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

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, ...

1785SandifortE

Fragments from the book Sandifort E. Descriptio ossium hominis. (1785). The author briefly writes about the attachment of the ligamentum capitis femoris (LCF). Quote p. 104 [Lat] Os ischium… … Qua spectat pelvim (a) os ischion æquabile est, modice cavatum, ab exteriore profunde sinuatum (b). Sinus hic, quem acetabulum vocant, maximus, sere rotundus, est, dividique potest in partes duas, alteram semilunarem quodammodo, cartilagine tectam (c), hinc æquabilem, alteram altius excavatam, asperam (d), glandulæ muciparæ sedem præbentem, & educentem ligamentum teres, quod capiti ossis femoris infigitur (e). … Quote p. 108-109 [Lat] Femoris os … … Caput magnum, globosum, cartilagine lævi incrustatum, oblique positum (b), id est, sursum introrsumque tendens, magnitudine & figura cum acetabulo (i) congruens, intra illud admittitur, illique alligatur per ligamentum teres, quod firmiter adhæret ab altera parte acetabulo, ab altera sinui profundo, inæquabili, qui in dicto capite est (k...

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...

18c.FontebassoF

Fontebasso F, painting, Jacob wrestling with the angel (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 ). Francesco Fontebasso – Jacob Wrestling with the Angel (18th cent.); original in the matthiesenga...

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...

Homo ergaster

HOMO ERGASTER The Homo ergaster species lived in Africa 1.8 million years ago and was alive until 600,000 years ago, likely becoming the ancestor of Homo erectus in Asia, Homo neanderthalensis in Europe, and Homo sapiens in Africa (1995CachelS_HarrisJ; 2005KleinR). Homo ergaster is occasionally equated with Homo erectus in publications (2013TattersallI). The most complete Homo ergaster skeleton belongs to an adolescent named "Turkana Boy" (KNM-WT 15000). The young man was between 8 and 12 years old (2010GravesRR_CunninghamDL; 2019BergmanJ). The age of this individual's remains is believed to be 1.6 million years (2007TattersallI). Turkana Boy (reconstruction) Author: Mettmann Neanderthal Museum; source: wikimedia.org collection (license CC BY-SA 4.0, no changes). The pelvis of specimen KNM-WT 15000 is well preserved. It shows ossified acetabulums. In turn, they have spacious acetabular fossae and wide acetabular notches. Based on these elements, it is possible to conc...

HISTORY OF THE STUDY

HISTORY OF THE STUDY (Reconstruction of the chronology of scientific achievements and events... ) The First Scientific Mention (video ) The first described of the LCF is Hippocrates (ca. 460-370 BCE). 1495Johannes de Ketham An excerpt from the treatise by Mondino de Luzzi describing the anatomy and role of LCF damage in the genesis of hip diseases. 1541MondinoL_DryanderJ An early description of the anatomy and role of the LCF is presented. 1550CortiM An early descri ption ( Mondino ) of the anatomy and role of LCF is presented, and a rare synonym is mentioned. 1725AndryN The author who proposed the term «orthopedics» and its symbol, taught us about the function of the LCF in the essay « Examen de divers points d'anatomie, de chirurgie, de physique, de medecine...». 1957SingerC The author discusses the connective function of the LCF, as well as its damage in hip dislocation and pathological transfor...

1527BenedettiA

Fragment from the book Benedetti A. Anatomice siue historia corporis humani (1527). The author explains the origin of the rare synonym of ligamentum capitis femoris (LCF) – ischion. Quote. Liber V. De femine et eius prolapsu. Cap. XXXI Sinus coxae à graecis cotylae, à nostris acetabula dicuntur, quae hos sinus complent circa quae uersurae siunt, coxendices uocatur, à graecis ischia, à quib ischiadici dicti sunt, qui coxedice laborant. Nam et neruus quo coxendix acetabulo comittitur, ischion quoqʒ dicitur. Translation [Eng] Book V. On the Hip and Its Prolapse. Chapter XXXI. The pelvic sinuses are called cups (cotylae) by the Greeks, and in these sinuses, we have an inkwell (acetabula). The region around which the movements take place is called the coxendices (hip joint), by the Greeks the sciatic (ischia), from which the term ischiadici (related to the hip) comes for those suffering from hip issues. And the sinew/nerve (neruus) which connects the hip (coxendix) to the ...

MORPHOLOGY AND TOPOGRAPHY

MORPHOLOGY AND TOPOGRAPHY ( Anatomy, histology, embryology, topography in normal and pathological conditions. .. ) 1176-1178(b)Rambam The author writes about the localization of LCF (גיד) ) and distinguishes it from a tendon, blood vessel or nerve. 1523Berengario da CarpiJ The author describes the attachment, physical properties and role of the LCF. 1543(a)VesaliusA The author describes the anatomy, attachment, properties and role of LCF, also interprets its synonyms. 1543(b)VesaliusA The author describes the attachment and shape of the LCF. 1555VesaliusA The author describes the anatomy, attachment, properties and role of LCF, also interprets its synonyms (second edition of the treatise) . 1559ColomboMR Selected fragments of the treatise describe the topography, function, geometric and physical properties of the LCF. 1600LaurensA The author writes about the anatomy, attachment, propertie...

1878MarshallJ

Fragments from the book Marshall J. Anatomy for artists (1878). The author discusses the anatomy and briefly the role of the ligamentum capitis femoris (LCF): «… checks adduction of the thigh, or a sinking down of the pelvis upon the opposite side, and, possibly, also limits the reciprocal, horizontal rotatory movements of the femur and the pelvis on each other» . Quote p. 65 The head of the femur is almost entirely received into the acetabulum, a deep socket of the hip-bone, thus forming the largest and most complete ball-and- socket joint in the body. At a point on the inner side of the head of the femur, a little below and also behind its centre, is a small rough, bifid , depression, for the attachment of the ligamentum teres of the hip-joint. Opposite this point, the head of the bone is, however, more prominent than elsewhere, and corresponds with a non- articular depressed portion of the acetabulum. Quote p. 68 The ligamentum teres, which is attached by one en...

Search This Blog