Disruption Of The Ligamentum Teres

The exact function of the ligamentum teres remains an enigma. Although its accompanying artery contributes to the vascularity of the epiphysis in childhood, its importance in the adult is less clear. The vessel remains patent in a variable percentage of adults and likely does little to contribute to the vascularity of the femoral head.38,39 The ligament contributes little to the stability of the joint, but it has been proposed that it has a windshield wiper effect that may facilitate lubrication and nutrition of the joint sur-faces.40 It may well have proprioceptive and nocio-ceptive importance as well.

Lesions of the ligamentum teres have been rare enough to be published only as isolated case re-ports.41-44 These are normally associated with major trauma such as dislocation of the joint. These lesions went unmentioned in the arthroscopic literature before Villar's classification system (partial, complete, and degenerative ruptures) published in 1997.40 In our series of athletes, we found disruption of the liga-mentum teres to be the third most common finding, and these individuals responded remarkably well to arthroscopic debridement with results comparable with loose body removal.45 More recently, we reported our overall experience in traumatic ruptures of the lig-amentum teres.46 Only 8% of these ligament tears were diagnosed on preoperative studies. However, our ability to recognize these lesions will undoubtedly improve as we have become more aware of their existence.

Disruption is expected in association with a dislocation of the hip but, more commonly, we have found the ligament to tear from a twisting injury. Among 24 cases, 40% were isolated lesions, whereas 60% had other associated pathology. Regardless of associated pathology, the results were remarkably good, with an average 43-point improvement and 96% demonstrating more than 20 points of improvement. Degenerative rupture of the ligament may coexist with de-

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