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Ligamentum teres lesions are associated with compositional and structural hip cartilage degenerative change:
Zehra Akkaya1,2, Paula J Giesler3,4, Koren E Roach5,6
1Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA, USA. zehraakkaya@gmail.com.
Insights
Magnetic resonance imaging (MRI) of the ligamentum teres (LT) can reveal lesions (LTL) associated with hip osteoarthritis. Abnormal LT findings on MRI correlate with more severe hip degeneration and cartilage composition changes.
Area of Science:
- Orthopedic imaging
- Biomedical engineering
- Radiology
Background:
- The ligamentum teres (LT) is a intra-articular structure in the hip joint.
- Lesions of the LT (LTL) are increasingly identified on MRI, but their clinical significance and association with hip degeneration are not fully understood.
Purpose of the Study:
- To investigate the association between MRI-based ligamentum teres lesions (LTL) and structural hip degeneration.
- To correlate LTL severity with osteoarthritis biomarkers and cartilage composition changes.
Main Methods:
- Bilateral 3-T hip MRIs were obtained from 93 participants.
- A novel MRI-based LTL scoring system (0-4) was developed.
- Relationships between LTL scores, hip osteoarthritis MRI scores (SHOMRI), cartilage T1ρ/T2 values, and morphological features were analyzed using regression models.
Main Results:
- Complete tears (MRI-LT score=4) were associated with significantly worse subchondral bony degenerative changes (SHOMRI-BML, SHOMRI-sc) (p<0.001, p=0.015).
- Abnormal LTL scores correlated with increased global acetabular T1ρ and femoral T2 values (p=0.005-0.032), with regional differences observed.
- Pulvinar effusion-synovitis, shallow fovea, and foveal osteophytes were significantly associated with abnormal LT findings (p<0.001-0.044).
Conclusions:
- MRI-identified LTL are associated with more severe hip osteoarthritis and altered cartilage composition.
- Specific morphological abnormalities, including pulvinar effusion-synovitis and foveal changes, are linked to LTL.
- These findings highlight the clinical relevance of LTL in assessing hip degeneration.
Objectives:
To investigate the association between magnetic resonance imaging (MRI)-based ligamentum teres lesions (LTL) and structural hip degeneration.
Methods:
Bilateral 3-T hip MRIs of participants (n = 93 [36 men]; mean age ( ± SD) 51 years ± 15.4) recruited from the community and the orthopedic clinic of a single medical center were included. Clinical and imaging data acquired included hip disability and osteoarthritis outcome scores, semi-quantitative scoring of hip osteoarthritis on MRI (SHOMRI) scores on fluid-sensitive sequences, and cartilage T1ρ/T2 compositional sequences. An MRI-based LTL scoring system, incorporating continuity, thickening, and signal intensity, ranging from 0 (normal) to 4 (complete tear) was constructed. Hip morphological features associated with LTL, based on functional or anatomical relationships to LT, were defined. Relationships between MRI-LT scores and SHOMRI, global/regional cartilage T1ρ/T2, and proposed morphological abnormalities and LTL were explored by mixed effects linear and logistic regression models.
Results:
In 82 (46.1%) hips, no pain was documented; 118 (63.4%) and 68 (36.6%) hips were graded as KL-grade ≤ 1 and ≥ 2, respectively. Compared to MRI-LT score = 0 (normal), score = 4 (complete tear) revealed significantly worse subchondral bony degenerative changes for bone marrow lesions (SHOMRI-BML) and subchondral cysts (SHOMRI-sc) (p < 0.001, p = 0.015, respectively). Global acetabular T1ρ, femoral T2 were significantly increased for abnormal MRI-LT scores (p-range = 0.005-0.032). Regional analyses revealed significantly increased T1ρ/T2 in central acetabular/increased T2 in off-central femoral regions (p-range = 0.005-0.046). Pulvinar effusion-synovitis, shallow fovea, and foveal osteophytes were significantly associated with abnormal LT MRI findings (p-range = < 0.001-0.044).
Conclusion:
MRI abnormalities of LT are associated with worse SHOMRI-sc/BML scores, indicative of hip osteoarthritis and higher T1ρ and T2 that differ by region. Pulvinar effusion-synovitis and changes in femoral head morphology are associated with LTL.
Clinical Relevance Statement:
Abnormal ligamentum teres findings identified via MRI are associated with structural degenerative changes of the hip joint and alterations in acetabular and femoral cartilage compositions show spatial differences in relation to LTL.
Key Points:
The clinical significance of common ligamentum teres lesions (LTL) on MRI is not well understood. LTL identified by an MRI-based scoring system is associated with worse biomarkers, indicating more advanced degenerative hip changes. Effusion-synovitis signal at pulvinar, shallow fovea capitis, and foveal osteophytes are associated with LTL on imaging.
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