The role of the transverse acetabular ligament in total hip arthroplasty. A Geometric Model to Determine Patient-Specific Cup Anteversion Based on Pelvic Motion in Total Hip Arthroplasty. 2014 Sep;96-B(9):1202-6. Abnormalities of the ligamentum teres account acetabular transverse ligament and the pubic and ischial margins of the acetabular notch. The central operative photograph shows the face of the cup lying parallel to the transverse acetabular ligament. Even when the acetabulum has been deepened because of mild dysplasia, reaming will not have gone as far as the true floor. A caliper is then used to measure femoral head diameter. The surgeon has to alternate between reaming and looking until the fibers of the transverse acetabular ligament start to appear. This is usually also associated with the cup sitting higher than the original joint center, thus offset and height are both incorrect with respect to restoration of joint center. When it comes to cup insertion the cup will initially obscure the transverse acetabular ligament. Recently, the transverse acetabular ligament (TAL), which bridges the acetabular notch (Löhe et al. The acetabulum should be reamed size for size or a maximum of 1 mm smaller. Perhaps not surprisingly, answers similar to the quoted literature were found in that the average operative anteversion of the transverse acetabular ligament-labrum plane was 23° and the average abduction was 45.6°. 2020 Oct 2;21(1):646. doi: 10.1186/s12891-020-03674-8. The hip is dislocated and the femoral head resected. If the cup is cradled by the transverse acetabular ligament, it helps restore acetabular joint center. This degree of anteversion was maintained throughout the different positions of abduction. There is also the rare (0.3%) grade IV transverse acetabular ligament, which cannot be found. The hemispherical trail cup is cradled by the TAL. The role of the transverse acetabular ligament in total hip arthroplasty. As can be appreciated from Figure 1, orthopedic surgeons are generally not good at judging 20°. Compared to cup abduction, anteversion is both more difficult to control during surgery and to measure on the postoperative radiograph. Placing this retractor over the anterior wall can damage the anterior wall and increase the risk of neurovascular injury because of the proximity of the structures. The transverse acetabular ligament straddles the inferior limit of the bony acetabulum. Tibiocalcaneal ligament 3. It is our hypothesis that, in the normal acetabulum, the transverse acetabular ligament and labrum form a plane that comes just beyond the equator of the acetabulum, unlike the bony acetabulum, which is less than a hemisphere. The transverse acetabular ligament straddles the inferior limit of the bony acetabulum. The human eye is able to discern when 2 lines are out of parallel by only 1° (Figure 6). A normal sulcus can be seen in the anterior and posterior aspects where the transverse ligament intersects with the acetabular labrum . In half the cases (49%), the transverse acetabular ligament is immediately visible on exposing the acetabulum. The transverse acetabular ligament forms a bridge across the inferior acetabular notch, continuing the outer edge of the acetabulum. Synonym (s): ligamentum transversum acetabuli [TA], transverse ligament of acetabulum Farlex Partner Medical Dictionary © Farlex 2012 Want to thank TFD for its existence? It completes the inferior deficiency of the acetabular rim and is continuous peripherally with the acetabular labrum. The transverse acetabular ligament straddles the inferior limit of the bony acetabulum. At our institution, Archbold et al4 reported on 25 consecutive patients, who were being investigated for labral tears with a magnetic resonance image (MRI) arthrogram of the hip. 8600 Rockville Pike 2006, 2008, Pearce et … It is critical that when the cup is inserted, there is no anterior overhang. Approximately one-third (35.1%) are grade II, which means the transverse acetabular ligament is covered by soft tissue. Among other functions, the ligamentum teres is an important stabilizer of the hip, particularly in adduction, fl exion, and external rotation. (approximately 23°). The surgeon can then lift his/her hand to the chosen abduction angle and then impact the cup. Presented at Current Concepts in Joint Replacement 2009 Winter Meeting; December 9-12, 2009; Orlando, Florida. Having exposed the acetabulum, an acetabular reamer that is the same size as the original femoral head is then used as a cup sizer. It is a strong load-bearing structure and, in the normal hip, in association with the labrum, provides part of the load-bearing surface for the femoral head. As reported by Archbold et al,5 the authors have created a classification of transverse acetabular ligament based on 1000 consecutive cases (Table). The key to using the transverse acetabular ligament is good exposure (Figure 2). Having exposed the acetabulum and transverse acetabular ligament, attention can then focus on the labrum. Dr Beverland’s research unit receives financial support from Biomet and DePuy. The anterior retractor goes anteriorly and superiorly so as not to go over the anterior wall. The definition and measurement of acetabular orientation. The deep aspect of the ligament is attached to the bone Hill J, Gibson D, Pagoti R, Beverland D. Photographical measurement of acetabular cup inclination in total hip arthroplasty using the posterior approach. In our body's pelvic region, the Transverse Acetabular Ligament is a fibrous continuation of the acetabular labrum composed of collagenous fibrocartilage bridging the anterior and posterior horns of the lunate surface, consisting of two densely packed fiber bundles slightly twisted around each other, that help stabilize the femoral head within the acetabulum during hip joint loading. In most cases, when using a cementless component, the external surface of the cup will be exposed superiorly and posteriorly as shown in Figure 4. Unable to load your collection due to an error, Unable to load your delegates due to an error. The transverse ligament bridges the acetabular notch at the inferomedial acetabulum and joins the two ends of the acetabular labrum, forming a complete ring . A summary of cup position is shown in Figure 5. The top left is too anteverted. When both of these structures were removed, the only significant change was a decrease in the maximum pressure in the posterior aspect of the acetabulum (p = 0.02). Accurate positioning of the acetabular component in total hip arthroplasty is essential to minimise the risk of dislocation and preserve the range of movement of the hip. Particularly with the lateral decubitus position, it is difficult to ensure correct patient position at the start of surgery compounded by the potential for the patient to move intraoperatively. In total hip arthroplasty (THA), excessive retroversion is associated with posterior instability, anterior impingement, and resultant groin pain. The safe range quoted in this article should be viewed with caution because of the small numbers involved and the diversity of the group.
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