The objective of the study was to describe the normal anatomy of the ligamentum capitis femoris and to determine the neurovascular structures potentially at risk during its reconstruction. Ten cadaveric specimens of the ligamentum capitis femoris (LCF) were dissected and photographed. Magnetic resonance (MR) and Computed tomography (CT) arthrography evaluation of the anatomy of the LCF in 30 hips were performed to measure length of the ligament and to study the proximity of neurovascular structures. The anatomical study showed that the LCF has a pyramidal structure and a banded appearance. The thickness of the medial wall of the acetabulum 3 mm superior to the inferior acetabular boundary was found to be 6.7 mm (4-9 mm) at point 1 (anterior), 4.1 mm (3-7 mm) at point 2 (central), and 6.5 mm (4-9 mm) at point 3 (posterior). Central anchors or screws were found to lie within 1.7 cm (1.6-1.9 cm) of the external iliac vein and artery. Angulation of anchors in the anterior and posterior columns in the axial plane with respect to acetabular fossa floor (the Optimal Angulation Angle or OAA), is safer (0 to 45º the safest optimal angles). The sagittal angulation created by the safe pathway in the anterior and posterior columns with respect to the plane of the facies lunata in this area was also measured and termed the Optimal Angle of Penetration (OAP) with normal values being: 110º (102-123º) for the posterior column and 90º (85-94º) for the anterior column. Our results suggest that reconstruction of the LCF can be safely performed if these guidelines are followed.
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