Understanding the ligamentum teres of the hip: a histological study

Objective: To perform a histological study describing the microstructure of the ligamentum teres of the hip, with special emphasis on the presence of nerve bundles. Our study aims to correlate the microstructure of the ligamentum teres with its postulated functions, allowing greater understanding of its role within the hip joint. Methods: Fresh specimens excised intra-operatively in 11 patients undergoing open hip procedures were preserved in formalin and sent to the laboratory for histological analysis by our collaborating pathologist. The specimens were sectioned and stained, and examined under the microscope to look at their microstructure. In addition, a novel staining technique was employed to detect neural elements within the individual specimens . Results: The ligamentum teres is composed predominantly of a connective tissue matrix of collagen fibers, fibrous and adipose tissue, with an overlying layer of investing synovium. In addition, there are blood vessels of various sizes surrounded by a layer of encircling fat. In all specimens examined, there were nerve bundles of various shapes and sizes, regardless of the age of the patient. Conclusion: The ligamentum teres has both mechanical and biological functions within the hip joint and should no longer be considered a developmental vestige. Where possible, any surgical procedures around the hip joint should aim to limit damage to this structure to minimize any potential loss of function. Level of Evidence Basic Science Study.

Anatomical study of the round ligament approach to segment III duct of the liver

The duct of segment III of the liver has been used as a conduit to the jejunum in cases of hilar biliary obstruction. Twenty five fresh livers were studied. The bile duct-common hepatic or common bile-, the hepatic artery and the portal vein were injected with latex and dissected to display the anatomy of the round ligament approach to segment III duct. The round ligament approach was attempted in six patients operated upon for hilar biliary stricture. In ten specimens [40%], the duct of segment III passed from its sheath and followed the left side of the left portal branch posterosuperiorly in the fissure for ligamentum teres till the origin of the sheath of segment II where it changed its direction to the right to run above and behind the left portal branch in the porta hepatis [the pattern of the curved duct]. In 9 specimens [36%], the duct of segment III passed from its sheath directly to the right in front of the left portal branch just proximal to its junction with the round ligament on its way to the left end of the porta hepatis [the pattern of straight duct]. In 6 specimens [24%], segment III was drained by two ducts [the pattern of double duct]. In the six cases operated upon, the duct could not be reached in a cirrhotic patient, three patients had straight ducts which were easily exposed, one patient had the curved duct pattern which was exposed with great difficulty, and in one patient a hepatotomy was done to reach the duct