Anatomy, biomechanics, imaging, and management of ligamentum teres injuries

The ligamentum teres has traditionally been viewed as an embryonic remnant with no role in the biomechanics or vascularity of adult hips. However, the ligamentum teres is a strong intraarticular ligament that is anatomically and biochemically similar to the anterior cruciate ligament of the knee. It is composed of two bands that originate from the acetabular transverse ligament and the pubic and ischial margins of the acetabular notch. Among other functions, the ligamentum teres is an important stabilizer of the hip, particularly in adduction, flexion, and external rotation. Abnormalities of the ligamentum teres account for 4%-15% of sports-related injuries and should be considered in the differential diagnosis of patients with hip pain. Lesions of the ligamentum teres include partial or complete traumatic tears, degenerative tears, avulsion fractures of the ligament at its insertion into the fovea capitis femoris, and a congenital absence of the ligament. Magnetic resonance arthrography and computed tomographic arthrography are the preferred modalities for precise preoperative diagnosis of ligamentum teres injuries and may be used to rule out other associated intraarticular injuries. Treatment of these lesions is still evolving; at present, treatment of most injuries is limited to arthroscopic débridement.