2015 ISAKOS Biennial Congress ePoster #808

Structural Properties of the Native Ligamentum Teres

Marc J. Philippon, MD, Vail, CO UNITED STATES
Matthew T. Rasmussen, BS, Vail, CO UNITED STATES
Travis Lee Turnbull, PhD, Vail, CO UNITED STATES
Christiano A.C. Trindade, MD, Vail, CO UNITED STATES
Mark Hamming, MD, Durham, NC UNITED STATES
Michael B. Ellman, MD, Chicago, IL UNITED STATES
Matthew J. Harris, MD, MBA, Jupiter, FL UNITED STATES
Robert F. LaPrade, MD, PhD, Chanhassen, MN UNITED STATES
Coen Abel Wijdicks, PhD, M√ľnchen, Bavaria GERMANY

Steadman Philippon Research Institute, Vail, Colorado, USA

FDA Status Not Applicable

Summary: This study defines the biomechanical characteristics of the ligamentum teres with preserved bony attachments in a human cadaveric model.

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Abstract:

Background

Surgical treatment of the ligamentum teres (LT) is an option for addressing hip instability and pain that persists in the absence of more common intra-articular pathology. While multiple surgical reconstruction techniques have been proposed, there is controversy regarding the exact role played by the LT in preserving a stable hip joint. A majority of studies investigating the role of the LT have focused primarily on anatomical and histological descriptions. To date, however, the structural properties of the LT have yet to be fully elucidated.

Purpose

The purpose of this study was to investigate the structural properties of the native LT in a human cadaveric model.

Methods

Twelve human cadaveric hemi-pelvises (mean age: 53.6 years, range 34-63) were dissected free of all extra-articular soft tissues in order to isolate the LT and its acetabular and femoral attachments. A dynamic tensile testing machine distracted each femur in-line with the fibers of the LT at a displacement-controlled rate of 0.5 mm/s. The anatomic dimensions, structural properties, and modes of failure were recorded.

Results

The LT had a mean ultimate failure load of 204 ± 128 N and tensile strength of 3.30 ± 1.60 MPa. The most common (75% of specimens) mechanism of failure was tearing at the fovea capitis. On average, the LT had a linear stiffness of 16 N/mm and elastic modulus of 9.24 MPa. The mean initial length and cross-sectional area were 32 mm and 59 mm^2, respectively.

Conclusions

The human LT had an ultimate failure load of 204 N. Therefore, the results of this investigation, combined with recent biomechanical and outcomes studies, suggest that special consideration should be given to preserving the structural and corresponding biomechanical integrity of the LT during surgical intervention.

CLINICAL RELEVANCE: The LT may be more important as a static stabilizer of the hip joint than previously recognized. Further studies are recommended to investigate the appropriate indications to perform surgical repair or reconstruction of the LT for preservation of hip stability and function.