Gavin Blair Gore MD, Presenter: Nothing to Disclose

Scott David Wuertzer MD, MS, Abstract Co-Author: Nothing to Disclose

Laura Raffield BS, Abstract Co-Author: Nothing to Disclose

Elizabeth A. Howse, Abstract Co-Author: Nothing to Disclose

Allston J. Stubbs, Abstract Co-Author: Nothing to Disclose

Leon Lenchik MD, Abstract Co-Author: Nothing to Disclose

In patients with femoroacetabular impingement (FAI), partial tears of the ligamentum teres are common and may contribute to the hip joint microinstability. The purpose of this study was to determine if the radiographic findings of acetabular over-coverage or early osteoarthritis are associated with arthroscopically proven partial tears of the ligamentum teres (LT). 

243 patients undergoing hip arthroscopy for FAI had radiographic evaluation with supine anteroposterior views of the pelvis as well as frog-lateral, cross-table lateral, and false-profile views of the symptomatic hips. Measurements of the lateral center-edge, anterior center-edge, and Sharp’s angles were performed. Evaluation of acetabular overcoverage using the cross over sign, the posterior wall sign, coxa profunda, and acetabular protrusio was performed. Evaluation of osteoarthritis using the Tonnis grade, hammock sign (posteromedial sclerosis), saber-tooth sign (cotyloid osteophyte), and sea-gull sign (remodeling of superolateral acetabulum) was performed. Univariate and age-adjusted analyses were used to evaluate the association between radiographic findings and LT tears.

74 men and 169 women, ranging in age from 12 to 68 with a mean age of 34 years, were included in the study. 163 had partial LT tears and 80 had normal LTs. Partial LT tears were significantly more common in younger patients (p=0.008). In the partial tear group, mean lateral center-edge was 30, anterior center-edge was 32, and Sharp’s angle was 41. In the normal group, mean lateral center-edge was 32, anterior center-edge was 33, and Sharp’s angle was 39. In women with partial tears, there was a trend toward a decreased lateral center-edge angle (p=0.053) and a trend toward a decreased anterior center-edge (p=0.057). After age-adjustment in women, there was also a trend toward decreased profunda (p=0.064). The remaining radiographic signs showed no significant association with partial LT tears.

There is no significant association between radiographic findings of acetabular over-coverage or early osteoarthritis and arthroscopically proven partial tears of the ligamentum teres.

Although ligamentum teres are common and contribute to hip pain, little is known about what radiographic or clinical findings predispose patients to them.

Gore, G, Wuertzer, S, Raffield, L, Howse, E, Stubbs, A, Lenchik, L, Radiographic Correlates of Arthroscopically Proven Partial Tears of the Ligamentum Teres in Patients with Femoroacetabular Impingement .  Radiological Society of North America 2014 Scientific Assembly and Annual Meeting, - ,Chicago IL. http://archive.rsna.org/2014/14011205.html