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Ligamentum capitis femoris – Anatomy and Function

The ligamentum capitis femoris is an intra-articular ligament of the hip joint connecting the femoral head to the acetabulum, contributing to joint stability and blood supply.

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Things worth knowing about "Ligamentum capitis femoris"

The ligamentum capitis femoris is an intra-articular ligament of the hip joint connecting the femoral head to the acetabulum, contributing to joint stability and blood supply.

What is the Ligamentum capitis femoris?

The ligamentum capitis femoris -- also referred to as the ligamentum teres or round ligament of the hip -- is an intra-articular ligament located inside the hip joint. It connects the fovea capitis femoris (a small depression on the femoral head) to the acetabular notch (incisura acetabuli) and the transverse acetabular ligament. The ligament is enclosed within a sleeve of synovial membrane and represents one of the few true intra-articular ligaments in the human body.

Anatomy and Structure

The ligamentum capitis femoris is composed of dense connective tissue fibers arranged in a triangular or fan-like configuration. In adult individuals, it measures approximately 30 to 35 millimetres in length.

Origin: Acetabular notch and transverse acetabular ligament
Insertion: Fovea capitis femoris (femoral head)
Covering: Synovial membrane

Function

The precise biomechanical role of the ligamentum capitis femoris has been a subject of ongoing research and debate. The following functions are currently attributed to it:

Blood supply to the femoral head: In children and adolescents, the artery of the ligamentum teres (a branch of the obturator artery) travels through the ligament and supplies part of the femoral head with blood. This contribution diminishes in adulthood as other vessels take over the primary supply.
Mechanical stabilisation: The ligament contributes to hip joint stability, particularly during movements such as external and internal rotation as well as adduction of the lower limb.
Proprioception: Nerve endings within the ligament may contribute to the perception of joint position (proprioception).

Clinical Relevance

Although the ligamentum capitis femoris was historically considered to have minimal clinical importance, it has gained increasing recognition in modern hip surgery and sports medicine.

Injuries

Tears or partial tears of the ligamentum capitis femoris can occur during hip dislocations, athletic injuries, or due to abnormal loading patterns. Such injuries may lead to chronic hip pain, instability, and restricted range of motion. They are most commonly diagnosed and treated via hip arthroscopy.

Femoroacetabular Impingement (FAI)

In patients with femoroacetabular impingement, the ligamentum capitis femoris may also be affected, contributing to pain and functional limitations in the hip joint.

Diagnosis

Injuries to the ligament are not visible on conventional X-rays. The preferred imaging modalities are magnetic resonance imaging (MRI) and diagnostic hip arthroscopy, which allows direct visualisation and assessment of the ligament.

Treatment Approaches

The management of ligamentum capitis femoris injuries depends on the extent of the damage:

Conservative treatment: Physiotherapy, analgesics, and activity modification for minor injuries
Arthroscopic treatment: For more extensive tears or persistent symptoms, hip arthroscopy with debridement (removal of torn tissue) or ligament reconstruction may be performed

References

Chandrasekaran S, Lodhia P, Suarez-Ahedo C, Vemula SP, Martin TJ, Domb BG. Symposium: Evidence for the treatment of ligamentum teres tears of the hip. Journal of Hip Preservation Surgery, 2016.
Gray H. Gray's Anatomy: The Anatomical Basis of Clinical Practice, 41st Edition. Elsevier, 2016.
Bardakos NV, Villar RN. The ligamentum teres of the adult hip. Journal of Bone and Joint Surgery, 2009.

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