Injuries of the ligamentum teres of the hip: a systematic review analysing the surgical indications, the treatment options and the outcomes

Hip arthroscopy is becoming a common surgical technique for the diagnosis and treatment of disorders of the ligamentum teres. In a systematic review published in the journal Arthroscopy, December 2014 issue, an attempt was made to define the indications, the contraindications, the treatments and the outcomes after surgical management of injuries of the ligament by hip arthroscopy.
A search was made for articles on the surgical treatment of the ligamentum teres in the EMBASE, MEDLINE and PubMed databases, from 1946 to November 2013, in the English language.
A total of 1016 studies were identified, nine of which met the eligibility criteria. These studies included a total of 87 patients who underwent either arthroscopic debridement of the ligamentum teres or reconstruction with an autograft, an allograft or a synthetic graft for a complete tear of the ligamentum teres. The main indications for surgery included persistent hip pain that did not respond to conservative treatment, as well as mechanical symptoms or symptoms of instability (clicking or a sensation of locking). The only contraindication reported was advanced osteoarthritis (joint space on the radiograph < 2 mm). The patients were followed up postoperatively for one and a half to 60 months and were assessed using objective methods (such as the modified Harris Hip Score and the Non Arthritic Hip Score). Overall, both debridement and reconstruction improved the patients' condition, with an increase of the order of 40% in the reported postoperative functional assessment scores, as well as a reported score of the order of 89% in patients who were able to return to sporting activities.
The authors concluded that debridement of the ligamentum teres is indicated for medium-term relief of hip pain caused by partial-thickness tears (Type 2), when this does not respond to conservative measures, while reconstruction with autografts, allografts or synthetic grafts may be indicated for type 1 (full-thickness) tears of the ligamentum teres that are considered correctable, cause instability, and in which previous debridement has failed, or a combination of these situations.