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

Dating and authorship of the Book of Genesis

An original perspective on the dating and authorship of the Book of Genesis. This approach can reconcile all faiths, including atheists and scientists. English version of the article: https://roundligament.blogspot.com/2026/02/great-compilation-introduction.html Abstract The Book of Genesis (Bereshith) was composed in Egypt during the 17th century BCE and reached its definitive protographic form following the Minoan eruption of Thera. This study argues that the work was the result of a collaboration between an Egyptian polymath and a distinguished scribe of Asiatic descent. By analyzing ancient texts, anatomical descriptions, archaeological data, Bronze Age cultural history, and climatic markers, this article demonstrates that the book emerged from the work of a high-ranking socio-political committee within the Egyptian House of Life. We argue that the inclusion of precise anatomical data, such as the ligamentum capitis femoris, serves as a diagnostic marker of this Egypti...

18c.JoubertJ

Joubert J, painting – Jacob's struggle with God in the form of an angel (17-18th cent.). Depicting the circumstances and mechanism of the ligamentum capitis femoris (LCF) injury based on the description in the Book of Genesis: 25 And Ja cob was left alone; and there wrestled a man with him until the breaking of the day. 26 And when he saw that he could not pre vail against him, he struck against the hollow of his thigh ; and the hollow of Jacob's thigh was put out of joint, as he was wrestling with him. … 33 Therefore do the children of Israel not eat the sinew which shrank, which is upon the hollow of the thigh, unto this day; because he struck against the hollow of Jacob's thigh on the sinew that shrank. ( 1922LeeserI , Genesis (Bereshit) 32:25-26,33) More about the plot in our work: Ninth month, eleventh day ( 2024АрхиповСВ. Девятый месяц, одиннадцатый день ). Jean Joubert – Jacob's struggle with God in the form of an angel (17-18th ce...

LCF in 2026 (September)

LCF in 2026 (September ) (Quotes from articles and books published in September 2026 mentioning the ligamentum capitis femoris) Goetz, J. E., Hockman, J., & Willey, M. C. (2026). Rabbit models of hip dysplasia: a narrative review. Laboratory animal research , 42 (1), 32. [i] link.springer.com Kahana-Rojkind, A. H., Strok, M. J., Walsh, E. G., Quesada-Jimenez, R., Kuhns, B. D., & Domb, B. G. (2026). Factors Associated With Return to Sport at Minimum 10-Year Follow-up in Athletes With Borderline Hip Dysplasia Undergoing Hip Arthroscopy With Capsular Plication. Orthopaedic Journal of Sports Medicine , 14 (9), 23259671261451218. [ii] journals.sagepub.com Stanard, I., Almhanna, H., Al-Mahmodi, A. M. M., Kilroy, D., & Kumar, A. H. (2026). Comparative Analysis of Vascular Density in the Femoral Head Ligament of the Dog, Sheep, and Goat. [iii] oajr.org , researchgate.net Hirt, J., Roshardt, ...

Human Children. Retelling of Chapter 13

Short retelling of chapter 13 of the essay: Arkhipov S.V. Human Children: The Origins of Biblical Legends from a Physician's Perspective. Joensuu: Author's Edition, 2025. [In Russian] Chapter 13. PROPHETIC DREAMS After his wanderings and battles, Abraham settles in “Mamre’s oaks in Hebron.” Following these events, he experiences a divine “word in a vision” and a dream promising him lands “from Egypt’s river to the great river, Euphrates.” His family relocates to a desert along the Shur road, near the well “Beer-Lahai-Roi,” between Kadesh and Bered. In another divine appearance, Abraham is commanded to circumcise all males’ foreskins, rename Sarai as Sarah, and is told he’ll father a child at 100, despite Sarah’s barrenness at 89. That day, Abraham circumcises his son Ishmael, household males, and, at 99, himself. In Mamre’s oaks, during “daytime heat,” a mirage foretells fatherhood. The dream shifts, showing Sodom and Gomorrah’s destruction and Lot’s miraculous rescue. ...

Morphology and Histology of LCF

Version : 20240418 MORPHOLOGY OF LCF 1. Individual fibers of stroma 2. Portions of stroma 3. Bundles of stroma portions 4. Entire stroma 5. Leg (attaching part of the ligament) 6. Synovial membrane 7. Synovial fold 8. Arterial vessels 9. Venous vessels 10. Capillary bed 11. Lymphatic vessels 12. Nerves 13. Receptors 14. Adipose tissue 15. Loose connective tissue 16. Bone tissue (in the area of attachment) 17. Fibrous tissue (in the area of attachment) 18. Cartilage tissue (in the area of attachment) HISTOLOGICAL CHARACTERISTICS OF LCF ATTACHMENT SITES Bone tissue 1. Femur 2. Pelvic bone Cartilage tissue 1. Femoral head (children, edges of the fovea capitis femoris in adults) 2. Acetabular cavity (children) Fibrous tissue 1. Transverse acetabular ligament 2. Obturator membrane 3. Periosteum of the pelvic bones 4. Joint capsule Keywords: ligamentum capitis femoris, ligament of head o...

Homo neanderthalensis

HOMO NEANDERTHALENSIS Homo neanderthalensis flourished 500-30 thousand years ago in Europe and Asia. It is assumed that its ancestor could have been Homo ergaster or Homo heidelbergensis (2005KleinR). Homo sapiens neanderthalensis «Mr. N» Neanderthal Museum in Mettmann, fragment of the original photograph; source in the wikimedia.org collection (license CC BY-SA 4.0, no changes). Neanderthal, late type, the old man from La Chapelle-aux-Saints, reconstruction by M.M. Gerasimov; exposition of the Orlov Paleontological Museum (Moscow); photo by the author. A reconstruction of the pelvis of the Neanderthal "Kebara 2" (Israel), whose remains are dated to 64-59 Kya (2021AdegboyegaMT_WeaverTD), is known. The well-preserved right pelvic bone (Fig. 1) has a large acetabulum with fossa and acetabular notch, indicating the presence of ligamentum capitis femoris (LCF). Neanderthal pelvis, right acetabulum view from the lateral side (3-D model); original image on sketchfab....

LCF in 2025 (July)

LCF in 2025 ( July ) (Quotes from articles and books published in July 2025 mentioning the ligamentum capitis femoris.) Tekcan, D., Bilgin, G., & Güven, Ş. Evaluation of Risk Factors for Developmental Dysplasia of the Hip. HAYDARPAŞA NUMUNE MEDICAL JOURNAL , 65 (2), 99-103. [i] jag.journalagent.com Domb, B. G., & Sabetian, P. W. (2025). Greater Trochanteric Pain Syndrome: Gluteal Tendinopathy, Partial Tear, Complete Tear, Iliotibial Band Syndrome, and Bursitis. In Orthopaedic Sports Medicine (pp. 1-17). Springer, Cham. [ii] link.springer.com Kuhns, B. D., Becker, N., Patel, D., Shah, P. P., & Domb, B. G. (2025). Significant Heterogeneity in Existing Literature Limits Both Indication and Outcome Comparability Between Studies Involving Periacetabular Osteotomy For Acetabular Dysplasia With or Without Arthroscopy Despite Improvement for Both: A Systematic Review. Arthroscopy . [iii] ...

Tiktaalik roseae

TIKTAALIK ROSEAE The first truly tetrapod animal (Limbed tetrapods) is recognized as the lobe-finned fish Tiktaalik roseae (clade Elpistostegalia), discovered in rocks aged about 375 Ma (2006DaeschlerEB_JenkinsJrFA; 2008ShubinN; 2017ShubinN). Discoveries in recent years have allowed us to place the taxa of early tetrapodomorphs in the following order: Tinirau, Eusthenopteron, Megalichthys, Panderichthys, Qikiqtania, Tiktaalik, Elpistostege, Parmastega, Ventastega, Acanthostega, Elginerpeton, Ymeria, Ichthyostega (2022StewartTA_ShubinNH). The closest ancestor of Tiktaalik roseae, the fragments of the skeleton of which are relatively well preserved, is Panderichthys. Reconstruction of the prehistoric fish Pandericthys Author Tyler Rhodes; original in the wikipedia.org collection (license CC BY-SA 3.0, no changes). The shape of the skeleton of the pectoral fin and shoulder girdle suggests that Panderichthys rhombolepis "walked" (2006AhlbergPE_ClackJA). At the very least...

Human Children. Retelling of Chapter 7

Short retelling of chapter 7 of the essay: Arkhipov S.V. Human Children: The Origins of Biblical Legends from a Physician's Perspective. Joensuu: Author's Edition, 2025. [In Russian] Chapter 7. ABEL AND CAIN A pivotal moment in the saga of early humanity was the departure from the "Garden of Eden" to cultivate fields, with a focus on growing grains, as "bread" is mentioned earlier in Genesis. The text does not specify where Adam and Eve settled after leaving Eden, but we can infer it was a warm region with ample water for crops and livestock. This is evidenced by their sons’ occupations: Cain as a "tiller of the ground" and Abel as a "keeper of sheep." Over time, Cain and his family moved "east of Eden" to the land of "Nod," where he founded a "city"—a settlement with permanent dwellings. His descendants developed sophisticated skills: some mastered music, playing the stringed "lyre" and the ...

LCF in 2026 (August)

LCF in 2026 (August ) (Quotes from articles and books published in August 2026 mentioning the ligamentum capitis femoris) Maldonado, D. R., Schab, A. R., & Domb, B. G. (2026). Improvement in Patient‐Reported Outcomes, High Rate of Return to Sport, and Secondary Surgery Rate Ranging From 0% to 9.8% After Hip Arthroscopy in Dancers and Athletes in Flexibility Sports: A Systematic Review. Arthroscopy, Sports Medicine, and Rehabilitation , e70020. [i] arthroscopyjournals.onlinelibrary.wiley.com Klingele, K., & Strub, D. (2026). Author Response: Considerations and Challenges in Open Reduction With Ligamentum Teres Reconstruction for Pediatric Developmental Dysplasia of the Hip. Journal of Pediatric Orthopaedics . [ii] ovid.com Quesada‐Jimenez, R., Rana, K., Strok, M. J., Kahana‐Rojkind, A. H., Burt, A. K., Sugarman, E. P., & Domb, B. G. (2026). Dual Labral and Ligamentum Ter...

Search This Blog