Acetabular Fossa, Femoral Fovea, and the Ligamentum Teres

Abstract

Lesions and pathology associated with the ligamentum teres and acetabular cotyloid fossa have been elucidated as an important and perhaps overlooked source of nonarthritic hip pain and mechanical symptoms. Tears of the ligamentum teres, stenosis of the cotyloid fossa, and disorders such as synovial chondromatosis are representative of the more commonly encountered pathologies in this area. The ligamentum teres has been established as a static stabilizer of the hip and as having a role in force and fluid distribution. In those patients with symptomatic instability and both subjective and positive clinical exam findings who have failed prior surgical procedures, ligamentum teres reconstruction using varying techniques and graft sources has shown promising early results. While an uncommon and benign condition, the cartilaginous loose bodies of synovial chondromatosis can lead to chondral damage secondary to mechanical abrasion from the loose bodies. Arthroscopic removal of the loose bodies and synovectomy has shown satisfactory results with a short rehab and few complications. A stenotic cotyloid fossa secondary to heterotopic bone formation or abnormal amounts of fibrous and fatty tissue can incarcerate the ligamentum teres and exert a space-occupying effect. This can lead to lateral subluxation of the femoral head with implications to pathology of the chondrolabral junction. The goal of treatment is removing any space-occupying tissue from the fossa to decompress the ligamentum and perhaps improve joint congruence.