Traumatic rupture of the ligamentum teres as a source of hip pain

PURPOSE: Lesions of the ligamentum teres have only occasionally been reported in the literature. However, with arthroscopy, pathology of the ligamentum teres has been increasingly recognized. The purpose of this article is to report the clinical characteristics associated with rupture of the ligamentum teres and the results of arthroscopic treatment. TYPE OF STUDY: Case series study. METHODS: All patients undergoing hip arthroscopy have been prospectively assessed using a modified Harris Hip score (100 point maximum) obtained preoperatively and postoperatively at 3, 12, 24, and 60 months. In this study, 271 cases had at least 1 year of follow-up evaluation. From this population, 41 patients were identified with lesions of the ligamentum teres. Twenty-three of these were traumatic in origin and represent the substance of this study. The remainder (18) were hypertrophic or degenerative. RESULTS: We noted 100% follow-up at an average of 29.2 months. Patients included 14 women and 9 men with an average age of 28.3 years. Duration of symptoms before surgery averaged 28.5 months. All patients experienced deep anterior groin pain. Nineteen patients experienced mechanical symptoms (catching, popping, locking, giving way), and 4 patients described simply pain with activities. Fifteen patients sustained major trauma (7 motor vehicle accidents, 3 falls from a height, 3 football, 1 snow skiing, 1 ice hockey), including 6 dislocations. The remaining 8 patients sustained a twisting injury. Evaluation included 20 magnetic resonance imaging (MRI) scans, 7 MR arthrograms, 7 computed tomography (CT) scans, and 3 bone scans. The diagnosis of a lesion of the ligamentum teres was made preoperatively in only 2 cases. Rupture of the ligament was complete in 12 cases and partial in 11. Ligament injury was an isolated finding in 8 cases, and associated pathology was found in 15 cases (9 labral tears, 5 loose bodies, 5 chondral damage). The average preoperative score was 47, and postoperative score was 90. No statistical difference was seen based on type of injury, complete versus partial rupture, or presence of coexistent pathology. CONCLUSIONS: Rupture of the ligamentum teres is increasingly recognized as a source of persistent hip pain. The diagnosis remains elusive to various imaging techniques. An index of suspicion should be maintained, especially in the presence of mechanical symptoms and a history of significant trauma. However, rupture may occur simply from a twisting injury in absence of major trauma. These lesions can be diagnosed using arthroscopy and, based on these results, may respond remarkably well to arthroscopic debridement. LEVEL OF EVIDENCE: Level IV.