Function of the ligamentum teres during multi-planar movement of the hip joint

The purpose of this study was to describe the orientation of the ligamentum teres and quantify the limb position when the ligamentum teres reached its endpoint during a simulated squat position in human cadavers. Dissection of eight (4 male; 4 female) cadavers resulted in the complete removal of all soft tissue attachment of the femur to the acetabulum, leaving only the ligamentum teres intact. The limb was then moved into combined flexion and abduction of the hip joint to simulate a deep squat position until a ligamentous endpoint of the ligamentum teres was achieved. The orientation of the ligamentum teres in relation to the femoral head was described and the position of the limb relative to the sagittal plane (flexion) and frontal plane (abduction) was quantified. The mean, standard deviation, 95 % confidence intervals, and standard error of the measurement were calculated for the observed angles. Multi-planar movement of flexion and abduction moved the ligamentum teres into an anterior/inferior position relative to the femoral head and prevented the femoral head from anterior/inferior subluxation. The ligamentum teres endpoint was obtained at a combined average position of 100.6A degrees (range 94A degrees-112A degrees; SD 5.5A(0); 95 % CI 96A(0)-105A(0)) and 20.0A degrees (range 12A degrees-32A degrees; SD 7.0A(0); 95 % CI 14A(0)-26A(0)) flexion and abduction angle. The ligamentum teres formed a "sling-like" structure to support the femoral head inferiorly as the hip joint was moved into a combined position of flexion and abduction that resembled a squat position. The results help to define a possible role of the ligamentum teres in hip joint stability and possible mechanisms of injury.