Ligamentum teres reattachment post-surgical dislocation of the hip: a case report. Regenerative capacity reaffirming its greater role in hip stability and function?

CASE REPORT A 15-year-old female patient underwent in 2012 a right hip surgical dislocation to treat a painful hip affecting her quality of life. Her presenting history, clinical examination and radiological investigations culminated to a diagnosis of intra-articular hip pathology: femoroacetabular impingement which included a femoral head with cam-type morphology and associated labrum tearing extending to the lateral acetabular rim as well as minor subspinal impingement. Pre-operative plain film radiograph of the patient’s pelvis (Fig. 1) and intra-operative clinical photograph documenting her right hip surgical dislocation and treatment including iatrogenic complete rupture of the ligamentum teres (LT) (Fig. 2). Post-operative plain film radiograph of the patient’s pelvis were taken after the procedure (Fig. 3). She went on to have an uneventful recovery immediately after her operation. The trochanteric screws were removed 6months after the index operation. Regular follow up documents a pain free period of about 31=2 years post the right hip surgical dislocation with return to sporting activities and satisfactory quality of life. In early 2016, the patient started experiencing some pain but mainly limitation in her range of motion of her right hip. Plain film of her pelvis was unremarkable (Fig. 4). The deterioration progressed over time as per serial clinical examinations. Radiological studies supported the suspected clinical suspicion of intra-articular adhesions (Fig. 5), a known complication following surgical hip dislocation [13, 14]. Interestingly, the same magnetic resonance imaging (MRI) in a coronal plane demonstrated an LT in continuity (Fig. 6). By the end of 2016 symptom progression and clinical deterioration of the patient mandated a second look through an arthroscopic procedure. The patient underwent a right hip arthroscopy on November 2016, 4 years after the index operation. The diagnosis was confirmed and the adhesions were released arthroscopically. The intra-operative range of movement, specifically the internal and external rotation improved significantly. The patient has had so far an uneventful recovery and was discharged from the hospital the day after her operation. During her hip arthroscopy, the LT was actually attached and there was no evidence of the initial lesion necessitated by the surgical dislocation (Figs 7 and 8). The iatrogenically sectioned LT was in continuity with intact attachments both at the femoral and acetabular sides. The intra-operative photos depict even a somewhat bundled LT appearance as it is described for its native anatomy.