The role of the iliofemoral ligament as a stabilizer of the hip joint

Abstract

The purpose of this systematic literature review is to analyse the role of the iliofemoral ligament (ILFL) as a hip joint stabilizer in the current literature.A total of 26 articles were included in the review. The ILFL is the largest hip ligament consisting of two distinct arms and is highly variable, both in its location and overall size, and plays a primary role in hip stability; in the case of hip dislocation, the iliofemoral ligament tear does not heal, resulting in a persistent anterior capsule defect. Clinically, the ILFL is felt to limit external rotation in flexion and both internal and external rotation in extension.The abduction-hyperextension-external rotation (AB-HEER) test is overall the most accurate test to detect ILFL lesions. Injuries of the ILFL could be iatrogenic or a consequence of traumatic hip instability, and can be accurately studied with magnetic resonance imaging. Different arthroscopic and open techniques have been described in order to preserve the ILFL during surgery and, in case of lesions, several procedures with good to excellent results have been reported in the existing literature.The current systematic review, focusing only on the ILFL of the hip, summarizes the existing knowledge on anatomy, imaging and function and contributes to the further understanding of the ILFL, confirming its key role in anterior hip stability. Future studies will have to develop clinical tests to evaluate the functionality and stability of the ILFL. Cite this article: EFORT Open Rev 2021;6:545-555. DOI: 10.1302/2058-5241.6.200112.

Keywords: biomechanics; hip capsule; hip joints; iliofemoral ligament; stabilizer.

Fig. 1

A flowchart of the literature screening performed in this study.

Fig. 2

Anteroposterior view of the hip showing ligamentous structures.

Fig. 3

Lateral view of the hip showing capsular hip ligaments.

Fig. 4

Extra-articular view from the anterolateral portal. *Iliofemoral ligament.

Fig. 5

MRI arthrography. Oblique axial T1-weighted  fat-suppressed image showing the iliofemoral ligament (white arrows) as a thick band lying anteriorly to the capsule. Note. MRI, magnetic resonance imaging.

Fig. 6

MRI arthrography. Oblique sagittal proton density image showing the iliofemoral ligament (white arrows) as a band lying anteriorly to the capsule. Note. MRI, magnetic resonance imaging.