Ligamentum Teres Repair
What is a Ligamentum Teres Repair?
The ligamentum teres is a ligament located deep in the hip joint. It connects the ball (femoral head) to the socket (acetabulum) and provides blood supply to the femoral head. It is also important for stability. Numerous nerve fibres run through the ligamentum teres and injuries to this ligament result in severe hip pain.
Partial ligamentum teres tear
Partial ligamentum teres tear
Ligamentum teres tear debrided and stabilised
How are Ligamentum Teres Tears Diagnosed?
Ligamentum teres tears are notoriously difficult to diagnose. Most patients will have had multiple investigations performed before the diagnosis is made or suspected. Although MRI is useful for visualising labral tears, cartilage damage and other soft tissues around the hip, damage to the ligamentum teres is often difficult to visualise.
A well trained doctor or other para-medical professional will suspect a ligamentum teres tear based on your symptoms and a thorough examination of your hip.
A good response, albeit temporary, to a local anaesthetic and corticosteroid injection into the hip, may aid diagnosis.
What are the Causes of Ligamentum Teres Tears?
The ligamentum teres may tear due to a fall or trauma, sudden or repetitive twisting movements, and performing the splits. In the medical literature, even everyday activities such as shopping have been reported as causing tears! Tears are commonly observed during hip arthroscopy. it may be pathology related to bony impingement within the hip (FAI).
Are Ligamentum Teres Tears Dangerous?
Ligamentum teres tears are not life threatening but it can severely impact your quality of life and function. They can affect anyone: elite athletes and the active individual, manual labourers and office workers. At this stage, it is not known to cause osteoarthritis.
What is the Treatment?
Ligament teres tears are best treated with hip arthroscopy (key-hole surgery). The tear can be trimmed and the ligament tightened and stabilised. Any inflamed tissue is removed. The hip is thus stabilised and identifying and correcting the cause of the tear can prevent recurrences.
When can I walk?
Full weight-bearing and walking is allowed immediately. Initially, this will be aided by crutches. Most people will walk independently by 10-14 days post-operatively.
When can I drive?
You should not drive for 48 hours after an anaesthetic. After 48 hours, your ability to drive will depend on the side you had your operation, left or right, and the type of vehicle you drive, manual or automatic. If you had a left hip procedure and drive an automatic, you can drive whenever you feel comfortable. Otherwise, it is reasonable to drive when you are confident with walking and can fully weight-bear on your affected side.
When can I work?
Your return to work will vary depending on the procedure performed and type of work you are engaged in. Most people can return to office work within 2 weeks. Labour intensive work however, may require you to take 4-6 weeks before returning to full duties.
When can I play?
Low impact activities, such as cycling and swimming, can be commenced from week 4. If your procedure involves bone removal, high impact activities, such as running and jumping, are best avoided for 6 weeks post-surgery. Sport specific re-training can commence from week 6, with the aim to return to elite level sports 3 months post-surgery.
How long will I take to heal?
The wounds take 7-10 days to heal. Most patients improve dramatically in the first 6 weeks. Occasionally, there are periods where the hip may become sore and then settle again. This is part of the normal healing process. It takes three months for your hip to fully recover from hip arthroscopy. Continued improvements may be gained up to 1 year post-surgery.
How much pain will I experience?
Your experience of pain will vary depending on the procedure performed and the amount of pre-existing damage in the hip. Most patients are pleasantly surprised at how little pain they have after the procedure. Local anaesthetic is injected before and after the procedure to minimise any pain you may feel.
Will the ligamentum teres tear return?
Once the hip joint has been stabilised the risk of a recurrent ligamentum teres tear is reduced. If the cause of the tear was bony impingement, this is corrected at the time of surgery. Any bone that is removed is unlikely to grow back and the likelihood of ongoing damage to the ligament is low once the cause of damage has been removed.
What are the risks of hip arthroscopy for the treatment of ligamentum teres tears?
Complications are not common but can occur. Prior to making any decision to have surgery, it is important that you understand the potential risks so that you can make an informed decision on the advantages and disadvantages of surgery. The following list is by no means exhaustive, so it is important to discuss your concerns with your your surgeon.
Some patients occasionally report numbness or tingling in the groin or inner thigh. This usually resolves with time. It is quite normal to experience some swelling and discomfort in the leg, thigh and buttock region. This is expected and will also resolve with time. It is important to avoid high impact activities during the early phase of recovery to minimise the risk of fracture.
Other general surgical risks include: risk of infection, bleeding and clots in the leg (DVT) or lung post-operatively.
Apart from surgical risks, medical (including allergies) and anaesthetic complications can occur, and these can affect your general well being and health.
- Femoroacetabular Impingement
- Cam Impingement
- Pincer Impingement
- Labral Tears
- Ligamentum Teres Tear
- Trochanteric Bursitis
- Psoas Tendinopathy
- Muscle Strain
- Hip Bursitis
- Hip Avascular Necrosis
- Hip Fracture
- Hip Dislocation
- Gluteus Medius Tear
- Hip Labral Tear
- Chondral Lesions
- Hip Instability
- Loose Bodies
- Hip Osteoarthritis
- Inflammatory Arthritis of the Hip
- Childhood Hip Problems