Journal of Pediatric Orthopaedics - 2026-04-01 - Journal Article
Intraosseous Tunneling and Ligamentum Teres Ligamentodesis "Teretization" to Enhance Stability in Congenital Hip Dislocation Surgery: Surgical Technique and Mid-Term Outcomes.
Sarassa C, Aristizabal S, Mejía R, García JJ, Quintero D, Herrera AM
Topics
Key Takeaway
Ligamentum teres intraosseous ligamentodesis ('Teretization') as an adjunct to open reduction in IHDI grade ≥III DDH achieved 0% redislocation and 10.5% asymptomatic AVN at median 23-month follow-up in 19 hips.
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Summary
This study evaluated a novel ligamentum teres ligamentodesis technique in 16 pediatric patients (19 hips) with IHDI grade ≥III DDH at median age 24 months, combining LT detachment, intraosseous tunneling from fovea to greater trochanter, and periosteal anchoring with concurrent femoral and pelvic osteotomies. At median 23-month follow-up, all hips achieved IHDI type I reduction with 80% Severin grade I and 20% grade II; no redislocations, physeal bars, or growth arrest occurred. Two hips (10.5%) developed asymptomatic AVN, and all but one patient had normal pain-free gait.
Key Limitation
The absence of a concurrent control group receiving open reduction with osteotomies alone makes it impossible to determine whether the ligamentodesis independently contributes to the observed stability or whether the osteotomies alone would produce equivalent outcomes.
Original Abstract
BACKGROUND
Developmental dysplasia of the hip (DDH) with complete dislocation (grade ≥III) in older patients often requires open reduction. However, achieving long-term stability remains challenging. This study introduces and evaluates a novel surgical technique, intraosseous tunneling and ligamentodesis of the ligamentum teres (LT), conceived to enhance postoperative hip stability while preserving the ligament's anatomic course.
METHODS
Pediatric patients with grade ≥III DDH, as classified by the International Hip Dysplasia Institute (IHDI), underwent open reduction using a novel ligamentum teres ligamentodesis technique to enhance joint stability. The ligament was detached, sutured, and tunneled intraosseously from the fovea to the greater trochanter, then anchored to the periosteum. Postoperative evaluation included gait status, pain, hip range of motion, reluxation, residual dysplasia, avascular necrosis (AVN), physeal bars, growth arrest, complications, and need for reintervention.
RESULTS
Nineteen hips in 16 patients (14 females, 2 males) with a median age of 24 months underwent LT intraosseous ligamentodesis combined with femoral and pelvic osteotomies. At a median follow-up of 23 months, all patients were pain-free, had normal gait, and no functional limitations, except for one case of persistent limping and one hip with mild limitation of abduction. Radiographically, all hips achieved satisfactory outcomes with IHDI type I, and severing grades I (80%) and II (20%). No cases of redislocation, dysplasia, infection, physeal bars, or growth arrest were observed. Two hips (10.5%) developed asymptomatic AVN.
CONCLUSIONS
The ligamentum teres intraosseous ligamentodesis ("Teretization") is a safe and technically feasible adjunct to open reduction in severe DDH, demonstrating favorable mid-term outcomes with no redislocations and low complication rates. These findings support its potential role in enhancing hip stability without jeopardizing femoral head physis and vascularity.
LEVEL OF EVIDENCE
Level IV-therapeutic case series. This study evaluates a novel surgical technique in a series of patients with congenital hip dislocation without a control group.