Intraosseous 'Synthetic Teretization' in the absence of ligamentum teres: surgical technique and early results

Achieving stable, concentric reduction in high-grade developmental dysplasia of the hip (DDH) remains challenging, particularly in older children or when the ligamentum teres is absent. Our previously described teretization technique enhances stability through intraosseous ligamentum teres ligamentodesis, but cannot be applied directly in such cases. We describe a synthetic variation using a button-suture-button construct to replicate ligamentum teres function and report early outcomes. We conducted a prospective case series of pediatric patients with International Hip Dysplasia Institute classification (IHDI) grade III-IV DDH and intraoperatively confirmed absence of the ligamentum teres. Open reduction with intraosseous femoral tunneling and synthetic teretization was performed, combined with femoral and pelvic osteotomies. The construct was tensioned to maintain concentric reduction without overconstraint. Clinical outcomes included hip stability, range of motion, McKay score, pain, and complications. Radiographic assessment included IHDI and Severin classification, acetabular index, and avascular necrosis. Nine hips in eight female patients, with a median age of 24 months, underwent synthetic teretization. At a median 23-month follow-up, all hips remained stable, painless, and without functional limitation. Eight hips achieved postoperative IHDI type I and one type II. Among patients aged 4 years or older at final follow-up, all hips were Severin grade I. No redislocation, infection, growth arrest, avascular necrosis, or hardware-related complications occurred. McKay scores were excellent in seven hips and good in two. Two hips in one patient developed acetabular graft resorption after Dega osteotomy and were successfully revised. Synthetic teretization is a feasible stabilizing option for DDH when the native ligamentum teres is absent.

Level IV - Therapeutic case series. This study evaluates a novel surgical technique in a series of patients with congenital hip dislocation without a control group.