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Published in: Clinical Orthopaedics and Related Research® 3/2009

01-03-2009 | Symposium: Femoroacetabular Impingement: Current Status of Diagnosis and Treatment

Labral Reconstruction Using the Ligamentum Teres Capitis: Report of a New Technique

Authors: Rafael J. Sierra, MD, Robert T. Trousdale, MD

Published in: Clinical Orthopaedics and Related Research® | Issue 3/2009

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Abstract

We have used the ligamentum teres capitis to reconstruct the deficient or absent labrum in five patients with femoroacetabular impingement at the time of surgical hip dislocation. Two had a deficient labrum overlying a sectorial retroverted acetabulum causing pincer-type impingement. Three patients had the labrum previously resected arthroscopically. The minimum followup from surgery was 5 months (average, 10 months; range, 5–20 months). There were no intraoperative or postoperative complications related to the reconstruction. All patients had improvement in their clinical function and one patient underwent total hip arthroplasty at last followup for unresolved pain without radiographic progression of arthritis. Reconstruction of the labrum in patients with deficient or resected labrums at the time of surgical hip dislocation provides the theoretical advantage of sealing and stabilizing the hip joint, restoring the fluid layer which could potentially prevent continued cartilage degeneration.
Level of Evidence: Level II, prognostic study. See the Guidelines for Authors for a complete description of levels of evidence.
Literature
1.
go back to reference Amstutz HC. Treatment of primary osteoarthritis of the hip: A comparison of total joint surface replacement arthroplasty. J Bone Joint Surg Am. 1984;66:228–241.PubMed Amstutz HC. Treatment of primary osteoarthritis of the hip: A comparison of total joint surface replacement arthroplasty. J Bone Joint Surg Am. 1984;66:228–241.PubMed
2.
go back to reference Beck M, Kalhor M, Leunig M, Ganz R. Hip morphology influences the pattern of damage to the acetabular cartilage: femoroacetabular impingement as a cause of early osteoarthritis of the hip. J Bone Joint Surg Br. 2005;87:1012–1018.PubMedCrossRef Beck M, Kalhor M, Leunig M, Ganz R. Hip morphology influences the pattern of damage to the acetabular cartilage: femoroacetabular impingement as a cause of early osteoarthritis of the hip. J Bone Joint Surg Br. 2005;87:1012–1018.PubMedCrossRef
3.
go back to reference Chandler SB, Kreuscher PH. A study of the blood supply of the ligamentum teres and its relation to the circulation of the head of the femur. J Bone Joint Surg Am. 1932;14:834–846. Chandler SB, Kreuscher PH. A study of the blood supply of the ligamentum teres and its relation to the circulation of the head of the femur. J Bone Joint Surg Am. 1932;14:834–846.
4.
go back to reference Crawford MJ, Dy CJ, Alexander JW, Thompson M, Schroder SJ, Vega CE, Patel RV, Miller AR, McCarthy JC, Lowe WR, Noble PC. The 2007 Frank Stinchfield Award. The biomechanics of the hip labrum and the stability of the hip. Clin Orthop Relat Res. 2007;465:16–22.PubMed Crawford MJ, Dy CJ, Alexander JW, Thompson M, Schroder SJ, Vega CE, Patel RV, Miller AR, McCarthy JC, Lowe WR, Noble PC. The 2007 Frank Stinchfield Award. The biomechanics of the hip labrum and the stability of the hip. Clin Orthop Relat Res. 2007;465:16–22.PubMed
5.
go back to reference Espinosa N, Rothefluh DA, Beck M, Ganz R, Leunig M. Treatment of femoroacetabular impingement: preliminary results of labral refixation. J Bone Joint Surg Am. 2006;88:925–935.PubMedCrossRef Espinosa N, Rothefluh DA, Beck M, Ganz R, Leunig M. Treatment of femoroacetabular impingement: preliminary results of labral refixation. J Bone Joint Surg Am. 2006;88:925–935.PubMedCrossRef
6.
go back to reference Ezoe M, Naito M, Inoue T. The prevalence of acetabular retroversion among various disorders of the hip. J Bone Joint Surg Am. 2006;88:372–379.PubMedCrossRef Ezoe M, Naito M, Inoue T. The prevalence of acetabular retroversion among various disorders of the hip. J Bone Joint Surg Am. 2006;88:372–379.PubMedCrossRef
7.
go back to reference Ferguson SJ, Bryant JT, Ganz R, Ito K. The acetabular labrum seal: a poroelastic finite element model. Clin Biomech (Bristol, Avon). 2000;15:463–468. Ferguson SJ, Bryant JT, Ganz R, Ito K. The acetabular labrum seal: a poroelastic finite element model. Clin Biomech (Bristol, Avon). 2000;15:463–468.
8.
go back to reference Ferguson SJ, Bryant JT, Ganz R, Ito K. The influence of the acetabular labrum on hip joint cartilage consolidation: a poroelastic finite element model. J Biomech. 2000;33:953–960.PubMedCrossRef Ferguson SJ, Bryant JT, Ganz R, Ito K. The influence of the acetabular labrum on hip joint cartilage consolidation: a poroelastic finite element model. J Biomech. 2000;33:953–960.PubMedCrossRef
9.
go back to reference Ferguson SJ, Bryant JT, Ganz R, Ito K. An in vitro investigation of the acetabular labral seal in hip joint mechanics. J Biomech. 2003;36:171–178.PubMedCrossRef Ferguson SJ, Bryant JT, Ganz R, Ito K. An in vitro investigation of the acetabular labral seal in hip joint mechanics. J Biomech. 2003;36:171–178.PubMedCrossRef
10.
go back to reference Ferguson SJ, Bryant JT, Ito K. The material properties of the bovine acetabular labrum. J Orthop Res. 2001;19:887–896.PubMedCrossRef Ferguson SJ, Bryant JT, Ito K. The material properties of the bovine acetabular labrum. J Orthop Res. 2001;19:887–896.PubMedCrossRef
11.
go back to reference Ganz R, Gill TJ, Gautier E, Ganz K, Krugel N, Berlemann U. Surgical dislocation of the adult hip: a technique with full access to femoral head and acetabulum without the risk of avascular necrosis J Bone Joint Surg Br. 2001;83:1119–1124.PubMedCrossRef Ganz R, Gill TJ, Gautier E, Ganz K, Krugel N, Berlemann U. Surgical dislocation of the adult hip: a technique with full access to femoral head and acetabulum without the risk of avascular necrosis J Bone Joint Surg Br. 2001;83:1119–1124.PubMedCrossRef
12.
go back to reference Ganz R, Leunig M, Leunig-Ganz K, Harris WH. The etiology of osteoarthritis of the hip: an integrated mechanical concept. Clin Orthop Relat Res. 2008;466:264–272.PubMedCrossRef Ganz R, Leunig M, Leunig-Ganz K, Harris WH. The etiology of osteoarthritis of the hip: an integrated mechanical concept. Clin Orthop Relat Res. 2008;466:264–272.PubMedCrossRef
13.
go back to reference Ganz R, Parvizi J, Beck M, Leunig M, Notzli H, Siebenrock KA. Femoroacetabular impingement: a cause for osteoarthritis of the hip. Clin Orthop Relat Res. 2003;417:112–120.PubMed Ganz R, Parvizi J, Beck M, Leunig M, Notzli H, Siebenrock KA. Femoroacetabular impingement: a cause for osteoarthritis of the hip. Clin Orthop Relat Res. 2003;417:112–120.PubMed
14.
go back to reference Ito K, Leunig M, Ganz R. Histopathologic features of the acetabular labrum in femoroacetabular impingement. Clin Orthop Relat Res. 2004;429:262–271.PubMedCrossRef Ito K, Leunig M, Ganz R. Histopathologic features of the acetabular labrum in femoroacetabular impingement. Clin Orthop Relat Res. 2004;429:262–271.PubMedCrossRef
15.
go back to reference Ito K, Minka II MA, Leunig M, Werlen S, Ganz R. Femoroacetabular impingement and the cam-effect: a MRI-based, quantitative anatomical study of the femoral head-neck offset. J Bone Joint Surg Br. 2001;83:171–176.PubMedCrossRef Ito K, Minka II MA, Leunig M, Werlen S, Ganz R. Femoroacetabular impingement and the cam-effect: a MRI-based, quantitative anatomical study of the femoral head-neck offset. J Bone Joint Surg Br. 2001;83:171–176.PubMedCrossRef
16.
go back to reference Kelly BT, Shapiro GS, Digiovanni CW, Buly RL, Potter HG, Hannafin JA. Vascularity of the hip labrum: a cadaveric investigation. Arthroscopy. 2005;21:3–11.PubMedCrossRef Kelly BT, Shapiro GS, Digiovanni CW, Buly RL, Potter HG, Hannafin JA. Vascularity of the hip labrum: a cadaveric investigation. Arthroscopy. 2005;21:3–11.PubMedCrossRef
17.
go back to reference Lavigne M, Parvizi J, Beck M, Siebenrock KA, Ganz R, Leunig M. Anterior femoroacetabular impingement: Part I: techniques of joint preserving surgery. Clin Orthop Relat Res. 2004;418:61–66.PubMedCrossRef Lavigne M, Parvizi J, Beck M, Siebenrock KA, Ganz R, Leunig M. Anterior femoroacetabular impingement: Part I: techniques of joint preserving surgery. Clin Orthop Relat Res. 2004;418:61–66.PubMedCrossRef
18.
go back to reference Li PL, Ganz R. Morphologic features of congenital acetabular dysplasia: one in six is retroverted. Clin Orthop Relat Res. 2003;416:245–253.PubMedCrossRef Li PL, Ganz R. Morphologic features of congenital acetabular dysplasia: one in six is retroverted. Clin Orthop Relat Res. 2003;416:245–253.PubMedCrossRef
19.
go back to reference Petersen W, Petersen F, Tillmann B. Structure and vascularization of the acetabular labrum with regard to the pathogenesis and healing of labral lesions. Arch Orthop Trauma Surg. 2003;123:283–288.PubMedCrossRef Petersen W, Petersen F, Tillmann B. Structure and vascularization of the acetabular labrum with regard to the pathogenesis and healing of labral lesions. Arch Orthop Trauma Surg. 2003;123:283–288.PubMedCrossRef
20.
go back to reference Rao J, Zhou YX, Villar RN. Injury to the ligamentum teres: mechanism, findings, and results of treatment. Clin Sports Med. 2001;20:791–799.PubMedCrossRef Rao J, Zhou YX, Villar RN. Injury to the ligamentum teres: mechanism, findings, and results of treatment. Clin Sports Med. 2001;20:791–799.PubMedCrossRef
21.
go back to reference Reynolds D, Lucas J, Klaue K. Retroversion of the acetabulum: a cause of hip pain. J Bone Joint Surg Br. 1999;81:281–288.PubMedCrossRef Reynolds D, Lucas J, Klaue K. Retroversion of the acetabulum: a cause of hip pain. J Bone Joint Surg Br. 1999;81:281–288.PubMedCrossRef
22.
go back to reference Seldes RM, Tan V, Hunt J, Katz M, Winiarsky R, Fitzgerald Jr RH. Anatomy, histologic features, and vascularity of the adult acetabular labrum. Clin Orthop Relat Res. 2001;382:232–240.PubMedCrossRef Seldes RM, Tan V, Hunt J, Katz M, Winiarsky R, Fitzgerald Jr RH. Anatomy, histologic features, and vascularity of the adult acetabular labrum. Clin Orthop Relat Res. 2001;382:232–240.PubMedCrossRef
23.
go back to reference Takechi H, Nagashima H, Ito S. Intra-articular pressure of the hip joint outside and inside the limbus. J Japan Orthop Assoc. 1982;56:529–536. Takechi H, Nagashima H, Ito S. Intra-articular pressure of the hip joint outside and inside the limbus. J Japan Orthop Assoc. 1982;56:529–536.
24.
go back to reference Weber W, Weber E. Ueber die mechanik der menschlichten gehwerkzeuge nebst der beschreibung eines versuches ueber das herausfallen des schenkelkopfes aus der pfanne im luftverduennten raum. Annals Physics Chem. 1837;40:1–13.CrossRef Weber W, Weber E. Ueber die mechanik der menschlichten gehwerkzeuge nebst der beschreibung eines versuches ueber das herausfallen des schenkelkopfes aus der pfanne im luftverduennten raum. Annals Physics Chem. 1837;40:1–13.CrossRef
Metadata
Title
Labral Reconstruction Using the Ligamentum Teres Capitis: Report of a New Technique
Authors
Rafael J. Sierra, MD
Robert T. Trousdale, MD
Publication date
01-03-2009
Publisher
Springer-Verlag
Published in
Clinical Orthopaedics and Related Research® / Issue 3/2009
Print ISSN: 0009-921X
Electronic ISSN: 1528-1132
DOI
https://doi.org/10.1007/s11999-008-0633-5

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