Arthroscopic Ligamentum Teres Reconstruction: Minimum 2-Year Patient-Reported Outcomes With Subanalysis of Patients With Ehlers-Danlos Syndrome

Rosinsky, Philip J.; Annin, Shawn; Maldonado, David R.; Kyin, Cynthia; Meghpara, Mitchell B.; Shapira, Jacob; Lall, Ajay C.; Domb, Benjamin G.

doi:10.1016/j.arthro.2020.04.028

Cited by 21 publications

(27 citation statements)

References 48 publications

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“…Furthermore, only the study by O'Donnell et al 31 used specific inclusion and exclusion criteria to account for potential confounding variables, whereas some studies included all patients receiving LTR performed by the authors. 26,30 No study involved the use of any comparison groups. Furthermore, the average MINORS score was 8.7, with only 1 of the 7 studies having a MINORS score greater than 13, whereas 4 (57.1%) had a MINORS score of 6, indicating a high risk of bias and poor methodology (Table 2).…”

Section: Resultsmentioning

confidence: 99%

Indications and Outcomes After Ligamentum Teres Reconstruction: A Systematic Review

Knapik

Farivar

Kunze

et al. 2021

Arthroscopy, Sports Medicine, and Rehabilitation

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Purpose: To systematically review the literature to better understand the current indications for ligamentum teres reconstruction (LTR), current graft and acetabular fixation options used, patient-reported outcomes after LTR, and incidence of complications and reoperations after LTR. Methods: A systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) statement. All literature related to LTR published prior to July 2020 was identified. The inclusion criteria consisted of investigations reporting on human patients with pathology of the ligamentum teres who underwent LTR, including mentions of the indications, graft type, acetabular fixation method, postoperative patient-reported outcome scores, and incidence of complications and reoperations. Results: Seven studies comprising 26 patients (28 hips) were included. The most commonly reported indication for LTR was persistent pain and instability after failed prior hip arthroscopy (68%, 19 of 28 hips). The mean postoperative modified Harris Hip Score, Non-arthritic Hip Score, and visual analog scale score all showed improvement when compared with preoperative values. A total of 2 complications occurred. Complication rates ranged from 0% to 100% in included case reports and 0% to 11% in included case series. A total of 9 reoperations were performed. Reoperation rates ranged from 0% to 100% for case reports and 18% to 100% for case series. Reoperation rates ranged from 33% to 100% in studies with patients receiving acetabular fixation using anchors versus 0% to 22% in studies performing LTR with buttons. Reoperation rates in athletic patients and patients with Ehlers-Danlos syndrome ranged from 0% to 100% and 0% to 50%, respectively. Conclusions: The main indication for LTR was persistent hip or groin pain and instability after a prior hip arthroscopy. The short-term postoperative modified Harris Hip Score, Non-arthritic Hip Score, and visual analog scale score after LTR showed favorable outcomes. However, reoperations after LTR were not uncommon. Level of Evidence: Level V, systematic review of Level IV and V studies.

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Section: Resultsmentioning

confidence: 99%

Indications and Outcomes After Ligamentum Teres Reconstruction: A Systematic Review

Knapik

Farivar

Kunze

et al. 2021

Arthroscopy, Sports Medicine, and Rehabilitation

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“…The literature described cases confirming hip joint instability with dislocation including a completely ruptured LT with accompanying other intra-articular injuries [ 9 , 11 ]. Increasingly, there are reports of reconstruction of the LT, which restores stability and prevents hip dislocation [ 9–13 ].…”

Section: Discussionmentioning

confidence: 99%

“…O'Donnell et al . [ 13 ] and Philippon et al [ 12 ] stabilizing the graft in the acetabulum with screws, Benjamin Domb [ 11 ], White et al [ 9 ] and Villar [ 6 ] have used an cortical button implants fixating the graft with interference screw at the proximal femur.…”

Section: Discussionmentioning

confidence: 99%

“…The main recommendation is clinical instability of the hip joint in the course of a completely ruptured ligament. Other proposed indications of LTR in hypermobile joints and in the case of reduced bone stability [ 11 ]. Cadaveric study carried out by Martin [ 7 ] confirmed the function of the femoral head ligament in controlling and stabilizing rotational movements.…”

Section: Discussionmentioning

confidence: 99%

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Ligamentum teres reconstruction with labrum and capsule repair after posterior acetabular wall fracture: a case report

Mazek

Gnatowski²,

Salas³

et al. 2021

Journal of Hip Preservation Surgery

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The aim of this case study is to present arthroscopic treatment of recurrent hip instability after acute post-traumatic posterior hip dislocation with a fracture of the posterior acetabular wall. A male patient aged 35 suffered a dislocation of the right hip joint with a fracture of the posterior acetabular wall due to an accident. The fracture was stabilized during emergency surgery with a locking compression plate, and the patient was released home in a hip brace. Multiple dislocations of the hip joint followed with the implant being confirmed as stable. Decision was made to qualify the patient for a right hip arthroscopy. During the surgery, ligamentum teres was reconstructed using gracilis and semitendinous muscle grafts, followed by the labrum and joint capsule repair, where the surgery that stabilized the acetabular wall fracture had damaged them. There were no complications following the procedure. Short-term follow-up of 3 months demonstrates the patient has a stable hip, reduced pain and has returned to pre-injury activities.

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“…This article was a systematic review of 3 case series on LT reconstruction and the reported results. [9][10][11] It demonstrated these very difficult patients can respond favorably to surgery with LT reconstruction approximately two-thirds of the time. However, in the remaining one-third of patients, an additional surgery was required.…”

Section: See Related Article On Page 1811mentioning

confidence: 99%

Editorial Commentary: Ligamentum Teres Reconstruction May Improve Hip Stability But Has High Revision Rates: Fad or Restoration of Function?

Hartigan¹,

Hegedus²

2021

Arthroscopy: The Journal of Arthroscopic & Related Surgery

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Ligamentum teres (LT) tears are correlated with hip instability, and biomechanical research suggests there is a stabilizing function of the intact native LT. With regard to LT reconstruction, currently, there are imaging studies demonstrating that the ligament goes on to heal and properly function. There are also no long-term clinical studies on the success rates of LT reconstruction. The clinical studies that have been done are done with a fairly high number of concomitant procedures, which makes it difficult to discern whether improvement can be attributed to the LT reconstruction. A recent review shows that after LT reconstruction, these very difficult patients can respond favorably to surgery two-thirds of the time. However, in the remaining one-third of patients, an additional surgery was required. In my own practice, patients with instability patterns on examination who have failed primary arthroscopy and have any degree of even minor bony dysplasia with signs of ligamentous laxity and LT tear are a population that I personally would recommend a periacetabular osteotomy to optimize bony stability. For those not a candidate for periacetabular osteotomy , the patient should be educated on the risks of failure of LT reconstruction and have reasonable expectations, and the operation should be performed by an experienced hip arthroscopist with LT reconstruction experience.

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Arthroscopic Ligamentum Teres Reconstruction: Minimum 2-Year Patient-Reported Outcomes With Subanalysis of Patients With Ehlers-Danlos Syndrome

Cited by 21 publications

References 48 publications

Indications and Outcomes After Ligamentum Teres Reconstruction: A Systematic Review

Indications and Outcomes After Ligamentum Teres Reconstruction: A Systematic Review

Ligamentum teres reconstruction with labrum and capsule repair after posterior acetabular wall fracture: a case report

Editorial Commentary: Ligamentum Teres Reconstruction May Improve Hip Stability But Has High Revision Rates: Fad or Restoration of Function?

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