Patent Ligament Teres
FIGURE 8.19. Ligamentum teres, partial rupture. (From Gray and Villar,29 with permission of Villar.)

In a retrospective arthroscopic review of ligamen-tum teres rupture, Gray and Villar29 identified 20 patients with ligamentum pathology. Three groups of patients were distinguished. Group 1 in their study included 7 patients with complete ligamentum teres rupture (Figure 8.18). In 4, the cause was fracture dislocation, in 2 previous closed reductions of CDH and in 1 a serious twisting injury of the hip. In two cases, at arthroscopy, an osteochondral fragment attached to the disrupted ligament was found. Group 2 included eight cases with partial rupture of the ligament (Figure 8.19). No specific injuries were identified in the previous history of these patents. A long (2 to 12 years) history of hip discomfort, pain, and aching, with occasional clicking, was the justification for arthroscopic surgery. In group 3 (5 cases), a degenerate, frayed ligament, combined with generalized degenerative changes, was identified (Figure 8.20). Arthroscopic de-

Degeneration The Ligamentum Teres
FIGURE 8.20. Ligamentum teres, degenerative, frayed. (From Gray and Villar,29 with permission of Villar.)

bridement gave unpredictable results in their series. However, the best outcome was obtained in group 1 and, to a lesser extent, in group 3. This is the first series of ligamentum teres injuries reported in the literature. However, other pathologic conditions could be related to ligamentum teres problems.

It is a common finding for the arthroscopic surgeon, after acute dislocation of the hip, that a much wider opening of the joint is possible with mild distraction. This event could perhaps be a warning sign of joint instability and may herald subsequent osteoarthritis.

Fitzgerald15 reported acute intraarticular hemorrhage of the ligamentum teres as a clinical entity. He suggests that this event must be considered when discussing the differential diagnosis of labral tears. Both conditions can cause what he describes as "mechanical pain" of the hip. We have not arthroscopically identified this entity as a primary cause of hip pain.

Undoubtedly, much still needs to be learned about the importance and incidence of these ligamentum teres lesions. An increased knowledge of both liga-mentum function and treatment of damage to it promises to advance the management and understanding of hip pathology.

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