Defining the Origins of the Iliofemoral, Ischiofemoral, and Pubofemoral Ligaments of the Hip Capsuloligamentous Complex Utilizing Computer Navigation

Denis Nam, MD
Department of Orthopaedics Surgery, Hospital for Special Surgery
Weill Medical College of Cornell University

Darly C. Oshbahr, MD
Department of Orthopaedics and Sports Medicine, Union Memorial Hospital

Daniel Choi, BA
Hospital for Special Surgery


Anil S. Ranawat, MD

Assistant Professor of Orthopaedic Surgery, Weill Cornell Medical College
Assistant Attending Orthopaedic Surgeon, NewYork-Presbyterian Hospital
Assistant Attending Orthopaedic Surgeon, Hospital for Special Surgery

Bryan T. Kelly, MD

Associate Attending Orthopedic Surgeon, Hospital for Special Surgery
Sports Medicine and Shoulder Service, Hospital for Special Surgery
Assistant Professor of Orthopedic Surgery, Weill Cornell Medical College

Struan H. Coleman, MD, PhD

Associate Attending Orthopaedic Surgeon, Hospital for Special Surgery
Associate Attending Orthopaedic Surgeon, NewYork-Presbyterian Hospital
Associate Professor of Clinical Orthopaedic Surgery, Weill Cornell Medical College

Abstract

Purpose 
To use computer navigation software to investigate the specific origins of the hip capsuloligamentous complex.

Methods 
Six fresh frozen cadaver hips were anatomically landmarked utilizing a three-dimensional computer navigation system. The acetabular origins of the iliofemoral, pubofemoral, and ischiofemoral ligaments were statically digitized. Computer software was used to create a 180° (6:00) meridian line positioned over the midpoint of the acetabular notch, and to present the results in a clocklike manner in hours and minutes (00:00) and also degrees relative to the 12 o’clock position.

Results 
The iliofemoral ligament origin starts at 17° (±31°) from the 12 o’clock position, or 12:35 (±1:02) in hours and minutes, and ends at 69° (±13°) or 2:18 (±0:25), spanning a mean distance of 52° (±19°). The ischiofemoral ligament has the broadest origin, starting at 262° (±12°) or 8:44 (±0:24), and ending at 353° (±17°) or 11:45 (±0:14), spanning a mean distance of 90° (±6°). The pubofemoral ligament origin is the smallest, starting at 121° (±5°) or 4:02 (±0:11), and ending at 163° (±9°) or 5:27 (±0:18), spanning a mean distance of 42° (±5°). The iliofemoral ligament origin demonstrates the greatest anatomic variability with regards to its location and its size (p#=#0.002).

Conclusion 
This study demonstrates that there is significant variability in the size and location of the iliofemoral ligament origin versus the pubofemoral and ischiofemoral ligaments.

Level of Evidence 
Level IV anatomic cadaveric study. See the guidelines online for a complete description of level of evidence.

This article appears in HSS Journal: Volume 7, Number 3.
View the full article at springerlink.com.

About the HSS Journal
HSS Journal, an academic peer-reviewed journal, is published twice a year, February and September, and features articles by internal faculty and HSS alumni that present current research and clinical work in the field of musculoskeletal medicine performed at HSS, including research articles, surgical procedures, and case reports.

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