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.

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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]

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ETIOLOGY AND PATHOGENESIS

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1886LesshaftP

According to the author, the ligamentum capitis femoris (LCF) reduces shocks and impacts of the articular surfaces. In addition, P. Lesshaft states an anatomical fact: the LCF is located vertically under the part of the acetabulum, which mainly bears the weight of the body. The text is prepared for machine translation using a service built into the blog from Google or your web browser. In some cases, we have added links to quotations about LCF available on our resource, as well as to publications posted on the Internet. Über die Vorriehtungen in den Gelenken zur Milderung der mit den Bewegungen verbundenen Stösse und Erschütterungen . Von P. Lesshaft, Professor der Anatomie in St. Petersburg. (Schluß.) Die Bewegungen im Kiefergelenke werden auch von einer hier liegenden Bandscheibe (Meniscus interarticularis) gemindert, aber außerdem von Syndesmosen, die als Gomphosis der Zähne und als Nahtverschmelzung (sutura) hier vorkommen und welche nichts anderes als eine (...

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...

163-192Galen

Fragment from the treatise Galen. On anatomical procedures (Περὶ Ἀνατομικῶν Ἐγχειρήσεων, ca. 163-192). The author writes about the high resiliency and hardness of ligamentum capitis femoris (LCF), and also notes its connective function. See our commentary at the link: 163-192Galen [Rus], and 2020ArkhipovSV_ProlyginaIV . Quote [Grc] Περὶ Ἀνατομικῶν Ἐγχειρήσεων. Βιβλιον B. K εφ . ι ʹ . Αλλά χρή σε, καθάπερ επί της χειρός επεσκέψω τους συνδέσμους των οστών, ούτω και νυν επισκέψασθαι πασών των γεγυμνωμένων διαρθρώσεων, πρώτης μεν της κατ' ισχίον, εχούσης ένα μεν εν κύκλω σύνδεσμον, απάντων των άρθρων κοινόν, (ουδέν γάρ έστιν, ότω μή περιβέβληται τοιούτος σύνδεσμος,) έτερον δε τον διά του βάθους εν τη διαρθρώσει κατακεκρυμμένον, ος συνάπτει την κεφαλήν του μηρού τη κατ' ισχίον κοιλότητι, πάνυ σκληρός ών, ώς ήδη δύνασθαι λέγεσθαι νεύρον χονδρώδες. (original source: 1821KühnCG, pp. 328-329) [Lat] De Anatomicis Administrationibus. Liber II. Cap. X. Verum considerare te convenit, ut i...

1877MorrisH

An excerpt from the article by Morris H. Dislocations of the Thigh: their mode of occurrence as indicated by experiments, and the Anatomy of the Hip-joint (1877, pp. 161-170). The author noted that the ligamentum capitis femoris (LCF) is stretched during flexion, adduction, and external rotation. It was found that the LCF is always damaged in hip dislocations, is more often torn from the femur, and is rarely ruptured. Discussion of article see article 1877BrookeC . DISLOCATIONS OF THE THIGH: THEIR MODE OF OCCURRENCE AS INDICATED BY EXPERIMENTS AND THE ANATOMY OF THE HIP-JOINT. BY HENRY MORRIS, M.A., M.B., F.R.C.S., ASSISTANT SURGEON TO, AND LECTURER ON ANATOY1 AT, THE MIDDLESEX HOSPITAL. Received January 9th-Read February 13th, 1877. RECENTLY, whilst making various dissections of the hip-joint, the usually accepted doctrine that dorsal and ischiatic dislocations of the femur occur when the thigh is in a position of adduction appeared to me as very improbable, on anatomi...

1857HyrtlJ

The author discusses the anatomy, structure, and role of the ligamentum capitis femoris (LCF). Based on his own research, Josef Hyrtl asserts that the vessels of the LCF do not participate in supplying blood to the femoral head. The author highlights the high strength of the LCF and changes in congenital dislocations. Apparently, this work was the first to suggest that the LCF serves as a conductor of inflammatory processes and a cause of coxalgia. Hyrtl J. Handbuch der topagraphischen Anatomie und ihrer praktisch medicinisch-chirurgischen Anwendungen. Zweiter band. Wien: W. Braumüller, 1857. [fragment] Quote p. 410-412 c. Rundes Band des Schenkelkopfes. Einfluss desselben auf die Stellung des Beins bei Coxalgie. Ein verticaler, durch die Mitte der Pfanne und des Schenkelkopfes und bei richtiger Beckenneigung von aussen nach innen geführter Schnitt, trennt das runde Band in zwei gleiche Schenkel, einen vorderen und hinteren. Das Band ...

LCF in 2026 (May)

LCF in 2026 (May ) (Quotes from articles and books published in May 2026 mentioning the ligamentum capitis femoris) Kim, P. S., Kang, C., Lee, J. K., & Hwang, J. M. (2026). Hip arthroscopy to treat symptomatic paralabral cysts: a retrospective analysis of clinical outcomes. Arthroscopy and Orthopedic Sports Medicine , 13 (1), 27-34. [i] e-aosm.org Ko, H. Y. (2026). Vascular Anatomy of the Extremities and Lungs. In Practical Functional Anatomy for Spinal Cord Injury Rehabilitation: A Guide for Physiatrists and Rehabilitation Specialists (pp. 191-223). Singapore: Springer Nature Singapore. [ii] link.springer.com Aiba, H., Yamaguchi, M., Kimura, H., & Murakami, H. (2026). Advances in limb-salvage surgery and reconstruction for pediatric bone and soft tissue tumors. Frontiers in Pediatrics , 14 , 1817788. [iii] pmc.ncbi.nlm.nih.gov Bajwa, A., Villar, R., ...

A Novel Technique for Proximal Fixation

Arkhipov SV. A Novel Technique for Proximal Fixation of Ligamentum Capitis Femoris Reconstruction: The Gifts of the Magi for Orthopedic Surgeons. About Round Ligament of Femur. January 14, 2026. DOI: 10.13140/RG.2.2.25269.33763 https://roundligament.blogspot.com/2026/01/the-gifts-of-magi-for-orthopedic.html Abstract Purpose: To describe an experimental technique for proximal fixation in ligamentum capitis femoris (ligamentum teres femoris; LCF) reconstruction using pubic and ischial portions anchored in corresponding pelvic bone tunnels, tested on synthetic hip joint models, and to propose it’s for arthroscopic application with visualization via an inferior portal and femoral tunnel. Methods: Synthetic polyurethane bone analogs (Synbone) of the pelvis and proximal femur were used to fabricate hip joint models. Acetabular cartilage analogs were created from self-curing plastic compound. Femoral tunnels were drilled along the neck axis from the subtrochanteric region below the tub...

1851HyrtlJ

The author expresses a classic view on the functions of the ligamentum capitis femoris (LCF): a conductor of blood vessels and a limiter of adduction of the femur. J. Hyrtl believed that it was impossible to completely dislocate the hip without tearing the LCF. Hyrtl J. Lehrbuch der Anatomie des Menschen, mit Rücksicht auf physiologische Begründung und praktische Anwendung. Wien: W. Braumüller, 1851. [fragment] Quote p. 265 In der Höhle des Gelenks liegt das runde Band des Schenkelkopfes (Lig. teres), welches an der Incisura acetabuli entspringt, und bei richtiger Neigung des Beckens, senkrecht zur Grube des Schenkelkopfes aufsteigt. Es beschränkt dieses Band die Zuziehung des Schenkels, und schreibt zugleich den durch die Incisura acetabuli eindringenden Blutgefässen den Weg vor, den sie zum Oberschenkelkopfe zu nehmen haben. Da das Band, wenn es in die Höhle des Gelenkes vorragen würde, durch Reibung viel zu leiden hätte, so...

14c.Rudolf_von_Ems

Rudolf von Ems. Weltchronik, m iniature Jacob Wrestling with an Angel ( 14th cent., between 1350 and 1375). 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 ). Unknown author , m iniature Jacob Wrestling with an Ang...

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...

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