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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1836-1840PartridgeR

«Prof. Partridge in his lectures on anatomy at King's College was accustomed to compare the Ligamentum Teres, in its function, to the leathern straps by which the body of a carriage is suspended on springs » ( 1874SavoryWS ). Perhaps Nikolai Pirogov listened to these lectures ( 1859PirogoffN ). The analogy that Richard Partridge used could have arisen after reading the monograph Bell J. The Principles of Surgery (1801) . In it, the author depicted a cart and a pelvis resting on the head of one and two femurs. However, there is no mention of ligamentum capitis femoris (LCF) in the chart descriptions. References Savory WS. On the use of the ligamentum teres of the hip joint. J Anat Physiol. 1874;8(2)291-6. [ ncbi.nlm.nih.gov , archive.org ] Pirogoff N. Anatome topographica sectionibus per corpus humanum congelatum triplici directione ductus illustrate. Petropoli: Typis Jacobi Trey, 1859. [ books.google , archive.org ] ...

LCF in 2025 (March)

LCF in 2025 ( March ): Quotes from articles and books published in March 2025 mentioning the ligamentum capitis femoris. Matsushita, Y., Sugiyama, H., Hayama, T., Sato, R., & Saito, M. (2025). Long-term Outcome of Pediatric Arthroscopic Surgery for Avulsion Fracture of the Ligamentum Teres: A Case Report. JBJS Case Connector , 15 (1), e25. [i] journals.lww.com Arkhipov, S. V. (2025). Inferior Portal for Hip Arthroscopy: A Pilot Experimental Study. Pt. 2. Inferior Portal Prototypes. About Round Ligament of Femur . February 26, 2025. [ii] researchgate . net Pfirrmann, C. W., & Kim, Y. J. (2025). Advanced Imaging. In Surgical Hip Dislocation: A Comprehensive Approach to Modern Hip Surgery (pp. 29-42). Cham: Springer Nature Switzerland. [iii] link.springer.com Singh, R., & Yadav, N. (2025). Morphometry and Morphology of the Fovea Capitis of the Femoral Head an...

2000-1600bcBM29663

Fragment of the text of clay tablet BM 29663 (Mesopotamia, 2000-1600 BC). In the list of body parts of a sheep, the author indicates ligamentum capitis femoris (LCF). See our commentary at the link: 2000-1600bcBM29663 [Rus]. Quote [Akk] Clay tablet BM 29663 (original source: photo - British Museum britishmuseum.org , text - 2018CohenY , p. 134). Translation [Eng] List of Sheep Body Parts ( с lay tablet BM 29663, obverse) 10. ni-im-šu → nimšu, “sciatic nerve”, “sinew” . ( original source: 2018CohenY , p. 135). ( original source: British Museum britishmuseum.org , CC BY-NC-SA 4.0) External links Clay tablet; museum number 29663; registration number 1898,1115.49. Middle East, Old Babylonian period (2000-1600 BC). [ britishmuseum.org , cdli.mpiwg-berlin.mpg.de ] Sigrist M, Zadok R, Walker C. Catalogue of the Babylonian tablets in the British Museum. Catalogue of the Babylonian tablets in the British Museum. London: British Museum Press, 2006. ...

2025ArkhipovSV. Human Children

The monograph Arkhipov S.V. Human Children: The Origins of Biblical Legends from a Physician's Perspective. An essay with references to interactive materials. 2nd revised and expanded edition. Joensuu: Author's Edition, 2025. [In Russian]. The monograph dates the writing of the Book of Genesis and the events depicted in it, as well as refutes the authorship of Moses. I offer mutually beneficial cooperation (50/50) in literary translation into English or native language. Proofreading of machine translation and cooperation in editing are expected. Requirements for co-author: 1. Native speaker 2. Experience as a writer. E-mail: archipovsv(&)gmail.com Annotation The first version of the Book of Genesis appeared in Ancient Egypt approximately 3,600 years ago, during the Hyksos period. The work was conceived as a fairy tale epic. An unknown physician-encyclopedist, who is also presumed to have authored the Edwin Smith Papyrus, played a role in its composition...

A FORCE THAT HELPS ROTATE THE PELVIS

A force that helps rotate the pelvis when walking. Modeling the key movement of the ligamentum capitis femoris when walking (the simplest but most visual experiments). See: https://kruglayasvyazka.blogspot.com/2024/05/blog-post_29.html #ligamentum_teres #ligamentum_capitis_femoris #hip #biomechanics Publication in the facebook group 03/24/2025. BLOG CONTENT NEWS AND ANNOUNCEMENTS FACEBOOK

2020ArkhipovSV_ProlyginaIV

Ancient Textual Sources on Ligamentum Teres: Context and Transmission S.V. Arkhipov, I.V. Prolygina KEYWORDS: ancient medicine; ancient traumatology; Galen; Hippocrates; hip joint; ligamentum capitis femoris; ligament of head of femur; ligamentum teres. SUMMARY Background. One of the least researched anatomical structures of the human body is the ligament of head of femur, most often referred to as ligamentum teres. The history of the nomination of this term, medical contexts of its use, the etymology and the first synonyms (Figure 1) are not sufficiently understood. Purpose. The purpose of the article is to present the most complete collection of evidence from ancient medical authors about the term ligamentum teres, trace the history of its nomination and analyze the gradual changes in the level of knowledge about the anatomy, mechanical and geometric properties of this structure, its pathology and treatment methods. Methods. The study is based on an inter...

EXTERNAL LIGAMENTS & LCF

external ligaments & LCF First experiments to study the interaction of the external ligaments and the ligamentum capitis femoris in a model: https://kruglayasvyazka.blogspot.com/2024/06/blog-post_6.html Pathological consequences of lengthening of the ligamentum capitis femoris: https://kruglayasvyazka.blogspot.com/2024/06/blog-post_63.html norm: https://kruglayasvyazka.blogspot.com/2024/06/blog-post_50.html #ligamentum_teres #ligamentum_capitis_femoris #hip #biomechanics Publication in the facebook group 03/27/2025. BLOG CONTE...

FACEBOOK

FACEBOOK (publications in the group LIGAMENTUM CAPITIS FEMORIS and this social network) A FACEBOOK section has been created (About publications in this social network). FACEBOOK GROUP On creating a group. OLDEST SYNONYMS Post in Facebook groups. Planar models of the hip joint Post in Facebook groups. The loading acting onthe femoral head Post in Facebook groups. Visualization of the LCF by the medial approach Post in Facebook groups. A FORCE THAT HELPS ROTATE THE PELVIS Post in Facebook groups. FIRST EXPERIMENTS ON A MECHANICAL MODEL Post in Facebook groups. HIP JOINT MODEL WITH LCF ANALOGUE Post in Facebook groups. EXTERNAL LIGAMENTS & LCF Post in Facebook groups. BIOMECHANICS OF THE HIP JOINT WITHOUT LCF Post in Facebook groups. F. Pauwels vis-à-vis S. Arkhipov ☺ Post in Facebook groups. ...

1956SingerCJ

Fragment from the book Singer CJ (Ed., trans.). On anatomical procedures: De anatomicis administrationibus (1956). Galen writes about the high resiliency and hardness of ligamentum capitis femoris (LCF), and also notes its connective function. See our commentary at the link: 1956SingerCJ [Rus], and 2020ArkhipovSV_ProlyginaIV . Quote. p. 55. [Eng] On anatomical procedures; Book II. Chapter 10. As with the arm you examined the ligaments of the bones, so now examine those of all the exposed joints and first of the hip. This has one ligament embracing it [capsular ligament], as with all joints. A second, hidden in the depths of the joint [ligamentum teres], ties the head of the femur to the hollow in the hip-bone [acetabulum]. It is so tough that it could be called a 'cartilaginous sinew'. (Transl. by Ch. Singer; original source: 1821KühnCG ). External links Singer CJ (Ed., trans.). On anatomical procedures: De anatomicis administrationibus. London, New York, Toronto: P...

INFERIOR PORTAL FOR HIP ARTHROSCOPY

Combined PDF version of the article: Arkhipov SV. Arkhipov SV. Inferior Portal for Hip A rthroscopy: A Pilot Experimental Study. This page contains a photocopy of the publication. The links for downloading the PDF version and the addresses of the online versions are given below. The original in Russian is available at the link: Нижний портал для артроскопии тазобедренного сустава .

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