Paper #52 - ISHA Annual Scientific Meeting 2016

Ligamentum Teres (LT) Rupture: Safety And Efficacy Of Allograft And Synthetic Ligament In LT Reconstruction

Ali S. Bajwa, MBBS,MRCSEd, MSc, MPhil, DSEM, FSEM,FRCS Tr & Orth, London, London UNITED KINGDOM
Richard N. Villar, BSc (Hons), MA, MS, FRCS, London, London UNITED KINGDOM

Villar Bajwa Practice, London & Cambridge, UK, UNITED KINGDOM

The FDA has not cleared the following pharmaceuticals and/or medical device for the use described in this presentation. The following pharmaceuticals and/or medical device are being discussed for an off-label use: Corin, LARS ligament for LT reconstruction

Summary: Ligamentum Teres (LT) reconstruction using allograft or synthetic ligament offers a safe and effective treatment for LT rupture with significant improvement in functional and pain scores.

Introduction: Ligamentum Teres (LT) provide a biomechanical, proprioceptive and nociceptive function. In addition, it appears to provide a role in hip stability resisting external rotation torque. LT reconstruction has been described using autograft, allograft and synthetic ligaments. Autograft is generally considered the gold-standard in ligament reconstruction. Aim of the study was to prospectively evaluate safety and efficacy of LT reconstruction using allograft and synthetic ligaments.

Materials and methods: Patients undergoing hip arthroscopy with complete rupture of LT (Villar and Gray Grade-1, Descriptive classification Grade-3) that under went LT reconstruction using allograft or synthetic ligament with a minimum follow-up of 2 years were included in the study. Patients with degenerate tear, Tonnis grade 2-3 osteoarthritis and Pincer deformity were excluded. The hip arthroscopic intervention was carried out in direct lateral position under general anaesthesia. The LT reconstruction was performed using a dedicated aiming jig and 7-8mm allograft or synthetic ligament (LARS, Corin, UK) with optimal tensioning. Data were collected pre and per-operatively, and at 6,12,26,52 weeks post-operatively and yearly thereafter. Collected data included radiographic and MRI features, associated hip injuries, Beighton score, modified Harris Hip Score (mHHS), Non-Arthritic Hip Score (NAHS) and visual analogue score (VAS) for satisfaction (0-10, 10=very satisfied). Mean follow-up was 32 months (24, 48). Descriptive statistics were principally used owing to small numbers in the study for this relatively uncommon procedure. Adverse reactions were noted including conversion to total hip replacement. It was felt that the uncommon nature of LT reconstruction using an allograft or synthetic ligament warranted the submission of a study with relatively small numbers.

Results: There were 12 patients that underwent LT reconstruction with mean age of 37.5 years (29, 54). All patients had excision of femoroacetabular impingement (FAI) lesion and labral stabilisation was done in 7/12. There was mean improvement in preoperative scores following LT reconstruction; mHHS from 62.5 to 87 (p=0.005), VAS from 5.7 (median 6) to 9 (median 9), NAHS from 62 to 86 (p=0.03)). Revision hip arthroscopy was required in 1/12 of patients. None of the patients had graft rejection, infection or conversion to hip replacement. Return to pre-injury level of sport was achieved in 83% (10/12) of patients.

Conclusion: LT reconstruction using an allograft or synthetic ligament appears to offer offers safe and effective treatment for complete rupture of LT. The early-medium term results are promising however the numbers in the study are small. Return to pre-injury level of sport was 83% in this group.