Ligament of the head of femur: A comprehensive review of its anatomy, embryology, and potential function

Abstract

The functional significance of the ligament of the head of femur (LHF), or ligamentum teres has often been debated. Having gained recent attention in clinical practice, it is suggested to partly provide some mechanical stability to the hip joint. However, the anatomy of this ligament is not well studied. This paper systematically reviews the anatomy of the LHF with the aim of exploring our current understanding of this structure and identifying any gaps in knowledge regarding its morphology and function. A systematic search of Medline, Embase, ProQuest, Web of Science, and Scopus databases was undertaken and relevant data extracted, analyzed. A total of 69 references were obtained, that included 53 full text articles, three published abstracts, and 13 textbooks. Many publications related to clinical studies (n = 11) rather than gross anatomy (n = 7), with one report on variation of the LHF. Considerable inconsistency in the naming and description of the LHF morphology was observed. Variable attachment sites were reported except for the acetabular notch, transverse acetabular ligament, and the femoral fovea. Presence and patency of the ligamental arteries supplying the head of the femur and their exact location were variably described and were often incomplete. The LHF is believed to be taught in extreme hip adduction, but there is little evidence to support this. In conclusions, further investigation of the anatomy of the LHF is recommended, particularly to clarify its mechanical role, innervation, and vascular contribution to the developing and adult femur, so to better inform clinical practice.

Femoral Head Fovea Capitis Variant Configurations and Age Related Changes- A Radiological Study

“…The head of the femur is covered by articular cartilage, except for a small ovoid depression situated slightly inferior and posterior to the center of the head called fovea capitis, it serves as a site of attachment of ligamentum teres (9,10).…”

“…Few studies focused on the anatomical location of the fovea capitis in the femoral heads, while other researchers studied the anatomical variations of the ligamentum teres and its artery which has its terminal branches piercing the fovea capitis (9)(10)(11)(12)(13). However, it is strange that searching the literature did not reveal any study focusing on the fovea capitis variant configurations and size changes related to the aging process.…”

The role of the ligamentum teres in the adult hip: redundant or relevant? A review

“…1 ) with a mean length of 30–35 mm [ 11 ], similar to the ACL. The ligament has a broad origin from almost the entire transverse acetabular ligament and is attached to the ischial and pubic bases by two bands or bundles [ 18 , 19 ], with the posterior bundle stronger than the anterior bundle. Again, this is similar to the ACL [ 20 ].…”

The ligamentum teres femoris in orangutans

“…However, the artery of the ligamentum teres femoris appears to be a critical vascular supply for the epiphysis or secondary center of ossification during development. In human pediatric patients, it is particularly important to preserve the LTF vasculature during treatment of hip disorders in order to reduce the possibility of osteonecrosis (Perumal et al, ; Wenger et al, ).…”

“…Crelin () states that the LTF is the most important structure in stabilizing the hip joint in utero when the knee and hip joints are in a fully flexed position. Based on tautness of the ligamentum teres in certain positions, it appears to restrict movement of the femoral head during combined flexion‐adduction‐external rotation of the hip (Gray and Villar, ; Perumal et al, ; Wenger et al, ) or perhaps abduction and rotation (Martin et al, ). Finally, the LTF contains nerve receptors that may provide some proprioceptive feedback about hip joint position (Haversath et al, ; Leunig et al, ; Sarban et al, ).…”