Ligamento redondo de la cadera: estudio anatómico, radiológico, funcional y molecular

Abstract

The ligamentum teres (LT) of the hip has been traditionally considered an embryonic remnant, however the important development of arthroscopic hip surgery and advanced imaging methods, has significantly increased the role attributed to the lesions of the LT as source of persistent pain and biomechanical symptoms. There has also been a change in the therapeutic approach, considering currently reconstruction techniques in selected groups of patients. Objectives: Description of the anatomy and radiological appearance of the LT. Assess the length and orientation of the LT in different positions of the hip, establishing the movements that involve greater tension in the ligament. Establish whether there is homology molecular in humans between the anterior cruciate ligament (ACL) and the LT. Method: For the first objective we conducted a study of magnetic resonance (MR) arthrography, sectional slices and dissection in 10 cadaveric hips. Fort the second objective we performed hip MRI studies in 7 forced positions to 10 healthy volunteers. For the third objective we studied the relative levels of expression of a subset of key genes in three representative human ligaments: the ACL, the LT and the iliofemoral ligament (IFL) of the hip. Results: We describe the normal appearance of the LT in images of MR arthrography , anatomical sectional cuts and anatomical dissection. The position in which the LT reached its maximum length in the coronal plane was adduction. In the axial plane, the maximum dimension was achieved in external rotation, followed by internal rotation and flexion. The LT and the LCA showed equivalent levels of expression of different types of collagen, proteoglycans, growth factors and transcription in comparison with the expression in the IFL. Conclusions: The LT might have a stabilizing role in the positions in which it reaches its greatest anatomical length (external rotation, internal rotation and flexion). The LT presents more similarities in the profile of gene expression with the LCA than with the IFL, suggesting similar functional properties.