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2015 - Domb et al. Arthroscopic Ligamentum Teres Reconstruction of the Hip in Ehlers-Danlos Syndrome: a Case Study. Hip International

Arthroscopic ligamentum teres reconstruction of the hip in Ehlers-Danlos syndrome: a case study

Jon E. Hammarstede, John M. Redmond', Asheesh Gupta', Benjamin G. Domb4

  • University of Illinois at Chicago, Chicago, Illinois - USA
  • Mayo Clinic, Jacksonville, Florida - USA
  • NoVa Orthopedic & Spine Care, Woodbridge, Virginia - USA
  • Hinsdale Orthopaedics, American Hip Institute, Westmont, Illinois - USA

Abstract

Background: Ehlers-Danlos syndrome (EDS) is a genetic disorder that affects the structural integrity of collagen within the body. This presents clinically as a connective tissue disorder with increased elasticity of joints, muscles, and ligaments. Multiple joints are affected by hypermobility and joint injury is common in these patients. It is estimated that EDS occurs once in every 5,000 births worldwide.

Case review: This article focuses on reconstruction of the ligamentum teres (LT) of the hip using a tibialis anterior allograft to treat severe instability and pain in a 43 year-old female with EDS. The LT reconstruction was accom-panied by labral repair and capsular plication. The patient was assessed pre- and postoperatively using modified Harris Hip Score (mHHS), Hip Outcome Score Activities of Daily Living (HOS-ADLS), Hip Outcome Score Sports Specific Subscale (HOS-SSS), Non Arthritic Hip Score (NAHS), Visual Analog Scale (VAS), and satisfaction. One year following surgery the patient has reported positive outcomes in terms of pain and instability.

Literature review: Ligament reconstruction has been reported in patients with Ehlers-Danlos syndrome for shoul-ders and knees with positive results and restoration of stability. Currently there is a paucity of literature regarding patients with EDS undergoing hip procedures. In addition, reconstruction of the ligamentum teres for hip instabil-ity and pain has rarely been reported in a normal patient cohort.

Clinical relevance: This is the first study to report ligamentum teres reconstruction of the hip in a patient with Ehlers-Danlos syndrome and hip instability. The patient demonstrated satisfactory results 1 year from surgery.

Keywords: Ehler Danlos syndrome, Ligamentum teres reconstruction, Hip, Arthroscopy, Allograft, Outcomes

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