title: Ligamentum teres injuries of the hip: a systematic review examining surgical indications, treatment options, and outcomes.
abstract: OBJECTIVE
  Hip arthroscopy is becoming a common technique for the diagnosis and treatment of ligamentum teres pathologic conditions. This systematic review aims to determine the indications/contraindications, treatments, and surgical outcomes for management of ligamentum teres injuries.
  
  
  METHODS
  We searched EMBASE, MEDLINE, and PubMed databases from 1946 to November 28, 2013 for all relevant English articles pertaining to surgical treatment of the ligamentum teres. A hand search of the reference sections of included articles was performed, and all relevant articles were systematically screened in duplicate, with agreement and descriptive statistics presented.
  
  
  RESULTS
  We identified 1,016 studies, 9 of which (4 case series and 5 case reports) met our eligibility criteria. These studies had a total of 87 patients (89 hips) who had undergone either arthroscopic debridement (81 patients, 83 hips) or reconstruction with autografting, allografting, or synthetic grafting (6 patients) of a torn ligamentum teres. Major qualifications for surgery included persistent hip pain despite conservative treatment and mechanical symptoms or instability symptoms (e.g., clicking or locking). Advanced arthritis (i.e., radiographic joint space < 2 mm) was the only reported contraindication. Patients were followed postoperatively for 1.5 to 60 months and were assessed using subjective methods (i.e., modified Harris Hip Score [mHHS] and Non-Arthritic Hip Score [NAHS]). Overall, both debridement and reconstruction improved the condition of patients, with a 40% increase in reported postoperative functional scores as well as a reported 89% of patients who were able to return to regular activity/sport.
  
  
  CONCLUSIONS
  Ligamentum teres debridement is indicated for short-term relief of hip pain caused by partial-thickness tears (type 2) failing conservative management, whereas reconstruction with autografts, allografts, or synthetic grafts may be indicated for type 1 (full-thickness) ligamentum teres tears that are deemed "reparable," cause instability, have failed previous debridement, or a combination of these conditions.
  
  
  METHODS
  Level IV, systematic review of Level IV and Level V studies.
authors.affiliation: Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada.
authors.forename: Darren
authors.initials: D
authors.lastname: de SA
authors.affiliation: Department of Life Science, McMaster University, Hamilton, Ontario, Canada.
authors.forename: Mark
authors.initials: M
authors.lastname: Phillips
authors.affiliation: Steadman Philippon Research Institute, Vail, Colorado, U.S.A.
authors.forename: Marc J
authors.initials: MJ
authors.lastname: Philippon
authors.affiliation: Physician Assistant Education Program, McMaster University, Hamilton, Ontario, Canada.
authors.forename: Shelby
authors.initials: S
authors.lastname: Letkemann
authors.affiliation: Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada.
authors.forename: Nicole
authors.initials: N
authors.lastname: Simunovic
authors.affiliation: Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada. Electronic address: ayenif@mcmaster.ca.
authors.forename: Olufemi R
authors.initials: OR
authors.lastname: Ayeni
mesh_terms: D000328:Adult; D001168:Arthritis / Q000601:surgery; D001182:Arthroscopy / Q000379:methods*; D003646:Debridement / Q000379:methods*; D005260:Female; D006615:Hip / Q000601:surgery; D025981:Hip Injuries / Q000175:diagnosis / Q000601:surgery*; D006621:Hip Joint / Q000601:surgery; D006801:Humans; D008022:Ligaments / Q000601:surgery; D008023:Ligaments, Articular / Q000601:surgery*; D008297:Male; D012421:Rupture / Q000175:diagnosis / Q000601:surgery; D016896:Treatment Outcome