Hip Labral Reconstruction Using the Ligamentum Teres Capitis: Case Report and Surgical Technique
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Published:
Aug 19, 2021
Keywords:
Hip, acetabulum, autografts, labral tear, surgical hip dislocation
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Abstract
Labral tears with insufficient substance can be treated with augmentation, reconstruction, or grafting techniques. If the remnant labrum is very scarce, reconstructive options would be the most appropriate. We present the case of a 40-year-old female patient who had undergone two failed hip arthroscopies due to labral tears. Following the original technique described by Ganz, a surgical hip dislocation was performed and the Ligamentum Teres Capitis was resected to cover the labral defect. To our knowledge, this is the first report of labral reconstruction using the Ligamentum Teres Capitis in our literature. Despite poorly reported outcomes in patients with previous procedures, surgical repair using the Ligamentum Teres Capitis has proven to be a viable option.
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Díaz Dilernia, F., De Cicco, F., Comba, F., Buttaro, M., & Zanotti, G. (2021). Hip Labral Reconstruction Using the Ligamentum Teres Capitis: Case Report and Surgical Technique. Revista De La Asociación Argentina De Ortopedia Y Traumatología, 86(4), 553-559. https://doi.org/10.15417/issn.1852-7434.2021.86.4.1281
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References
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4. Ejnisman L, Philippon MJ, Lertwanich P. Acetabular labral tears: diagnosis, repair, and a method for labral
reconstruction. Clin Sports Med 2011;30(2):317-29. https://doi.org/10.1016/j.csm.2010.12.006
5. Ferguson SJ, Bryant JT, Ganz R, Ito K. An in vitro investigation of the acetabular labral seal in hip joint mechanics. J Biomech 2003;36(2):171-8. https://doi.org/10.1016/s0021-9290(02)00365-2
6. Ferguson SJ, Bryant JT, Ganz R, Ito K. The influence of the acetabular labrum on hip joint cartilage consolidation: a poroelastic finite element model. J Biomech 2000;33(8):953-60. https://doi.org/10.1016/s0021-9290(00)00042-7
7. Cadet ER, Chan AK, Vorys GC, Gardner T, Yin B. Investigation of the preservation of the fluid seal effect in
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9. Espinosa N, Beck M, Rothenfluh DA, Ganz R, Leunig M. Treatment of femoro-acetabular impingement:
preliminary results of labral refixation. Surgical technique. J Bone Joint Surg Am 2007;(89 Suppl 2) Pt.1:36-53.
https://doi.org/10.2106/JBJS.F.01123
10. Byrd JWT, Jones KS. Prospective analysis of hip arthroscopy with 10-year follow up. Clin Orthop Relat Res
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11. Ganz R, Gill TJ, Gautier E, Ganz K, Krügel N, Berlemann U. Surgical dislocation of the adult hip a technique
with full access to the femoral head and acetabulum without the risk of avascular necrosis. J Bone Joint Surg Br
2001;83(8):1119-24. https://doi.org/10.1302/0301-620x.83b8.11964
12. Peters CL, Erickson JA. Treatment of femoro-acetabular impingement with surgical dislocation and debridement in young adults. J Bone Joint Surg Am 2006;88(8):1735-41. https://doi.org/10.2106/JBJS.E.00514
13. Ganz R, Parvizi J, Beck M, Leunig M, Nötzli H, Siebenrock KA. Femoroacetabular impingement: a cause for
osteoarthritis of the hip. Clin Orthop Relat Res 2003;(417):112-20. https://doi.org/10.1097/01.blo.0000096804.78689.c2
14. Hartmann A, Günther K-P. Arthroscopically assisted anterior decompression for femoroacetabular impingement: technique and early clinical results. Arch Orthop Trauma Surg 2009;129(8):1001-9.
https://doi.org/10.1007/s00402-008-0806-4
15. Sevitt S, Thompson RG. The distribution and anastomoses of arteries supplying the head and neck of the femur. J Bone Joint Surg Br 1965;47:560-73. https://doi.org/10.1302/0301-620X.47B3.560
16. Amenabar T, Piriz J, Mella C, Hetaimish BM, O’Donnell J. Reliability of 3 different arthroscopic classifications for chondral damage of the acetabulum. Arthroscopy 2015;31(8):1492-6. https://doi.org/10.1016/j.arthro.2015.02.029
17. Beck M, Leunig M, Parvizi J, Boutier V, Wyss D, Ganz R. Anterior femoroacetabular impingement: part II. Midterm results of surgical treatment. Clin Orthop Relat Res 2004;(418):67-73. PMID: 15043095
18. Philippon MJ, Nepple JJ, Campbell KJ, Dornan GJ, Jansson KS, LaPrade RF, et al. The hip fluid seal--Part I: the
effect of an acetabular labral tear, repair, resection, and reconstruction on hip fluid pressurization. Knee Surg Sports Traumatol Arthrosc 2014;22(4):722-9. https://doi.org/10.1007/s00167-014-2874-z
19. Ito K, Leunig M, Ganz R. Histopathologic features of the acetabular labrum in femoroacetabular impingement. Clin Orthop Relat Res 2004;(429):262-71. https://doi.org/10.1097/01.blo.0000144861.11193.17
20. Philippon MJ, Briggs KK, Hay CJ, Kuppersmith DA, Dewing CB, Huang MJ. Arthroscopic labral reconstruction in
the hip using iliotibial band autograft: technique and early outcomes. Arthroscopy 2010;26(6):750-6.
https://doi.org/10.1016/j.arthro.2009.10.016
21. Weidner J, Wyatt M, Beck M. Labral augmentation with ligamentum capitis femoris: presentation of a new
technique and preliminary results. J Hip Preserv Surg 2018;5(1):47-53. https://doi.org/10.1093/jhps/hnx049
2. Singh PJ, O’Donnell JM. The outcome of hip arthroscopy in Australian football league players: a review of 27 hips. Arthroscopy 2010;26(6):743-9. https://doi.org/10.1016/j.arthro.2009.10.010
3. Haviv B, O’Donnell J. Arthroscopic treatment for acetabular labral tears of the hip without bony dysmorphism. Am J Sports Med 2011;(39 Suppl):79S-84S. https://doi.org/10.1177/0363546511412915
4. Ejnisman L, Philippon MJ, Lertwanich P. Acetabular labral tears: diagnosis, repair, and a method for labral
reconstruction. Clin Sports Med 2011;30(2):317-29. https://doi.org/10.1016/j.csm.2010.12.006
5. Ferguson SJ, Bryant JT, Ganz R, Ito K. An in vitro investigation of the acetabular labral seal in hip joint mechanics. J Biomech 2003;36(2):171-8. https://doi.org/10.1016/s0021-9290(02)00365-2
6. Ferguson SJ, Bryant JT, Ganz R, Ito K. The influence of the acetabular labrum on hip joint cartilage consolidation: a poroelastic finite element model. J Biomech 2000;33(8):953-60. https://doi.org/10.1016/s0021-9290(00)00042-7
7. Cadet ER, Chan AK, Vorys GC, Gardner T, Yin B. Investigation of the preservation of the fluid seal effect in
the repaired, partially resected, and reconstructed acetabular labrum in a cadaveric hip model. Am J Sports Med
2012;40(10):2218-23. https://doi.org/10.1177/0363546512457645
8. Nepple JJ, Philippon MJ, Campbell KJ, Dornan GJ, Jansson KS, LaPrade RF, et al. The hip fluid seal--Part II: The
effect of an acetabular labral tear, repair, resection, and reconstruction on hip stability to distraction. Knee Surg
Sports Traumatol Arthrosc 2014;22(4):730-6. https://doi.org/10.1007/s00167-014-2875-y
9. Espinosa N, Beck M, Rothenfluh DA, Ganz R, Leunig M. Treatment of femoro-acetabular impingement:
preliminary results of labral refixation. Surgical technique. J Bone Joint Surg Am 2007;(89 Suppl 2) Pt.1:36-53.
https://doi.org/10.2106/JBJS.F.01123
10. Byrd JWT, Jones KS. Prospective analysis of hip arthroscopy with 10-year follow up. Clin Orthop Relat Res
2010;468(3):741-6. https://doi.org/10.1007/s11999-009-0841-11
11. Ganz R, Gill TJ, Gautier E, Ganz K, Krügel N, Berlemann U. Surgical dislocation of the adult hip a technique
with full access to the femoral head and acetabulum without the risk of avascular necrosis. J Bone Joint Surg Br
2001;83(8):1119-24. https://doi.org/10.1302/0301-620x.83b8.11964
12. Peters CL, Erickson JA. Treatment of femoro-acetabular impingement with surgical dislocation and debridement in young adults. J Bone Joint Surg Am 2006;88(8):1735-41. https://doi.org/10.2106/JBJS.E.00514
13. Ganz R, Parvizi J, Beck M, Leunig M, Nötzli H, Siebenrock KA. Femoroacetabular impingement: a cause for
osteoarthritis of the hip. Clin Orthop Relat Res 2003;(417):112-20. https://doi.org/10.1097/01.blo.0000096804.78689.c2
14. Hartmann A, Günther K-P. Arthroscopically assisted anterior decompression for femoroacetabular impingement: technique and early clinical results. Arch Orthop Trauma Surg 2009;129(8):1001-9.
https://doi.org/10.1007/s00402-008-0806-4
15. Sevitt S, Thompson RG. The distribution and anastomoses of arteries supplying the head and neck of the femur. J Bone Joint Surg Br 1965;47:560-73. https://doi.org/10.1302/0301-620X.47B3.560
16. Amenabar T, Piriz J, Mella C, Hetaimish BM, O’Donnell J. Reliability of 3 different arthroscopic classifications for chondral damage of the acetabulum. Arthroscopy 2015;31(8):1492-6. https://doi.org/10.1016/j.arthro.2015.02.029
17. Beck M, Leunig M, Parvizi J, Boutier V, Wyss D, Ganz R. Anterior femoroacetabular impingement: part II. Midterm results of surgical treatment. Clin Orthop Relat Res 2004;(418):67-73. PMID: 15043095
18. Philippon MJ, Nepple JJ, Campbell KJ, Dornan GJ, Jansson KS, LaPrade RF, et al. The hip fluid seal--Part I: the
effect of an acetabular labral tear, repair, resection, and reconstruction on hip fluid pressurization. Knee Surg Sports Traumatol Arthrosc 2014;22(4):722-9. https://doi.org/10.1007/s00167-014-2874-z
19. Ito K, Leunig M, Ganz R. Histopathologic features of the acetabular labrum in femoroacetabular impingement. Clin Orthop Relat Res 2004;(429):262-71. https://doi.org/10.1097/01.blo.0000144861.11193.17
20. Philippon MJ, Briggs KK, Hay CJ, Kuppersmith DA, Dewing CB, Huang MJ. Arthroscopic labral reconstruction in
the hip using iliotibial band autograft: technique and early outcomes. Arthroscopy 2010;26(6):750-6.
https://doi.org/10.1016/j.arthro.2009.10.016
21. Weidner J, Wyatt M, Beck M. Labral augmentation with ligamentum capitis femoris: presentation of a new
technique and preliminary results. J Hip Preserv Surg 2018;5(1):47-53. https://doi.org/10.1093/jhps/hnx049