Tears of the Ligamentum Teres: Prevalence in Hip Arthroscopy Using 2 Classification Systems
Authors: Botser IB, Martin DE, Stout CE, Domb BG
DOI: 10.1177/0363546511413865
Purpose
To determine how common ligamentum teres (LT) tears are during hip arthroscopy and classify them using both an established and a new grading system.
Methods
Reviewed 558 hip arthroscopies in 502 patients, grading LT tears by Gray and Villar’s system and a descriptive scale (grades 0–3). Analyzed preoperative symptoms, MRI accuracy, and intraoperative findings.
Key Findings
- LT tears were found in 51% of hips.
- Descriptive grading: 22% grade 1 (<50% tear), 24% grade 2 (>50% tear), 5% grade 3 (complete tear).
- Tears correlated with older age, poorer function, more labral damage, and greater hip motion.
- MRI was unreliable for detecting LT tears.
- No direct link between LT tears and reported pain levels.
Conclusion
LT tears are common and often underdiagnosed due to poor MRI sensitivity; they are associated with functional problems and joint damage.
What this means for providers
Ligamentum teres tears are frequently encountered during hip arthroscopy but are often missed on preoperative MRI, highlighting the importance of thorough intraoperative assessment. These tears are associated with older age, decreased function, increased range of motion, and concomitant labral pathology. Recognizing and grading LT tears intraoperatively may influence surgical decision-making and postoperative management, even in the absence of significant preoperative pain.