting Items for Systematic Reviews and Meta-Analyses: The PRISMA statement.
        PLOS Med. 2009; 6e1000097
        • Slim K.
        • Nini E.
        • Forestier D.
        • Kwiatkowski F.
        • Panis Y.
        • Chipponi J.
        Methodological index for non-randomized studies (MINORS): Development and validation of a new instrument.
        ANZ J Surg. 2003; 73: 712-716
        • Gray A.J.
        • Villar R.N.
        The ligamentum teres of the hip: An arthroscopic classification of its pathology.
        Arthroscopy. 1997; 13: 575-578
        • Chandrasekaran S.
        • Darwish N.
        • Mu B.H.
        • et al.
        Arthroscopic reconstruction of the irreparable acetabular labrum: A match-controlled study.
        Arthroscopy. 2019; 35: 480-488
        • Griffin D.W.
        • Kinnard M.J.
        • Formby P.M.
        • McCabe M.P.
        • Anderson T.D.
        Outcomes of hip arthroscopy in the older adult: A systematic review of the literature.
        Am J Sports Med. 2017; 45: 1928-1936
        • Hozo S.P.
        • Djulbegovic B.
        • Hozo I.
        Estimating the mean and variance from the median, range, and the size of a sample.
        BMC Med Res Methodol. 2005; 5: 13
        • Higgins J.P.T.
        • Green S.
        Cochrane handbook for systematic reviews of interventions, 5.10. John Wiley & Sons, Chichester (UK)2011
        • Levy D.M.
        • Kuhns B.D.
        • Chahal J.
        • Philippon M.J.
        • Kelly B.T.
        • Nho S.J.
        Hip Arthroscopy outcomes with respect to patient acceptable symptomatic state and minimal clinically important difference.
        Arthroscopy. 2016; 32: 1877-1886
        • Chandrasekaran S.
        • Martin T.J.
        • Close M.R.
        • Suarez-Ahedo C.
        • Lodhia P.
        • Domb B.G.
        Arthroscopic reconstruction of the Ligamentum Teres: A case series in four patients with connective tissue disorders and generalized ligamentous laxity.
        J Hip Preserv Surg. 2016; 3: 358-367
        • Philippon M.J.
        • Pennock A.
        • Gaskill T.R.
        Arthroscopic reconstruction of the ligamentum teres: Technique and early outcomes.
        J Bone Joint Surg Br. 2012; 94: 1494-1498
        • Martin H.D.
        • Hatem M.A.
        • Kivlan B.R.
        • Martin R.L.
        Function of the ligamentum teres in limiting hip rotation: A cadaveric study.
        Arthroscopy. 2014; 30: 1085-1091
        • Maldonado D.R.
        • Laseter J.R.
        • Perets I.
        • et al.
        The effect of complete tearing of the ligamentum teres in patients undergoing primary hip arthroscopy for femoroacetabular impingement and labral tears: A match-controlled study.
        Arthroscopy. 2019; 35: 80-88
        • Minkara A.A.
        • Westermann R.W.
        • Rosneck J.
        • Lynch T.S.
        Systematic review and meta-analysis of outcomes after hip arthroscopy in femoroacetabular impingement.
        Am J Sports Med. 2019; 47: 488-500