EP3.49 Qualitative and quantitative anatomical analysis of the hip capsular ligaments

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ID: 331111
2026
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Abstract
Abstract Background An increasing number of surgeons are recognizing the importance of the soft tissue hip envelope, particularly the capsular ligaments of the hip (CLH)—comprising the iliofemoral (ILFL), ischiofemoral (ISFL), and pubofemoral (PFL) ligaments, as well as the zona orbicularis (ZO)—and their crucial role in both static and dynamic hip stability and functionality. However, ongoing anatomical controversies, including the number of ligament bands, their interconnections, and the existence of the ZO, combined with limited quantitative data on ligament dimensions, prevent surgeons from performing meticulous evidence-based CLH management. This study aims to clarify these anatomical features and quantify ligament dimensions. Methods We dissected 12 cadaveric hip joints to identify the origin, insertion, fiber direction, and interconnection of the ILFL, PFL, and ISFL. From these, nine hip joints were used to construct bone-ligament-bone samples to measure ligament dimensions and attachment sizes, while capsules of three additional joints were completely separated from the joints to investigate the deep ZO. Results We found that both the PFL and ISFL comprise of one band, and the ISFL was not connected with the ILFL. The ZO was confirmed as a complete circular structure located deep within hip capsule, passing through the ILFL, PFL, and ISFL without bony attachment. A portion of the ZO can be observed from the outer surface of the inferior capsule, which may be misidentified as another band of the ISLF or PFL. Dimensional analysis revealed that the medial arm (MA) of the ILFL was the longest (62.7±10.1 mm), the lateral arm (LA) of the ILFL the thickest (6.8±1.6 mm), the PFL the narrowest (9.8±2.0 mm), and the ISFL the widest (21.0±4.7 mm) but also the shortest (48.8±3.7 mm) and thinnest (3.8±0.5 mm). Conclusions The presence and surface visibility of the ZO is the primary reason for anatomical inconsistencies within the CLH. Dimensional differences exist among the MA, LA, PFL, and ISFL. Clinical Relevance Surgeons should incise the CLH along their fiber orientation and perform routine repair.
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Authors Weilong Xu
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Journal Journal of hip preservation surgery
Year 2026
DOI
10.1093/jhps/hnag043.334
URL
https://doi.org/10.1093/jhps/hnag043.334
Keywords Keywords not found

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