Arthroscopic Ligamentum Teres Reconstruction: Minimum 2-Year Patient-Reported Outcomes With Subanalysis of Patients With Ehlers-Danlos Syndrome
Authors: Rosinsky PJ, Annin S, Maldonado DR, Kyin C, Meghpara MB, Shapira J, Lall AC, Domb BG
DOI: 10.1016/j.arthro.2020.04.028
Background
Damage or absence of the ligamentum teres (LT) has been increasingly recognized as a contributor to hip pain and instability, particularly in patients with hypermobility or connective tissue disorders. This study examined mid-term outcomes following arthroscopic ligamentum teres reconstruction (LTR), with a focus on a subset of patients with Ehlers-Danlos syndrome (EDS).
Methods
A retrospective review of patients who underwent arthroscopic LTR was conducted with a minimum follow-up of two years. Patient-reported outcomes, pain levels, and satisfaction scores were evaluated, with a comparative subanalysis of those with a diagnosis of EDS.
Key Findings
- Overall, patients showed meaningful improvements in hip function, reduced pain, and high satisfaction rates.
- However, the subgroup with EDS had a higher rate of clinical failure, underscoring the challenges of treating instability in the setting of generalized connective tissue disorders.
- These findings suggest a potential role for LTR in select cases, but with caution in hyperlax populations.
Conclusions
LTR is a viable surgical treatment for patients with symptomatic ligamentum teres pathology and hip instability, though outcomes are more guarded in patients with underlying syndromic laxity such as EDS.
What Does This Mean for Providers?
For patients presenting with microinstability and confirmed ligamentum teres pathology, LTR can offer symptomatic relief and improved function. Providers should be particularly cautious in patients with Ehlers-Danlos syndrome, setting appropriate expectations and considering adjunct capsular or stabilization procedures as needed.