Arthroscopic Ligamentum Teres Reconstruction in the Hip: Clinical Outcomes With Minimum 2-Year Follow-up

Abstract

Background:

The ligamentum teres (LT) plays an important role in the general stability of the hip joint. A high prevalence of concomitant LT pathology has been noted in patients undergoing hip arthroscopy. This increased prevalence has led to the development of multiple treatment options, including reconstruction techniques using different types of grafts. The current literature on outcomes of LT reconstruction is limited.

Purpose:

To evaluate the outcomes of LT reconstruction with tibialis anterior allograft treatment for LT tears with a minimum 2-year follow-up.

Study Design:

Case series; Level of evidence, 4.

Methods:

Data were retrospectively analyzed for all patients who underwent arthroscopic LT reconstruction with a tibialis anterior allograft between 2014 and 2021. Preoperatively and a minimum of 2 years postoperatively, included patients had completed questionnaires for the following patient-reported outcome (PRO) measures: modified Harris Hip Score (mHHS), Non-Arthritic Hip Score (NAHS), Hip Outcome Score–Sports Specific Subscale (HOS-SSS), 12-item International Hip Outcome Tool (iHOT-12) score, visual analog scale (VAS) for pain score, and patient satisfaction score; or they had a documented endpoint within the study’s time frame. The minimal clinically important difference (MCID) was calculated for the mentioned PROs and included in the analysis. Survivorship was also evaluated and included in the analysis.

Results:

A total of 22 patients were included in the study. Significant improvement was shown in mHHS, NAHS, HOS-SSS, iHOT-12 score, and VAS pain score. A high patient satisfaction score was also observed at the latest follow-up. Furthermore, a high percentage of patients reached the calculated MCID for the mHHS, NAHS, HOS-SSS, and VAS score. Patients demonstrated 95.5% survivorship.

Conclusion:

Arthroscopic LT reconstruction with a tibialis anterior allograft, concomitant with labral repairs and osteoplasties for femoroacetabular impingement, has shown favorable outcomes, high patient satisfaction rates, and a high percentage of patients reaching clinically important thresholds, with a low rate of complications and total hip arthroplasty conversion at a minimum 2-year follow-up. Furthermore, the choice of a graft rests in the hands of the surgeon based on training, familiarity, circumstances, and resources, as the optimal graft option has yet to be elucidated.