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Maryland Orthopedic Specialists
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Hip

Ligamentum Teres Tear

The ligamentum teres — the round ligament of the femoral head — is an intra-articular structure once considered functionally insignificant. It is now recognized as an important contributor to hip microinstability and a distinct source of hip pain, particularly in young active patients with a history of hip dislocation or twisting injury. At Maryland Orthopedic Specialists, Dr. John Christoforetti — fellowship-trained hip arthroscopy specialist and past President of the International Society for Hip Arthroscopy (ISHA) — is at the forefront of diagnosing and treating ligamentum teres pathology, including emerging reconstruction techniques for complete tears contributing to hip instability.

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What is ligamentum teres tear?

The ligamentum teres (also called the round ligament of the head of the femur) is a triangular fibrovascular band originating from the acetabular fossa and inserting on the fovea capitis (a small pit on the femoral head). It carries a branch of the obturator artery, which contributes to femoral head blood supply in children (less so in adults).

The ligamentum teres (also called the round ligament of the head of the femur) is a triangular fibrovascular band originating from the acetabular fossa and inserting on the fovea capitis (a small pit on the femoral head). It carries a branch of the obturator artery, which contributes to femoral head blood supply in children (less so in adults).

Role in hip function: Historically dismissed as a vestigial structure, the ligamentum teres is now understood to contribute to:

  • Hip stability — particularly against anterior translation and during hip external rotation
  • Microinstability: Partial or complete tears may allow subtle abnormal motion of the femoral head within the acetabulum, producing pain and a sensation of instability
  • Proprioception — the ligament contains nerve endings that contribute to hip position sense

Causes of tears:

  • Acute hip dislocation or subluxation
  • Twisting, pivoting, or traction mechanism in sports (wrestling, gymnastics, soccer)
  • Indirect mechanism with labral tear and FAI
  • Degenerative tears in older patients (incidental at arthroscopy)

Classification:

  • Type 1: Complete tear
  • Type 2: Partial tear
  • Type 3: Degenerative (attenuated, no discrete tear line)

Treatment options

Arthroscopic debridement: For partial tears and degenerate ligamentum teres without significant instability. Unstable, frayed tissue is debrided to a stable rim. Combined with labral repair and FAI correction as indicated. Arthroscopic ligamentum teres reconstruction: An emerging technique for complete tears contributing to hip microinstability. Grafts (autograft gracilis/semitendinosus or allograft tissue) are used to reconstruct the ligament through bone tunnels at the acetabular and foveal attachment sites. Dr. Christoforetti is among the specialist surgeons performing this procedure. Non-operative management: PT focused on hip stabilizer strengthening (gluteus medius, short external rotators, core) may improve microinstability symptoms and is always attempted before surgery for non-acute presentations. Activity modification to avoid provocative movements.

Surgical Procedure

Hip Arthroscopy

Minimally invasive hip scope performed at our ambulatory surgery center, addressing labral tears, cartilage defects, femoroacetabular impingement, loose bodies, and synovial disease through small portals with same-day discharge.

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Frequently Asked Questions

How common are ligamentum teres tears?
Studies report ligamentum teres pathology in 4–15% of hip arthroscopy cases, making it an uncommon but clinically significant finding. It is easily missed without high-index-of-suspicion imaging and thorough arthroscopic assessment.
Can a ligamentum teres tear cause instability like an ACL tear?
The hip is the body's most stable joint by virtue of its bony architecture, labrum, and capsular ligaments. Ligamentum teres tears do not produce gross instability like an ACL tear, but they can contribute to subtle microinstability — particularly in patients with hypermobility or prior hip dislocation — causing pain and a "loose" feeling.
Is reconstruction always needed for a complete tear?
Not necessarily. Many patients with complete tears are managed successfully with labral repair, FAI correction, and PT. Reconstruction is reserved for patients with clear instability symptoms, specific anatomic indications, and failure of non-operative care.
How is a ligamentum teres tear diagnosed?
A ligamentum teres tear is most reliably identified on MRI arthrography of the hip, where contrast injected into the joint highlights the torn tissue. Standard MRI may miss partial tears, so your MOS surgeon may recommend an MR arthrogram if clinical suspicion is high. During examination, a positive FADIR test or pain with axial traction can suggest the diagnosis. Ultimately, hip arthroscopy is considered the gold standard because the ligament can be directly visualized and treated in the same procedure.
What does recovery look like after ligamentum teres debridement or reconstruction?
After arthroscopic debridement of a partial tear, most patients are weight-bearing as tolerated within a few days and begin physical therapy within the first week. Return to non-impact activities typically occurs at 6–8 weeks, while return to sport may take 3–4 months. If reconstruction was performed for a complete, unstable tear, recovery is longer — approximately 4–6 months before return to full activity. Your MOS surgeon will provide a structured rehabilitation protocol tailored to the extent of your injury and your activity goals.

Meet the specialists

John J. Christoforetti, MD

John J. Christoforetti, MD

Orthopedic Surgery · Sports Medicine · Hip Preservation Surgery

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Related conditions

Hip Capsular Contracture
Medically reviewed by John J. Christoforetti, MD, MD, FAAOS
Last reviewed May 1, 2026

References

  1. Bardakos NV, Villar RN. The ligamentum teres of the adult hip. J Bone Joint Surg Br. 2009;91(1):8–15. https://doi.org/10.1302/0301-620X.91B1.21421
  2. Cerezal L, Kassarjian A, Canga A, et al. Anatomy, biomechanics, imaging, and management of ligamentum teres injuries. Radiographics. 2010;30(6):1637–1651. https://doi.org/10.1148/rg.306105516
  3. Domb BG, Martin DE, Botser IB. Risk factors for ligamentum teres tears. Arthroscopy. 2013;29(1):64–73. https://doi.org/10.1016/j.arthro.2012.07.009
  4. Philippon MJ, Pennock A, Gaskill TR. Arthroscopic reconstruction of the ligamentum teres: technique and early outcomes. J Bone Joint Surg Br. 2012;94(11):1494–1498. https://doi.org/10.1302/0301-620X.94B11.29055
  5. Kalisvaart MM, Safran MR. Microinstability of the hip — it does exist: etiology, diagnosis and treatment. Knee Surg Sports Traumatol Arthrosc. 2017;25(1):3–17. https://doi.org/10.1007/s00167-016-4357-4