Tears of the Ligamentum Teres: Prevalence in Hip Arthroscopy Using Two Classification Systems

TitleTears of the Ligamentum Teres: Prevalence in Hip Arthroscopy Using Two Classification Systems
Publication TypeConference Paper
Year of Publication2011
AuthorsMartin DE, Botser I B, Stout CE, Domb BG
Conference NameInternational Society of Hip Arthroscopy (ISHA)
Date Published10/2011
Conference LocationParis, France
Abstract

Summary: This study presents the prevalence of ligmantum teres tears on 558 hip arthroscopy cases. Two classification systems were used the Gray and Villar and a new descriptive classification. Prevalence of 51% ligamentun tears was found in the cohort. Magnetic resonance was found to be inaccurate for the diagnosis of ligamentum tears.

Introduction:

While several studies have suggested that tears of the ligamentum teres may generate hip pain, and may be successfully treated arthroscopically, the prevalence of such tears has not been established. The purpose of this study was to report the prevalence of ligamentum tears in a population of patients who underwent hip arthroscopy, using both the Gray and Villar classification and new descriptive classification.

Methods:

After excluding revision surgeries, a total of 558 surgeries (502 patients) were included during the study period Between February 2008 and January 2011. Data were prospectively collected regarding patients’ demographics, mechanism of injury, range of motion, magnetic resonance arthrogram (MRA) results, and intra-operative findings. All patients completed the modified Harris hip score (mHHS), non-arthritic hip score (NAHS), hip outcome score sport specific subscale (HOS SSS) and activities of daily living (HOS ADL), and visual analog pain score (VAS), preoperatively. Ligamentum tears were classified according to Gray and Villar’s classification(1), and were also categorized using a descriptive grading system as: 0) no tear; I) low-grade tear involving <50% of ligament; II) high-grade tear involving >50% of ligament; or III) 100% tear.

Results:

A total of 284 (51%) LT tears were found in the cohort. By the descriptive classification, 122 (22%) patients had grade I tears, 134 (24%) had grade II tears, and 28 (5%) had grade III tears. According to the Gray and Villar classification, 21 patients had a full rupture, 238 had a partial tear, and 25 had a degenerative tear. The average age of patients with ligamentum tears was higher (42.31 years) than patients without tears (36.17 years) (p<0.00001). Preoperatively, patients with tears had lower NAHS, HOS SSS, and ADL scores (p<0.05 for all 3 scores), but had larger range of motion in flexion and internal rotation (p= 0.02 and 0.06, respectively). Labral tear size significantly increased with increasing descriptive grade of ligamentum tear (p < 0.05). Hips with grade 4 acetabular chondral lesions were 3.6 times more likely to have a high-grade partial thickness ligamentum tear than patients without chondral lesions. Pre-operative MRA had a very low sensitivity of 1.8% for detecting tears of the ligamentum. No correlation was found between ligamentum tears and gender, BMI, flexion, abduction, pain level, or pre-operative duration of symptoms,.

Conclusions:

To our knowledge, this study is the largest report of prevalence of ligamentum tears to date. The incidence was defined using the Gray and Villar classification, as well as a new descriptive grading system which categorizes the ligamentum according to the amount of tearing. A higher prevalence of tears was found than in previous studies, most likely due to our inclusion of low-grade partial thickness tears using the descriptive grading system. Despite the high prevalence of ligamentum teres tears shown in this series, further research is needed to define their clinical relevance and recommended treatment.

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