BACKGROUND Intraarticular hip pain represents a substantial clinical challenge, with recent studies implicating lesions in the ligamentum teres as potential contributors. Even more so, damage to the ligamentum teres is particularly prevalent among young patients undergoing joint-preserving interventions. Although several studies have investigated the biomechanical attributes of the ligamentum teres, inconsistencies in reported findings and reliance on cadaveric or animal models have raised concerns regarding the extrapolation of results to clinical practice. Furthermore, there is a lack of research examining ligamentum teres biomechanics specifically within the relevant patient cohort-individuals who benefit from joint-preserving surgical interventions. QUESTIONS/PURPOSES We sought (1) to determine the biomechanical properties (ultimate load to failure, tensile strength, stiffness, and elastic modulus) of fresh-frozen ligaments from patients undergoing surgical hip dislocation, and (2) to identify patient-specific factors that are associated with them. METHODS This was an institutional review board-approved study on intraoperatively harvested ligamentum teres from 74 consecutive patients undergoing surgical hip dislocation for joint preservation (August 2021 to September 2022). After the exclusion of patients with previous surgery, posttraumatic deformities, avascular necrosis, slipped capital femoral epiphysis, and Perthes disease, 31 ligaments from 31 patients were analyzed. The mean age of the study group was 27 ± 8 years, and 61% (19) of participants were male. The main indication for surgery was femoroacetabular impingement. Standardized AP pelvic and axial radiographs and CT scans were performed in all patients for better radiological description of the population and to identify associated radiological factors. The ligament was thoroughly transected at its origin on the fossa acetabuli and at the insertion area on the fovea capitis and stored at -20°C until utilization. Specimens were mounted to a materials testing machine via custom clamps that minimized slippage and the likelihood of failure at the clamp. Force-displacement and stress-strain curves were generated. Ultimate failure load (N), tensile strength (MPa), stiffness (N/mm), and elastic modulus (MPa) were determined. Using a multivariate regression analysis and a subgroup analysis, we tested demographic, degenerative, and radiographic factors as potential associated factors. RESULTS The ligamentum teres demonstrated an ultimate load to failure of 126 ± 92 N, and the tensile strength was 1 ± 1 MPa. The ligaments exhibited a stiffness of 24 ± 15 N/mm and an elastic modulus of 7 ± 5 MPa. After controlling for potential confounding variables like age, fossa/fovea degeneration, and acetabular/femoral morphologies, we found that female sex was an independent factor for higher tensile strength, stiffness, and elastic modulus. Excessive femoral version was independently associated with lower load to failure (HR 122 [95% CI 47 to 197]) and stiffness (HR 15 [95% CI 2 to 27]). Damage to the acetabular fossa was associated with reduced load to failure (HR -93 [95% CI -159 to -27]). CONCLUSION Overall, the ligamentum teres is a relatively weak ligament. Sex, degeneration, and excessive femoral version are influencing factors on strength of the ligamentum teres. The ligamentum teres exhibits lower strength compared with other joint-stabilizing ligaments, which calls into question its overall contribution to hip stability. CLINICAL RELEVANCE Young patients undergoing hip-preserving surgery are the population at risk for ligamentum teres lesions. Baseline values for load to failure, tensile strength, elastic modulus, and stiffness are needed to better understand those lesions in this cohort of interest.

中文翻译：

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髋关节圆韧带有多强？生物力学分析。


背景技术关节内髋部疼痛是一项重大的临床挑战，最近的研究表明圆韧带损伤是潜在的原因。更重要的是，圆韧带损伤在接受关节保留干预措施的年轻患者中尤其普遍。尽管有几项研究调查了圆韧带的生物力学属性，但报告结果的不一致以及对尸体或动物模型的依赖引起了人们对将结果外推到临床实践的担忧。此外，缺乏专门针对受益于关节保留手术干预的相关患者群体中的圆韧带生物力学进行检查的研究。问题/目的我们试图（1）确定接受手术髋关节脱位的患者的新鲜冷冻韧带的生物力学特性（最终失效载荷、拉伸强度、刚度和弹性模量），以及（2）确定患者特定因素与他们相关的。方法 这是一项经机构审查委员会批准的研究，对 74 名连续接受髋关节脱位手术以保留关节的患者（2021 年 8 月至 2022 年 9 月）术中摘取的圆韧带进行研究。排除既往手术史、创伤后畸形、股骨头缺血性坏死、股骨头骨骺滑脱和 Perthes 病患者后，对 31 名患者的 31 条韧带进行了分析。研究组的平均年龄为 27 ± 8 岁，61% (19) 的参与者为男性。手术的主要适应症是股骨髋臼撞击。 对所有患者进行标准化的 AP 骨盆和轴向 X 光片以及 CT 扫描，以便更好地对人群进行放射学描述并确定相关的放射学因素。将韧带在髋臼窝的起点和头凹的插入区域彻底横切，并保存在-20°C直至使用。样本通过定制夹具安装到材料测试机上，最大限度地减少了夹具的滑动和故障的可能性。生成力-位移和应力-应变曲线。测定极限破坏载荷（N）、拉伸强度（MPa）、刚度（N/mm）和弹性模量（MPa）。使用多元回归分析和亚组分析，我们测试了人口统计学、退行性和放射学因素作为潜在的相关因素。结果 圆韧带的极限失效载荷为 126 ± 92 N，拉伸强度为 1 ± 1 MPa。韧带的刚度为 24 ± 15 N/mm，弹性模量为 7 ± 5 MPa。在控制了年龄、窝/中央凹变性和髋臼/股骨形态等潜在混杂变量后，我们发现女性是较高拉伸强度、刚度和弹性模量的独立因素。股骨过度旋转与较低的失效负荷（HR 122 [95% CI 47 至 197]）和刚度（HR 15 [95% CI 2 至 27]）独立相关。髋臼窝损伤与失效负荷降低相关（HR -93 [95% CI -159 至 -27]）。结论 总体而言，圆韧带是一条相对较弱的韧带。性别、退化和股骨过度前倾是圆韧带强度的影响因素。 与其他关节稳定韧带相比，圆韧带的强度较低，这令人质疑其对髋部稳定性的整体贡献。临床相关性 接受髋关节保留手术的年轻患者是圆韧带损伤的高危人群。需要破坏载荷、拉伸强度、弹性模量和刚度的基线值，以更好地了解这组感兴趣的病变。