Arthroscopic treatment in patients with femoroacetabular impingement combined with ligamentum teres injury_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

HAN Siyu , LI Song , JIA Di , LI Yanlin ,  CAI Guofeng

Department of Sports Medicine, the First Affiliated Hospital of Kunming Medical University, Kunming Yunnan, 650031, P. R. China;

Corresponding author：

CAI Guofeng, Email: 34763623@qq.com

Keywords：

Hip arthroscopy; femoroacetabular impingement; ligamentum teres injury

DOI：

10.7507/1002-1892.202508055

Video：

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Objective To investigate the effectiveness of hip arthroscopy in the treatment of patients with femoroacetabular impingement (FAI) combined with ligamentum teres injury. Methods A retrospective analysis was conducted on 23 patients (23 hips) with Cam-type FAI combined with ligamentum teres injury who met the selection criteria between April 2022 and May 2024. The cohort included 12 males and 11 females, with a mean age of 29.16 years (range, 16-57 years). According to Tönnis classification, there were 5 cases of grade 0, 10 cases of grade Ⅰ, and 8 cases of grade Ⅱ in hip osteoarthritis The disease duration ranged from 6 to 24 months, with an average of 12 months. Under hip arthroscopy, hypertrophic synovium and the damaged ligamentum teres were debrided, while the torn labrum and cartilage were repaired, and femoral head-neck osteoplasty was performed to eliminate impingement, restore the normal morphology of the acetabulum and femoral head-neck, and suture the joint capsule.Acetabular lateral center-edge angle (LCEA) and α angle (reflecting the degree of non-sphericity at the femoral head-neck junction) were measured before and after operation, and the modified Harris hip score (mHHS), the International Hip Outcome Tool-12 (IHOT-12), and the visual analogue scale (VAS) score for pain were evaluated. Results The operation was successfully completed in all patients. The incisions healed by first intention after operation, and there were no perioperative complications such as iatrogenic cartilage injury, fracture, infection, neurovascular traction injury, and lower extremity venous thrombosis. All the 23 patients were followed up 12-24 months, with an average of 14.6 months. The pain of hip joint was significantly relieved, and the function of hip joint was improved; no complication such as joint stiffness, joint instability, and osteonecrosis of the femoral head occurred. The α angle, VAS score, mHHS score, and iHOT-12 score were significantly better than those before operation at last follow-up (P<0.05). Conclusion Hip arthroscopy is a safe and effective treatment for patients with FAI combined with ligamentum teres injury, which can achieve satisfactory effectiveness.

1.	Ganz R, Parvizi J, Beck M, et al. Femoroacetabular impingement: a cause for osteoarthritis of the hip. Clin Orthop Relat Res, 2003(417): 112-120.
2.	Lameire DL, Pathak A, Hu SY, et al. The impact of hip arthroscopy on the progression of hip osteoarthritis in patients with femoroacetabular impingement syndrome: A systematic review and meta-analysis. Orthop J Sports Med, 2025, 13(4): 23259671251326116. doi: 10.1177/23259671251326116.
3.	Trigg SD, Schroeder JD, Hulsopple C. Femoroacetabular Impingement Syndrome. Curr Sports Med Rep, 2020, 19(9): 360-366.
4.	Annin S, Lall AC, Yelton MJ, et al. Patient-reported outcomes in athletes following hip arthroscopy for femoroacetabular impingement with subanalysis on return to sport and performance level: A systematic review. Arthroscopy, 2021, 37(8): 2657-2676.
5.	Cerezal L, Kassarjian A, Canga A, et al. Anatomy, biomechanics, imaging, and management of ligamentum teres injuries. Radiographics, 2010, 30(6): 1637-1651.
6.	Bardakos NV, Villar RN. The ligamentum teres of the adult hip. J Bone Joint Surg (Br), 2009, 91(1): 8-15.
7.	Rao J, Zhou YX, Villar RN. Injury to the ligamentum teres. Mechanism, findings, and results of treatment. Clin Sports Med, 2001, 20(4): 791-799.
8.	Martin HD, Hatem MA, Kivlan BR, et al. Function of the ligamentum teres in limiting hip rotation: a cadaveric study. Arthroscopy, 2014, 30(9): 1085-1091.
9.	Wenger D, Miyanji F, Mahar A, et al. The mechanical properties of the ligamentum teres: a pilot study to assess its potential for improving stability in children’s hip surgery. J Pediatr Orthop, 2007, 27(4): 408-410.
10.	Griffin DR, Dickenson EJ, O’Donnell J, et al. The Warwick Agreement on femoroacetabular impingement syndrome (FAI syndrome): an international consensus statement. Br J Sports Med, 2016, 50(19): 1169-1176.
11.	Devitt BM, Philippon MJ, Goljan P, et al. Preoperative diagnosis of pathologic conditions of the ligamentum teres: is MRI a valuable imaging modality? Arthroscopy, 2014, 30(5): 568-574.
12.	Gray AJ, Villar RN. The ligamentum teres of the hip: an arthroscopic classification of its pathology. Arthroscopy, 1997, 13(5): 575-578.
13.	黄洪杰, 孙昊, 蒋艳芳, 等. 青少年凸轮型髋关节撞击综合征诊治专家共识. 中国微创外科杂志, 2022, 22(10): 769-778.
14.	Leunig M, Beck M, Stauffer E, et al. Free nerve endings in the ligamentum capitis femoris. Acta Orthop Scand, 2000, 71(5): 452-454.
15.	Ganz R, Gill TJ, Gautier E, et al. 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): 1119-1124.
16.	吴子煜, 韩小涛, 李皓桓. 髋关节圆韧带损伤的诊断与治疗进展. 武汉大学学报 (医学版), 2025, 46(2): 272-276.
17.	Lee JK, Hwang DS, Kim SB, et al. The role and clinical relevance of the ligamentum teres: long-term outcomes after hip arthroscopic surgery of cam-type femoroacetabular impingement. J Hip Preserv Surg, 2021, 8(4): 360-366.
18.	Migliorini F, Cocconi F, Bardazzi T, et al. The ligamentum teres and its role in hip arthroscopy for femoroacetabular impingement: a systematic review. J Orthop Traumatol, 2024, 25(1): 68. doi: 10.1186/s10195-024-00810-1.
19.	Maldonado DR, Laseter JR, Perets I, et al. The effect of complete tearing of the ligamentum teres in patients undergoing primary hip arthroscopy for femoroacetabular impingement and labral tears: A match-controlled study. Arthroscopy, 2019, 35(1): 80-88.
20.	Ajabnoor RM, Quinzi DA, Carmody E, et al. Intraligamentous synovial osteochondroma of the ligamentum teres: a series of 14 cases. Int J Clin Exp Pathol, 2022, 15(7): 282-288.
21.	Chahla J, Soares EA, Devitt BM, et al. Ligamentum teres tears and femoroacetabular impingement: Prevalence and preoperative findings. Arthroscopy, 2016, 32(7): 1293-1297.
22.	Larson CM. Editorial commentary: Ligamentum teres tears and femoroacetabular impingement: Complex coexistence of impingement and instability. Arthroscopy, 2016, 32(7): 1298-1299.
23.	Krych AJ, Thompson M, Larson CM, et al. Is posterior hip instability associated with cam and pincer deformity? Clin Orthop Relat Res, 2012, 470(12): 3390-3397.
24.	Domb BG, Martin DE, Botser IB. Risk factors for ligamentum teres tears. Arthroscopy, 2013, 29(1): 64-73.

1. Ganz R, Parvizi J, Beck M, et al. Femoroacetabular impingement: a cause for osteoarthritis of the hip. Clin Orthop Relat Res, 2003(417): 112-120.
2. Lameire DL, Pathak A, Hu SY, et al. The impact of hip arthroscopy on the progression of hip osteoarthritis in patients with femoroacetabular impingement syndrome: A systematic review and meta-analysis. Orthop J Sports Med, 2025, 13(4): 23259671251326116. doi: 10.1177/23259671251326116.
3. Trigg SD, Schroeder JD, Hulsopple C. Femoroacetabular Impingement Syndrome. Curr Sports Med Rep, 2020, 19(9): 360-366.
4. Annin S, Lall AC, Yelton MJ, et al. Patient-reported outcomes in athletes following hip arthroscopy for femoroacetabular impingement with subanalysis on return to sport and performance level: A systematic review. Arthroscopy, 2021, 37(8): 2657-2676.
5. Cerezal L, Kassarjian A, Canga A, et al. Anatomy, biomechanics, imaging, and management of ligamentum teres injuries. Radiographics, 2010, 30(6): 1637-1651.
6. Bardakos NV, Villar RN. The ligamentum teres of the adult hip. J Bone Joint Surg (Br), 2009, 91(1): 8-15.
7. Rao J, Zhou YX, Villar RN. Injury to the ligamentum teres. Mechanism, findings, and results of treatment. Clin Sports Med, 2001, 20(4): 791-799.
8. Martin HD, Hatem MA, Kivlan BR, et al. Function of the ligamentum teres in limiting hip rotation: a cadaveric study. Arthroscopy, 2014, 30(9): 1085-1091.
9. Wenger D, Miyanji F, Mahar A, et al. The mechanical properties of the ligamentum teres: a pilot study to assess its potential for improving stability in children’s hip surgery. J Pediatr Orthop, 2007, 27(4): 408-410.
10. Griffin DR, Dickenson EJ, O’Donnell J, et al. The Warwick Agreement on femoroacetabular impingement syndrome (FAI syndrome): an international consensus statement. Br J Sports Med, 2016, 50(19): 1169-1176.
11. Devitt BM, Philippon MJ, Goljan P, et al. Preoperative diagnosis of pathologic conditions of the ligamentum teres: is MRI a valuable imaging modality? Arthroscopy, 2014, 30(5): 568-574.
12. Gray AJ, Villar RN. The ligamentum teres of the hip: an arthroscopic classification of its pathology. Arthroscopy, 1997, 13(5): 575-578.
13. 黄洪杰, 孙昊, 蒋艳芳, 等. 青少年凸轮型髋关节撞击综合征诊治专家共识. 中国微创外科杂志, 2022, 22(10): 769-778.
14. Leunig M, Beck M, Stauffer E, et al. Free nerve endings in the ligamentum capitis femoris. Acta Orthop Scand, 2000, 71(5): 452-454.
15. Ganz R, Gill TJ, Gautier E, et al. 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): 1119-1124.
16. 吴子煜, 韩小涛, 李皓桓. 髋关节圆韧带损伤的诊断与治疗进展. 武汉大学学报 (医学版), 2025, 46(2): 272-276.
17. Lee JK, Hwang DS, Kim SB, et al. The role and clinical relevance of the ligamentum teres: long-term outcomes after hip arthroscopic surgery of cam-type femoroacetabular impingement. J Hip Preserv Surg, 2021, 8(4): 360-366.
18. Migliorini F, Cocconi F, Bardazzi T, et al. The ligamentum teres and its role in hip arthroscopy for femoroacetabular impingement: a systematic review. J Orthop Traumatol, 2024, 25(1): 68. doi: 10.1186/s10195-024-00810-1.
19. Maldonado DR, Laseter JR, Perets I, et al. The effect of complete tearing of the ligamentum teres in patients undergoing primary hip arthroscopy for femoroacetabular impingement and labral tears: A match-controlled study. Arthroscopy, 2019, 35(1): 80-88.
20. Ajabnoor RM, Quinzi DA, Carmody E, et al. Intraligamentous synovial osteochondroma of the ligamentum teres: a series of 14 cases. Int J Clin Exp Pathol, 2022, 15(7): 282-288.
21. Chahla J, Soares EA, Devitt BM, et al. Ligamentum teres tears and femoroacetabular impingement: Prevalence and preoperative findings. Arthroscopy, 2016, 32(7): 1293-1297.
22. Larson CM. Editorial commentary: Ligamentum teres tears and femoroacetabular impingement: Complex coexistence of impingement and instability. Arthroscopy, 2016, 32(7): 1298-1299.
23. Krych AJ, Thompson M, Larson CM, et al. Is posterior hip instability associated with cam and pincer deformity? Clin Orthop Relat Res, 2012, 470(12): 3390-3397.
24. Domb BG, Martin DE, Botser IB. Risk factors for ligamentum teres tears. Arthroscopy, 2013, 29(1): 64-73.

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