The Mechanical Properties of the Ligamentum Teres: A Pilot Study to Assess Its Potential for Improving Stability in Children's Hip Surgery

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The anatomic and histological characteristics of the ligamentum teres and its vascular contributions to the femoral head have been well described. The function of the ligamentum teres remains poorly understood. Although excision is the current standard in treating complete developmental hip dysplasia, we developed an interest in maintaining, shortening, and reattaching the ligament to assure early postoperative stability in developmental hip dysplasia. To analyze its potential for providing hip joint stability, we investigated the biomechanical properties of the ligamentum teres in an in vitro porcine model. Six immature porcine hips were dissected, with the proximal femur and acetabular anatomy kept intact, isolating the ligamentum teres. Specimens were loaded in tension using custom fixation rigs at 0.5 mm/s in line with the fibers. Data for displacement and force were collected and sampled at 10 Hz for duration of each test. The ligamentum teres failed in a stepwise fashion. The mean ultimate load to failure was 882 ± 168 N. Mean stiffness and failure stress were calculated as 86 ± 25 N/mm and 10 ± 2 MPa, respectively. The biomechanical function of the ligamentum teres is not inconsequential. We found the ultimate load of the ligamentum teres in the porcine model to be similar to those reported for the human anterior cruciate ligament. The strength of the ligamentum teres may confirm its potential for providing early stability in childhood hip reconstructions. In the setting of dysplasia, the preservation and the transfer of the ligamentum teres to augment stability should be considered as an adjunct to open reduction.

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