Perthes disease. Pathogenesis

An original view on the pathogenesis of Perthes' disease (femoral head osteochondropathy, Legg-Calvé-Perthes disease).

By the onset of Perthes disease, the hip joint is generally formed, and the femoral head and acetabulum represent bone structures. From our perspective, the initiating factor is trauma, specifically, damage to the ligamentum capitis femoris (LCF). This can be its rupture (most commonly), detachment from its attachment point, or irreversible plastic elongation. In other words, the amount of mechanical energy acting on the LCF, at a certain moment, exceeds the amount that it can absorb. Another option is possible when individual LCF fibers are damaged. Bioeffective stresses arise and increase in it, inducing biological processes that transform the LCF (for more details, see the Law of Bioinduction). As a result, it is either permanently damaged or significantly lengthened.

Due to damage or uncompensated lengthening of the LCF, the statics and dynamics of the hip joint are disrupted. In the single-support phase of gait and in the single-support posture, it no longer functions as a second-class lever, but as a first-class lever. In the upper sector of the femoral head and acetabulum, the value of the actual average daily stresses increases, which turns out to be greater than optimal stresses. Bioeffective stresses emerge. The volume of the femoral head is smaller than the volume of the pelvic bone, therefore the magnitude of the effective stresses, and therefore the average daily stresses in it is greater. Accordingly, bioeffective stresses are higher in the head of the femur and biological processes are more active.

Due to mechanical phenomena and biological processes in the upper sector of the femoral head, an area of compression of the spongy substance is formed with its subsequent restructuring. Partially the bone tissue atrophies, its mass in the upper sector decreases. The presence of bioeffective stresses induces adaptive processes in the femoral head. The granulation tissue that appears at the site of damage through the processes of metaplasia is gradually transformed into fibrous and then into bone tissue. With a satisfactory course of adaptive processes in the head of the femur, not only qualitative, but also quantitative changes are observed. The trabecular systems are rearranged, the shape of the femoral head changes, which increases in size.

Changes in the head of the femur neutralize bioeffective stresses in it. This is achieved by eliminating zones of stress concentration, increasing the contact area of the femoral head and acetabulum, strengthening their upper sectors due to subchondral sclerosis, thickening and increasing the number of trabeculae. As these changes develop, the optimal average daily stresses for the newly formed femoral head are equalized with the actual stresses, and the bioeffective stresses are leveled. After this, the ongoing adaptive processes induced by bioeffective stresses fade away. The hip joint acquires a different structure from the norm, and the kinematics of locomotion also changes.

Keywords: ligamentum capitis femoris, ligamentum teres, ligament of head of femur, hip joint, biomechanics, osteochondropathy, Perthes' disease, pathogenesis

In translating to English, the author is assisted by ChatGPT (version 3.5) and the Google Translate service.

If you notice an error, please let us know!

The first version of the text in:

Архипов-Балтийский СВ. Рассуждение о морфомеханике. Норма. В 2 т. Т. 2. Гл. 5-6. испр. и доп. изд. Калининград, 2004. (Archipov-Baltic SV. Reasoning about Morphomechanics. The norm – Kaliningrad, 2004. [Rus]) [aleph.rsl.ru]

BLOG CONTENT

ETIOLOGY AND PATHOGENESIS

Comments

A BRONZE AGE MEDICAL CASE HISTORY. Title and contents

Book manuscript: Arkhipov S.V. A Bronze Age Medical Case History: Interpreting the Book of Genesis in the Light of Modern Medicine. Kyrö : Author’s Edition, 2026. – 808 pp. – 52 tables. – Bibliographical references: 959 entries. ISBN 978-952-19-7020-7 play.google.com , books.google.com Title, Abstract and Contents CONTENT [i] Abstract [ii] Dedication [iii] Book Covers and Title [iv] Table of Contents [v] Application [i] ABSTRACT This special "case history" book is the culmination of the author's long-standing career as an orthopaedic surgeon with a passion for the history of medicine. At the heart of this popular science study lies a Middle Bronze Age patient who sustained an injury to the ligament of the head of femur (ligamentum teres). The narrative, drawn from the Book of Genesis, is cross-checked against data from archaeology, history, natural science, linguistics, and modern medicine. The processed and structur...

YOUR PUBLICATION IN THE BLOG

The blog's publications are dedicated to the ligament of the head of femur, called ligamentum capitis femoris (LCF) in Latin. Articles and illustrative material, updated and publicly discussed. On our platform, you can post your text about LCF for free in any language and further edit it. It is permissible to publish of significant quotes, annotation, or the entire work of another author, provided that his legal rights are respected. Participation in the project is a promising type of scientific cooperation, a way to increase efficiency in clinical practice and the effectiveness of research activities. Here, everyone's contribution is multiplied by the knowledge and experience of colleagues, as well as previous generations of doctors and scientists who have studied LCF. All writers gain a convenient opportunity: to participate in discussions on the topics raised in their article, to receive comments from experts, valuable advice in practical work and scientific research. ...

A BRONZE AGE MEDICAL CASE HISTORY. Prologue

Book manuscript: Arkhipov S.V. A Bronze Age Medical Case History: Interpreting the Book of Genesis in the Light of Modern Medicine. Kyrö : Author’s Edition, 2026. – 808 pp. – 52 tables. – Bibliographical references: 959 entries. ISBN 978-952-19-7020-7 play.google.com , books.google.com Prologue ProLOGUE CONTENT [i] Text [ii] Navigation [iii] Application [i] Text The present work is based on a medical hypothesis formulated by the author. According to this assumption, the protograph of the Book of Genesis was written in Egypt in the late 17th century BCE following the Minoan eruption, with the participation of an encyclopaedic physician. The formulated hypothesis undoubtedly requires comprehensive discussion by the interdisciplinary research community. The theoretical possibility of such a work appearing in the Nile Valley finds support in the history of writing. The earliest texts were compiled in the Tigris – Euphrates basin and Ancient Egypt. In th...

1879BischoffTLW

A fragment from the work by Bischoff TLW. Beiträge zur Anatomie des Gorilla (1879). The paper discusses the size of the ligamentum capitis femoris (LCF) of gorilla. Quote p. 1 8. [Deu] 5. Muskeln der unteren Extremität. Ich erwähne zunächst, dass mein Gorilla an dem mehr als eine Halbkugel bildenden Schenkelkopf ein ansehnlich langes Ligam. teres besitzt. Translation [Eng] 5. Muscles of the lower limbs. First of all, I would like to point out that my gorilla has a rather long round ligament on the head of the femur, which forms more than one hemisphere. External links Bischoff TLW. Beiträge zur Anatomie des Gorilla. Abh. d. II. Cl. d. k. Ak. d. Wiss. XIII. Bd. III. Abth. Munchen: Verlag der Akademie, in Commission bei G. Franz. 1879. zobodat.at Authors & Affiliations Theodor Ludwig Wilhelm von Bischoff (1807-1882) was a German physician and biologist. wikipedia.org Theodor Ludwig Wilhelm von Bischoff (circa 870). Unknown author; original in the...

For those who remain skeptical. Announcement

The ligamentum capitis femoris has been studied for 3,600 years. For those who remain skeptical, a new book— Arkhipov S.V. A Bronze Age Medical Case History: Interpreting the Book of Genesis in the Light of Modern Medicine . Kyrö : Author’s Edition, 2026. – 808 pp. – 52 tables. – Bibliographical references: 959 entries. (a synthesis of two previous monographs). Available for free access at the following link: http://books.google.com/books/about?id=viIpEgAAQBAJ Information about the book, along with the manuscript itself, can be accessed via this link: https://roundligament.blogspot.com/2026/11/a-bronze-age-medical-case-history-title.html Abstract: This special "case history" book is the culmination of the author's long-standing career as an orthopaedic surgeon with a passion for the history of medicine. At the heart of this popular science study lies a Middle Bronze Age patient who sustained an injury to the ligament of the head of femur (ligamentum teres). The...

EXPERIMENTS AND OBSERVATIONS

EXPERIMENTS AND OBSERVATIONS (Observed effects of norm and pathology, experiments on models... ) 1672GengaB The author reports for the first time a case of absence of the LCF in both hip joints. 1725SaltzmannJ_NicolaiHA The authors report the absence of LCF in an elderly woman. 1751HallerA The author describes a case of absence of LCF from two sides. 1779SandifortE The author reports the absence of LCF. 1783BonnA The author describes cases of absence of the LCF and the fossa of the femoral head. 1823GerdyPN The author o bserves the displacement of the fem oral head from the acetabulum when the ligamentum capitis femoris (LCF) is stretched. 1841StanleyE The article is mainly devoted to pathological hip dislocations and changes in the LCF. 1858StruthersJ One o f the early works dedicated to the experimental study of the function of the LCF. 1863StruthersJ The work is devoted to an ex...

LCF in English Bibles

The primary source for translating the Bible into English is the Hebrew literary monument Torah. In its first part, the Book of Bereshit (32:33 ) , there is a mention of ligamentum capitis femoris (LCF), which in Hebrew is called « גיד » (gheed, gid) (1923, 2004PreussJ; 2019ArkhipovSV_SkvortsovDV; 2020ArkhipovSV_ProlyginaIV). Probably one of the earliest written translations of the Bible into Old English was made by Ælfric of Eynsham, who worked approximately between 955–1010 CE (1050Aelfric’s). In Aelfric's Anglo-Saxon Paraphrase, the Hebrew concept of « גיד » [gheed], that is, LCF, is mentioned twice in the 25th and 32nd verses of the XXXII Chapter of the Book of Genesis and is called «sine» ( Figure 1, 2 ). In Middle English, translators Nicholas of Hereford and John Wycliffe named LCF as «synwe», and in John Purvey's Bible edition - «senewe» (1850ForshallJ_MaddenF). In Bibles in Early Modern English, LCF is designated as «senow» and «senowe» (1530TyndaleW; 1535CoverdaleM; 1...

MEDICAL RECORD. Chapter 18

Book manuscript: Arkhipov S.V. Medical Record: The Contribution of a Middle Bronze Age Egyptian Physician to the Book of Genesis. Kyrö: Author’s Edition, 2026. – 312 pp. – 2 tables. – Bibliographical references: 856 entries. play.google.com , books.google.com History of Present Illness Chapter 18 MECHANISM OF THE BIBLICAL Injury CONTENT [i] On the Mechanism of Injuries [ii] Literal Mechanism of Injury [iii] High-Energy Trauma? [ iv] Low-Energy Trauma [v] Actual Mechanism of Injury [vi] Navigation [vii] Application [ i] On the Mechanism of Injuries Determining the mechanism of injury plays a significant role in establishing the correct diagnosis. It is defined by the point of application of force, its magnitude, direction relative to the damaged element of the musculoskeletal system, and the resulting deformation within it. A direct mechanism of injury implies the action of force directly at the site of damage, whereas in an indirect mechanism, the force is applied ...

Eryops megacephalus

ERYOPS MEGACEPHALUS Eryops megacephalus Cope 1877 is an early tetrapod from the Permian (298 .9-251.9 Ma ), apparently showing strong similarities to salamanders (2022HerbstEC_HutchinsonJR; 2023CohenKM_C arN). Adults reached an advanced degree of terrestrial habitation and a size of about three meters from head to tail (2002SchochRR). Eryops megacephalus (Lower Permian); top – reconstruction of the skeleton; bottom – appearance of the animal, sculptor Ya.M. Eglon; exposition of the Orlov Paleontological Museum (Moscow); photo by the author. Anatomical evidences of the ligamentum capitis femoris (LCF) in Eryops megacephalus is suggested by certain features in fossilized pelvic and femoral bones. Notable LCF indicators on the femur include the fovea capitis, the groove on the femoral head, and the femoral head’s tuberosity. In the pelvic bone, signs of LCF presence include acetabular notches, an acetabular fossa, perforations, and irregularities on the acetabular surface. We used th...

MEDICAL RECORD. References

Book manuscript: Arkhipov S.V. Medical Record: The Contribution of a Middle Bronze Age Egyptian Physician to the Book of Genesis. Kyrö: Author’s Edition, 2026. – 312 pp. – 2 tables. – Bibliographical references: 856 entries. play.google.com , books.google.com References References CONTENT [i] References [ii] Navigation [iii] Application [i] References Aboelsoud NH . Herbal medicine in ancient Egypt. Journal of Medicinal Plants Research. 2010;4(2)82-6. academicjournals.org Abouelata M. Travel to the Healing Centers in the Egyptian Temples: The Prototype of the Modern Medical Tourism. Egyptian Journal of Archaeological and Restoration Studies. 2018;8(2)121-32. academia.edu Abusch T. Further Studies on Mesopotamian Witchcraft Beliefs and Literature. Leiden, Boston: Brill, 2020. brill.com Acar DB, Bülbül A, Uslu S. Current overview of neonatal convulsions. Şişli Etfal Hastanesi Tip Bülteni. 2019;53(1)1-6. pubmed.ncbi.nlm.nih.gov Acar F, Naderi S, Guvencer M, Türe U, Arda MN. Her...

Search This Blog