Novel Ligamentum Teres Reconstruction Technique May Improve Hip Development in Developmental Hip Dysplasia

Children treated with a novel suture button technique experienced improved acetabular remodeling following open hip reduction.

Achieving a stable reduction, in which the femoral head remains securely positioned within the hip socket, is the primary goal of treatment for developmental dysplasia of the hip (DDH). Greater hip stability has shown to improve acetabular remodeling following reduction. Acetabular remodeling is the natural reshaping and deepening of the hip socket as a child grows after the hip has been successfully reduced.

New research from Nationwide Children’s Hospital suggests that using a novel suture button construct for ligamentum teres reconstruction (LTR) during open reduction may improve acetabular remodeling and reduce the need for subsequent reconstructive surgery.

The study, published in the Journal of Pediatric Orthopaedics, compared outcomes following closed reduction, open reduction alone and open reduction with LTR using a suture button construct in children 2.5 years of age and younger with idiopathic DDH.

Investigators evaluated acetabular remodeling by measuring changes in the acetabular index over an average follow-up of nearly three years. The acetabular index measures the slope of the hip socket. Higher angles indicate a shallower socket and more severe dysplasia. Lower angles signify a deeper, more normally developed socket.

“For the acetabulum to develop normally, the hip must remain stable,” says Kevin E. Klingele, MD, chief of Orthopaedic Surgery and co-director of the Center for Hip Preservation at Nationwide Children’s and adjunct assistant professor of Orthopaedic Surgery at The Ohio State University College of Medicine. “Our goal was to determine whether further increasing stability during open reduction would improve remodeling during the critical early years of growth.”

The analysis included comparison of 71 hips in 63 children treated with open reduction and LTR, open reduction alone or closed reduction of DDH.

The findings support the hypothesis that greater hip stability accelerates acetabular remodeling. Children treated with LTR demonstrated an average annual improvement in acetabular index of 7.9 degrees. By comparison, improvement averaged 4.7 degrees following open reduction alone and 4.0 degrees after closed reduction. Most notably, the greatest remodeling occurred during the first postoperative year. Hips in the LTR group improved by approximately 1 degree each month.

Within the follow-up period, none of the children who underwent LTR required a subsequent pelvic osteotomy for residual acetabular dysplasia. In comparison, 12.5% of children who had open reduction needed a pelvic osteotomy and 34.5% of those who received closed reduction required osteotomy within a similar timeframe from surgery.

“Our previous study established that ligamentum teres reconstruction using the suture button technique was both a safe and effective adjunct to open hip reduction,” says Dr. Klingele.”This study followed many of those same patients over a longer period and included additional cohorts to determine that added stability translates into better acetabular remodeling.”

The investigators also observed that remodeling rates declined after surgeons removed the temporary suture button 1 year post-surgery. The results suggest that maintaining hip stability may be important for acetabular remodeling during this critical period of growth.

“The results guide the next phase of our research,” Dr. Klingele says. “We’re investigating techniques to create a more permanent ligament reconstruction so we can maintain better stability and restore more normal ligamentum teres anatomy throughout the remodeling process.”

The LTR suture button technique was developed at Nationwide Children’s, where surgeons have now performed this procedure on more than 100 hips in children with various diagnoses. Although longer follow-up is needed, the research supports maximizing postoperative hip stability to improve acetabular development and reduce the need for future reconstructive procedures in children with DDH.

“Residual dysplasia can lead to early osteoarthritis and additional surgery later in childhood, adolescence, or young adulthood,” Dr. Klingele explains. “If we can improve remodeling early by providing greater hip stability, we have the opportunity to change that child’s long-term outcome.”

He continues, “In addition, the technique provides improved stability in hips that we often deem high risk due to associated neuromuscular disorders, allowing surgeons to treat various hip disorders more aggressively than we have in the past.”

Looking ahead, Dr. Klingele’s team is continuing to innovate the technique, including development of bioabsorbable implants for ligament reconstruction. Longer term follow-up will assess outcomes in older children and in patients with cerebral palsy and other neuromuscular conditions as well as the current idiopathic DDH cohort.

References:

1. Englert EG, Peabody T, Stokey P, et al. Does Hip Stability Influence Rates of Acetabular Remodeling Following Reduction of Idiopathic Developmental Hip Dysplasia? A Comparison of Closed Versus Open Reduction With and Without Ligamentum Teres Reconstruction. J Pediatr Orthop. Published online April 7, 2026. doi:10.1097/BPO.0000000000003289.
2. Englert G, Mansour A, Strub D, et al. Open Reduction With Ligamentum Teres Reconstruction-Preliminary Results of a Novel Technique for the Management of Pediatric Developmental Dysplasia of Hip. J Pediatr Orthop. Published online July 23, 2025. doi:10.1097/BPO.0000000000003051.