Arthroscopic ligamentum teres reconstruction using semitendinosus tendon: surgical technique and an unusual outcome

Abstract

Although the exact biomechanical function of the ligamentum teres (LT) remains unclear, an important role in hip stability has been suggested. In some patients, perhaps because of their specific anatomy or physical activity, it seems to have a major function as a hip stabilizer. Therefore, after a complete LT tear, this group of patients may have persistent hip pain and mechanical symptoms probably related to microinstability and subtle subluxation. We present the case of a female patient with a complete LT tear. This had been treated by debridement and anterior capsule tightening, followed by prolonged rehabilitation. However, she had persistent symptoms. An LT reconstruction with a novel surgical technique was performed. The LT was reconstructed with double-stranded semitendinosus graft. The acetabular end was fixed with 2 anchors, and the femoral end was passed into a bone tunnel and fixed with an interference screw. After surgery, the patient's modified Harris Hip Score and Non-Arthritic Hip Score improved from 53 and 73 to 100 and 95, respectively, at 12 months of follow-up. At repeat arthroscopy 15 months after surgery, it was observed that the graft had resorbed, although the 2 Ticron stitches (Covidien, Mansfield, MA) remained firmly attached and were still acting as a small synthetic ligament.

Figure 1

Lateral decubitus position for hip arthroscopy with McCarthy lateral hip distractor.

Figure 2

Anchors inserted in previously prepared acetabular fossa (left side with patient in lateral decubitus position, viewed from midtrochanteric portal).

Figure 3

Femoral tunnel drilled.

Figure 4

Semitendinosus double-stranded graft with 1 strand of each anchor stitch passed through looped end.

Figure 5

Graft in situ before tensioning (left side with patient in lateral decubitus position, viewed from midtrochanteric portal).

Figure 6

Modifications of original technique to improve debridement of acetabular fossa and to achieve better graft fixation (right side with patient in lateral decubitus position, viewed from midtrochanteric portal). (A) Debridement of posterior zone of acetabular fossa through posterior paratrochanteric portal. (B) Anchors inserted in posterior zone of acetabular fossa through femoral tunnel. (C) Final appearance of the semitendinosus graft after use of aforementioned modifications to original surgical technique.

Figure 7

Graft resorption and intact sutures and anchors at second-look arthroscopy (left side with patient in lateral decubitus position, viewed from midtrochanteric portal).