Arthroscopic Ligamentum Teres Reconstruction Using Anterior Tibialis Allograft and the Tension-Slide Technique
Authors: Maldonado DR, Chen JW, Lall AC, Go CC, Walker-Santiago R, Rosinsky PJ, Shapira J, Domb BG
DOI: 10.1016/j.eats.2019.05.022
Background
Historically underappreciated, the ligamentum teres (LT) is now recognized as a critical stabilizer of the hip joint, particularly in patients with ligamentous laxity or microinstability. This study presents a detailed arthroscopic technique for LT reconstruction using an anterior tibialis allograft, leveraging a tension-slide method for fixation.
Methods
The surgical technique utilizes the tension-slide fixation method to secure the graft to the acetabular fossa during hip arthroscopy. This approach aims to restore native LT function in cases of full-thickness or functionally significant tears.
Key Findings
- The technique provides reliable fixation and restoration of LT tension and orientation.
- LT reconstruction is especially beneficial in patients with gross instability or generalized ligamentous laxity where debridement alone is insufficient.
Conclusions
This technique offers an anatomic, biomechanically sound alternative to LT debridement, supporting improved joint stability in appropriately selected patients.
What Does This Mean for Providers?
- Providers should consider LT reconstruction in patients with symptomatic, complete LT tears, particularly those with hip microinstability or failed prior arthroscopy.
- Incorporating this technique requires familiarity with advanced hip arthroscopy and graft passage/fixation, but it may provide superior outcomes in selected cases compared to debridement alone.