The hip joint is a ball and socket joint which is made up of the thigh bone (femur) which forms the ball (femoral head) and pelvic bone which forms the socket (acetabulum). The hip is a very stable joint and is surrounded by very strong muscles and ligaments.
The ligamentum teres is a ligament which is within the hip joint and attaches from the middle of the femoral head to the middle of the acetabulum. In spite of what might seem like an obvious role in keeping the hip stable, the absolute role of the ligamentum teres in providing hip stability is unclear. This ligament may also play a role in supplying blood to the femoral head, but again the importance of this remains unclear.
What has been found however is that damage to the ligamentum teres can cause hip pain. Tears of the ligamentum teres are commonly found with other problems in the hip such as femoroacetabular impingement (FAI) and labral tears. It is a common condition found in dancers and gymnasts.
It can be difficult to diagnose a ligamentum teres tears, as MRI scans are currently not accurate enough to reliably diagnose it. Fortunately, these tears can easily be diagnosed and treated by hip arthroscopy.
What are the symptoms of a ligamentum teres tear?
If you have a ligamentum teres tear, you will have discomfort in your groin which may radiate to the inner thigh. Initially, the pain may only be felt whilst playing sport, especially if you are involved in dancing or gymnastics. There may be symptoms such as painful clicking of the hip, locking or giving way of the hip.
With time, you may feel pain with any movement that brings your knees towards your chest, such as:
- sitting in low chairs
- getting up from chairs
- driving
- putting on your socks and shoes
- picking things off the ground
- climbing stairs
If you are involved in gymnastics or dancing, you will not be able to perform your usual hip movements and you may feel that your hip is unstable.
Causes
The ligamentum teres may be torn either all the way through (complete), or only part of the way through (partial). This can be due to trauma or associated with structural problems with the hip.
Trauma
Any uncontrolled movement that puts the hip into a position where the ligamentum teres is stretched to it’s limit may lead to a tear or rupture of the ligament. Examples include:
- a fall on the knee, especially if the hip is partially bent
- slipping such that the leg goes to the side
- hip dislocation: if your have been in a severe accident in which you dislocated your hip, then your ligamentum teres may be torn
- sports and activities: dancers and gymnasts are at risk of developing tears due to the hip flexibility required in these activities.
Structural problems
- Femoroacetabular Impingement (FAI): tears of the ligamentum teres are very common in patients with FAI.
- Osteoarthritis: wear and tear of the hip joint can lead to tears in the ligamentum teres
What are the risk factors for developing tears of the ligamentum teres?
The following are risk factors for developing a ligamentum teres tear:
Femoroacetabular impingement (FAI):
Femoroacetabular impingement is highly associated with ligamentum teres tears. It is not uncommon to need to treat both problems during a hip arthroscopy.
Osteoarthritis:
Wear and tear of the hip leads to an increased risk of developing a ligamentum teres tear.
Dancers and Gymnasts: Due to the flexibility and movements needed for dancing and gymnastics, tears can occur in these activities.
Investigations
There are currently no investigations that can accurately diagnose ligamentum teres tears.
A ligamentum teres tears is often diagnosed on your symptoms and examination.
Often the Xray, Ct scan and MRI do not show a tear.
An injection of local anesthetic and corticosteroid into the hip joint can be helpful. If the injection relieves your pain, then it is very likely that your pain is coming from your hip joint.
A hip arthroscopy is the best way to diagnose and treat a ligamentum teres tear.
Complications
Ligamentum teres tears are associated with inflammation of your hip joint.
This inflammation causes increasing pain with hip movement, sitting and even sleeping on your side.
People with ligamentum teres tears also have synovitis / inflammation of other parts of your hip joint, such as the capsule. The capsule is the envelope of tissue that surrounds your hip joint. This is a painful condition.
Treatment
Ligamentum Teres tears are treated with arthroscopic surgery. This involves making small incisions (1- 2cm) in usually three places around the hip and then inserting small instruments and a small camera into the hip joint.
Ligamentum teres tears are usually treated with a special device called a radio-frequency ablator. It’s a device that helps remove the inflamed torn tissue and stabilises the torn ligament.
Usually the ligament is not repaired. At this stage, due to the lack of evidence for the role of ligamentum teres in hip stability, repair is not thought to be warranted.
Seeking Advice
Your Family Doctor (GP)
Your Family Doctor will be able to diagnose and help treat your problem. He or she will be able to
- tell you about your problem
- advise you of the best treatment methods
- prescribe you medications
- and if necessary, refer you to Specialists (Consultants) for further treatment
Sports Physician
Is a doctor who specialises in sports injuries. A Sports physician is well trained to diagnose the tear and help you though your treatment before and after your surgery.
Physiotherapist
The physiotherapy for ligamentum teres tears is highly specialised and requires extra training. Standard hip exercises can actually make the pain worse and delay your recovery. A well trained physiotherapist can show you which exercises to perform, and which not to perform.
Orthopaedic Surgeon
An orthopaedic surgeon trained in hip arthroscopy will be able to treat your tear. As hip arthroscopy is a specialised technique, your orthopaedic surgeon may need to refer you to a surgeon who has been trained in the technique.
Prevention
Ligamentum teres tears are associated with femoroacetabular impingement. If you have femoroacetabular impingement, hip arthroscopy may help prevent tears of your ligamentum teres.
Unfortunately, there is no definite way to prevent the tears from other causes, but avoiding hip movements that stretch the hip to its end range may help to prevent tearing the ligament.