All About the Ligamentum Teres: From Biomechanical Role to Surgical Reconstruction
Authors: Rosinsky PJ, Shapira J, Lall AC, Domb BG
DOI: 10.5435/JAAOS-D-19-00352
Background
Long considered vestigial, the ligamentum teres (LT) is now understood to contribute to hip stability, proprioception, and potentially pain in certain pathologic conditions. This review explores biomechanical data and surgical approaches related to LT injuries.
Methods
This narrative review synthesizes data on LT anatomy, function, diagnosis, and treatment—focusing on surgical indications and techniques for LT reconstruction.
Key Findings
- LT tears are increasingly recognized as contributors to microinstability, particularly in patients with hyperlaxity or connective tissue disorders.
- Arthroscopic LT reconstruction may benefit patients with persistent instability or pain despite other interventions.
- Diagnosis remains challenging due to non-specific imaging and intraoperative variability.
Conclusions
The LT plays a more critical role in hip mechanics than previously thought. In select patients with instability, especially those with ligamentous laxity, reconstruction may restore functional stability.
What Does This Mean for Providers?
- Maintain a high index of suspicion for LT pathology in patients with persistent hip pain and instability, particularly if other causes have been addressed.
- Consider LT reconstruction in patients with irreparable tears, especially those with generalized ligamentous laxity or failed prior arthroscopy.
- Accurate intraoperative assessment and knowledge of reconstructive techniques are key to optimizing outcomes.